Stars & Quality

Strategies to achieve long-lasting improvement in Star Ratings and quality

To effectively achieve and maintain the highest Star Ratings, plans must implement an intentional strategy that is simultaneously focused on individual and population and informed by data-driven gap identification. This includes educating providers and beneficiaries on the myriad of services and resources available, on the importance of timing seasonal outreach and participation in preventive screenings, and on collecting responses from patient experience surveys.

GHG’s experts advise on data analysis, uncovering process opportunities, intervention strategies, and workflows that improve overall quality improvement and member satisfaction to support the success of your plan year after year.

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GHG’s Star Ratings experts have helped hundreds of plans develop, or improve upon, their Star Ratings strategy. Our teams will work with you to evaluate your current Star Ratings approach and recommend specific tactics that you can implement immediately, to integrate initiatives, eliminate redundancies, and build an enterprise-wide Star management structure. We can help you identify clinical, operational, and networking opportunities to increase your rating.

Star Ratings Assessment

GHG can work with your organization to perform a Star Ratings performance assessment to identify potential areas of improvement and implement best practices to increase your HEDIS and Star scores. Whether your plan’s Star Rating is currently on the bubble or is solidly above 4 stars, an assessment can help you re-evaluate your strategies to ensure that your Stars remain aligned.

Quality Improvement

GHG will work with your team to improve quality of care with renewed engagement strategies, data management, and advanced planning to further improve health outcomes, and reduce the cost of care for beneficiaries. Through data and reporting measure assessments, we will be able to recommend strategies that will improve clinical quality performance and ensure your processes are aligned with CMS expectations.

HEDIS Reporting & Evaluation

GHG can help support your organization’s overall quality improvement goals, metrics, and performance by conducting a HEDIS evaluation. We will work with you to analyze your NCQA HEDIS data to mine for improvement opportunities and identify interventions for your health plan, targeting operations, providers and/or members.

Member Experience Services

CMS’ increased weighting of member experience measures means that MA plans will need to consider Star Ratings and member experience in nearly every aspect of their organizations. It’s important that plans also incentivize, manage, and measure staff performance. GHG’s stars experts partner with our clinical team to help you improve performance on patient access and experiences measures to ensure your plan’s success.

Interim Management

If you are looking for a seasoned veteran, GHG can enrich your team with our own, providing the leadership and knowledge your organization needs. GHG’s stars and quality expertscan supplement your existing team with able professionals who have years of experience providing strategic services to the industry.

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