In a pay-for-performance ecosystem, payers want to stay ahead of the Stars curve and maximize their ratings with the goal of increased revenue. It’s challenging considering that CMS changes the guidelines and the weightings of measures every year. You may find yourself ahead one year, but behind the next.
Surprisingly, most payers don’t have a process for improving their Star ratings consistently. And, we find that many payers erroneously believe that what got them to two or three Stars will be the same activities to get them to four or five Stars.
From our experience working with health plan clients, fixing these two issues is at the heart of achieving higher Star rating maturity.
In the face of over 65-plus data points and measures, as well as the complexities of the rating criteria and changes, we’ve put together a four-step strategy for continuous monitoring, assessment, and improvement.
Health plans need a repeatable process that achieves three things:
- Stay on top of changing CMS requirements
- Identify which gaps to address
- Choose the right interventions based on time, cost, and impact
These four steps can help you achieve all three:
Step One: Year-to-Year Review
Conduct a year-to-year assessment of your program’s maturity along with a regulatory compliance review.
Plan Assessment Questions:
- Does your plan have a holistic process in place to evaluate the plan’s performance?
- Is the process documented to a level that a new employee could work the process?
- Is there a rigorous cost/benefit analysis performed to prescribe what interventions to take?
- Has the process been used on an ongoing basis? (Or is the process ad-hoc?)
- Is the process updated annually to account for Stars changes?
If your answer to all of the questions was yes, you are most likely a top performing health plan.
If you answered no to one or more of the questions, your plan has process improvement potential.
Step Two: Annual Review
Perform an annual review that can act as an early warning system to illustrate what preparations you should make in light of approaching scoring and regulatory changes. Conduct this review in the second quarter once all performance results are available from the prior calendar year.
Step Three: Identify, Prioritize & Plan
Use the two different reviews to regularly identify gaps so that you can achieve the goal of using the right intervention for the right members at the right time. The best time to do this is in the summer so that you can launch interventions by September. See the Data Box for steps to Identify Gaps and Plan Implementation.
- On a measure-by-measure basis, identify your plan’s potential for measurement improvement
- Prioritize Interventions by looking at three areas:
- Size of the gap and potential for improvement
- The weight and importance of the measurement
- The cost – and benefit — for eliminating that gap
Now comes the work of putting your priorities into action. The cost-benefit analysis will reveal the “low hanging” interventions that will result in the best improvement for the dollars spent.
Step Four: “Last Minute” Intervention
Maximize the final readiness before – and after – the communication black out dates to ensure you implement effective and targeted interventions before the end of year.
Appropriate interventions could include sending reminders (or “thank you” letters) to members for flu shots and annual visits. Reviewing your complain logs for issues that could be remedied with members. Analyze call center logs to determine what language and scripting could help head-off complaints and missed opportunities to address care gaps.
Top performing health plans establish a continuous process to improve their Stars ratings. Our four-step process can become a habitual and high-value activity for your organization.
We’ve helped our healthcare clients improve their Stars ratings by establishing a high-level project plan, helping them create an annual process customized to them, and assisting in their cost-benefit analysis to ensure the best intervention strategy for the time and resources available.
By taking a proactive and consistent approach to managing your Star ratings, you can capitalize on opportunities before they become problems, as well as plan appropriately for coming changes that other plans don’t have on their radar.
Was this Point of View helpful? We would like to hear from you and discuss how our strategies might be helpful to maximize your Star ratings for 2017. Contact us to get the conversation started.