Key Changes to Star Ratings from 2016 Draft Call Letter
Now that the news from last month’s 2016 Advance Notice (also known as “the Call Letter”) from the Centers for Medicare & Medicaid Services (CMS) has had time to sink in, it’s time for the real work to begin.
Perhaps even more noteworthy than the long-discussed removal of 4-Star thresholds is CMS’ planned interim action to reduce the weights of six Part C measures (for Medicare Advantage Organizations), and one Part D measure (for Prescription Drug Plans) by half to provide immediate Stars relief to plans serving dual eligibles. With these changes looking likely, plans are working feverishly to predict whether they may be on the winning or losing end of these program changes.
While CMS continues to study the correlation between low-income status and lower quality scores, there is much work to be done by health plans to rapidly operationalize the six 0.5-weighted measures, the retirement of three measures, the temporary retirement of one measure, specification changes to more than a dozen measures, and CMS’ return of several additional measures that had previously been removed from the program. The sheer volume of these changes almost overshadow the long-awaited, and much-anticipated, introduction of the new Comprehensive Medication Review (CMR) Completion Rate for beneficiaries eligible for Medication Therapy Management (MTM) programs measure.
As is always the case with Star Ratings, time is of the essence as we chase the moving target set forth by CMS. With CMS’ renewed commitment (inclusive of a timeline) for termination of plans with less than 3 Stars for three years, plans whose ratings are trending downward will need to work swiftly and effectively to incorporate not only these changes but also proven Stars best practices into 2015 work plans.
With the many changes to Star measures announced in the 2016 Advance Notice, plans may be finding it increasingly difficult to design, implement, and manage Star Ratings programs. Has your 2015 Stars action plan adequately addressed:
- Internal reporting, monitoring, and trending of measure-level performance?
- Provider targeting, education, and pay-for-performance (P4P) program changes to capture these changes?
- Evaluations of programs to determine those that are working (and those that are not)?
- The reduced influence that Diabetes Disease Management programs will have on Star Ratings?
- Changes to member interventions and wellness programs to address these program changes?
- Any weaknesses identified in the 2015 Star Ratings?
- Population health tools and strategies needed for Star Ratings success?
Gorman Health Group’s team of experts can help your organization adapt to the new clinical areas emphasized in the Advance Notice, develop or enhance care coordination within your programs, or evaluate the effectiveness of your current Star Ratings program.
Contact us today, and let’s work together to help your plan achieve 4 Stars.
Resources
Gorman Health Group’s Summary and Analysis of the 2016 Draft Call Letter and the Medicare Advantage (MA) Advance Notice is now available. Download it today >>
Our team of experts can help you develop or enhance care coordination within your programs and processes. Contact us today, and let’s work together to help your plan achieve 4 Stars.
GHG can evaluate your Star Ratings approach, and identify tactics you can begin implementing immediately, to integrate initiatives, eliminate redundancies, and build an enterprise-wide Star management structure. Visit our website to learn more >>
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