Summary of the 2017 CMS Advance Notice and Draft Call Letter

The Centers for Medicare and Medicaid Services (CMS) released their 2017 Advance Notice and Draft Call Letter on February 19, 2016. Upon careful review, we have distilled the essence of the changes. Our goal is to ensure that clients have the most accurate information
and access to thought leaders and advisors who possess deep payer industry experience and real-world success with CMS compliance.

The CMS Policy Goals are to:

  1. Improve the quality of individual care
  2. Promote alternative payment methods
  3. Ensure program integrity and beneficiary/tax payer value
  4. Improve the beneficiary experience

Brief Focus

2017 Proposed Changes:
• Existing Star Measures
• Existing Display Measures
• New Display Measures
• Overall Methodology Changes

2018 and Beyond:
• Star Measures
• CAHPS Survey
• Potential New Measures

Brief Focus

2017 Proposed Changes:
• Existing Star Measures
• Existing Display Measures
• New Display Measures
• Overall Methodology Changes

2018 and Beyond:
• Star Measures
• CAHPS Survey
• Potential New Measures

The 2017 Advance Notice and Draft Call Letter furthers these policy goals.

While the Call Letter features four components (see box at left), three contain the bulk of the changes. A heavy focus on the first three components is due to several factors:

  1. CMS is updating their risk revenue model from the current singular model to six new models.
  2. CMS is changing how they look at data and what data sources they will consider.
  3. CMS is making updates to their audits and benefits being offered.

These changes are important to health plans because it indicates a fundamental shift to the risk/revenue models. Depending on the source, and the health plan, this change could affect plan revenue from a decrease of 5 percent to an increase of 10 percent.

There are two other unexpected effects from the changes to a more complex model structure. First, much more data modeling, data gathering, and data integrity efforts will be required for health plans. Second, these changes highlight the need for more transformation and flexibility as well as the ongoing uncertainty of how changes will impact health plans over time.

We should not lose sight of the fourth component – Star Ratings – as this area makes up about 40 percent of the Call Letter.

2017 Proposed Changes

Overall, there are less material changes to the metrics than in other years. However, there
are important changes in the calculations. In addition, there are changes to display measures that will impact future Star Ratings calculations.

Display Measures: There are relatively minor changes to existing display measures.

New Display Measures: There are a few new display measures to become effective during the
next one to two years. One measure has been removed to display only. Also, there are display measures that may become a Star Ratings measures in the future.

2018 and Beyond

Star Ratings: CMS continues to modify future Star Ratings measures as part of their goal to improve Medicare member outcomes.

CAHPS Survey: There are several changes to existing survey questions proposed. These changes would take effect for the 2017 CAHPS survey administration. If accepted, they will be used for the 2018 Star Ratings.

Potential New Star Measures: CMS continues to propose new future Star Ratings to further improve Medicare member health experience outcomes.

We’re committed to helping health plans adjust to these changes and achieve improved performance and member experiences. Forward-thinking payers that want to take a proactive approach to these changes know that their actions will lead to increased profitability, market growth, and stronger contracts.

  • Our team of healthcare experts can help you build your plan for facing these changes head-on, including:
  • Strategize which member interventions will have the biggest rate of return and impact on your CMS Star Ratings scores
  • Assist with dissecting and implementing the metrics changes that affect you most
  • Collaborate with your organization to change member behaviors via incentive plans
  • Promote more positive patient outcomes while positively impacting Star Ratings scores
  • Assist in developing Star metrics dashboards to monitor trends during, and throughout, the reporting year

We’re poised to help you make specific metrics changes and create a plan to achieve your goals for 2016.

Let’s look behind these changes together. Contact our solution desk or any of our focused resources listed below – solutiondesk@sdlcpartners.com.

Meet Our Team of Focused Resources

Author:

Jim Walters, Business Transformation Services Lead
jwalters@sdlcpartners.com

Jim is responsible for one of four SDLC Partners service lines – Business Transformation. He brings over 30 years of consulting and industry experience from his work at IBM, Deloitte, Abbott, Allstate, WellPoint, as well as through his own consulting firm. Through Business Transformation, he and his team, leverage technology and process to achieve competitive advantage for healthcare clients to improve operational efficiency, boost service levels, and deliver measurable, bottom-line results.

 

Contributors:

Sandeep Munnangi
Senior Consultant, Process Analyst

Dan Szelc
Senior Consultant, BI Analyst

Share:Share on FacebookShare on Google+Tweet about this on TwitterShare on LinkedInPrint this page