Because not all CMS Five-Star Quality Ratings measures are created equal, organizations seeking to improve their ratings need to have a strategy in place, says Joseph Johnson, vice president of L.E.K. Consulting. Finding an area with the greatest financial opportunities is part of Johnson’s three-step approach to star improvement efforts.
For starters, a single criterion score must improve enough to change its star rating to have any measureable impact on the plan’s overall star rating; said another way, the more attractive criteria that are candidates for change are those that are closest to the next star bonus threshold.
Second, when you think about the impact of an individual member segment on the overall score, all things being equal, the larger the membership of that segment, the more impact a score improvement in that provider/member cohort or segment will have on the overall average score of the plan.
And finally, when you compare and rank-order improvement opportunities along these two dimensions, the size of the member segment and current scores relative to the next threshold, what starts to emerge are the areas of greatest financial opportunity. This is the starting point for creating a star’s improvement roadmap for a given health plan that can drive more meaningful star improvement uplifts and facilitate implementation and execution road maps.
Formula for CMS Five-Star Quality Population Health Management examines star quality improvement strategies, including Kaiser Permanente’s successful care management efforts that have made it a leader in the five-star space.