Advice from 5-Star Medicare Advantage Plans: Engage Low-Performing Providers, Members

Thursday, April 25th, 2013
This post was written by Patricia Donovan

Webinar Replay: Best Practice Approach to Improve CMS Star Quality Ratings

Medicare Advantage health plans in search of higher Star Quality Ratings should follow the lead of five-star MA plans, suggests Joe Johnson, vice president of L.E.K. Consulting.

Five-star best practices for improving all-important clinical performance markers include mailings and telephonic outreach to low-performing member cohorts, notes Johnson, as well as shared savings, profit-sharing goals and even provider report cards. The latter is likely to spur low-performing providers into aligning with health plan quality improvement efforts, which can help to raise ratings.

Provider engagement is critical, since the majority of the Star Quality Ratings’ 37 measures, which span five domains, is influenced by the work done by providers, such as in closing gaps in care and managing chronic conditions, and are weighted most heavily by CMS. For example, the monitoring of care transitions to prevent readmissions is one area where five-star plans shine, he says.

During a recent webinar on A Strategic, Best Practice Approach to Improve CMS Star Quality Ratings, Johnson suggested MA plans map out an enterprise-wide Star Quality Ratings strategy to target improvement opportunities and identify the most addressable gaps in the organization — giving priority to those that will give the plan the most ‘bang’ for its buck.

Reimbursement for MA plans is tied in part to awarding of stars for patient care and satisfaction. Factoring in the bonus structure for high-performing plans, L.E.K Consulting estimates that moving from a three-star to four-star rating is roughly worth $50 PMPM — or $6 million in revenue per year for a 10,000-member plan.

Of the five domains in the Star Quality Ratings Program, management of chronic conditions is ripest for MA plan innovation and improvement, Johnson notes. Plans should identify the size and magnitude of conditions presenting in their member populations, and prioritize efforts based on potential for economic impact.

The designated “Star Czars” team (individuals spearheading the quality ratings improvement effort) should be cross-functional and analytical but also speak the requisite clinical language to inform and engage providers, advises Johnson.

Johnson also shared a half-dozen other strategies for Star Quality Ratings improvement from five-star plans, including benchmarking of local competitors, and examined some of the changes CMS is considering for 2014 and 2015 Star Quality Ratings.

Listen to an in-depth interview with Joe Johnson here.

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