Miss Our Star Ratings Webinar? Here Are the Top 5 Takeaways

With just a few more weeks remaining before the 2018 Star Ratings cycle begins, we are on the cusp of yet another exciting iteration of program changes and updates within the Star Ratings program. In case you missed our Star Ratings webinar, here are our top five takeaways from the session:

Silo-busting will be more important than ever to earning a 4 Star Rating.

Despite the absence of any new Star Ratings measures in 2017, the areas to be measured by the new 2018 Star Ratings measures proposed by the Centers for Medicare & Medicaid Services (CMS) cut right to the heart of some silos still remaining within health plans. For example, many, if not all, health plans have developed their Medication Therapy Management (MTM) programs within their pharmacy department, and many MTM programs are outsourced entirely through the Pharmacy Benefit Manager (PBM). However, CMS is proposing addition of the Medication Reconciliation Post Discharge measure as a Part C Healthcare Effectiveness Data and Information Set (HEDIS®) measure. Simultaneous success on this new HEDIS® measure and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) measures will require a well-coordinated, cross-functional evolution of medication reconciliation workflows into time-sensitive, clinically-appropriate patient engagement workstreams. CMS’ proposal to introduce the new statin therapy measures without classifying both as either Part C measures or as Part D measures will be a true test of internal silo-busting within health plans. From provider reporting and outreach to member engagement and outreach, simultaneous success on these measures and CAHPS® measures will require strategic, innovative use of data and analytics to drive a seamless experience for all. CMS’ proposal to introduce the new asthma-related medication measures (which contain significant adherence components) as HEDIS® measures will reinforce this need.

Star Ratings must be approached strategically and managed as a program.

Approximately 35% of the 2016 Star Rating is driven by patient experience, complaints, and measures capturing access. An additional 11% is driven from the remaining CAHPS® survey measures and the Health Outcomes Survey (HOS) measures, and yet another 12% is based on the contract’s overall improvement or decline from one year to the next. Mathematically, that means less than 50% of the Star Rating is now driven by traditional measures of clinical quality. This, combined with the breadth, depth, and scope of the individual measures which comprise each of these categories and the expertise necessary to improve performance on individual measures, necessitates use of a highly-strategic approach to designing a Star Ratings program in order to ensure time and resources are invested where most needed in a way that is seamless and well-coordinated to members and providers.

Your members’ perceptions matter. A lot.

The combination of patient experience and complaints, measures capturing access, and the other survey measures comprise 46% of the Star Rating. This, combined with the fact the range between a 2 Star Rating and a 5 Star Rating was less than 10% for 8 of the 1.5-weighted CAHPS® measures in the 2016 ratings, requires us to be strategic and purposeful in all of our operational decision-making. Every program, phone script, and member mailer should be evaluated from the member’s perspective. It is no longer enough for us to do the right thing — now we have to both do the right thing and manage the member’s perception of what we are doing. With this in mind, it’s important for us to ask:

• Will the member understand why we’re calling/mailing?
• Will our request resonate with the member’s current health status?
• Will the member perceive our outreach to be well coordinated?
• Will our outreach align with his/her doctor’s recommendations?

Each of these questions is important to consider as part of every decision made by every team in the new era of Star Ratings.

Change is the only constant in Star Ratings.

From the changes introduced in the 2016 Star Ratings program to the future changes proposed in CMS’ recent Request for Comments on potential future changes to the Star Ratings program, it is clear change will continue to abound within Star Ratings. We must prepare for growth in the number of Star-rated Medicare Advantage plans, an interim and permanent solution to address the impact of socio-economic and disability status on Star Ratings, and the new measures proposed by CMS as potential 2018 Star Ratings. Educating providers, staff, and the executive team, adjusting reports and analytics, and enhancing strategies and tactics to account for these changes will require increased investment of resources and expertise during the coming months.

Measure, manage, then act.

Success will depend on purposeful activity during the coming months. With the extent of changes on the horizon, it will be important to stay focused on identifying the actions needed for success and executing such tactics swiftly. We can enhance the member’s experience (and our Star Ratings) by conducting the right action, at the right time, using the right channel.

The first quarter is a great time for strategic planning and reflection. Not only is there still opportunity to influence your 2017 Star Ratings, but there is also time to refine and enhance your 2016 tactical roadmap to help you earn ≥4 Stars next year.