Posts Tagged ‘CMS Five-Star Quality Ratings’

Infographic: Shooting for Five Stars in Medicare Advantage

May 28th, 2018 by Melanie Matthews

Health plans have continued to mature in their approach to the Centers for Medicare and Medicaid Services’ Stars rating. Over the past two years, they have become more effective and more efficient at driving high quality scores overall, demonstrated by significant increases in the 4-Star thresholds of key measures, according to a new infographic by Oliver Wyman.

The infographic provides an analysis of annual Stars metrics, which demonstrates a continued high correlation between plans’ overall Stars scores and their performance on provider-driven measures.

2018 Healthcare Benchmarks: Telehealth & Remote Patient MonitoringArtificial intelligence. Automation. Blockchain. Robotics. Once the domain of science fiction, these telehealth technologies have begun to transform the fabric of healthcare delivery systems. As further proof of telehealth’s explosive growth, the use of wearable health-tracking devices and remote patient monitoring has proliferated, and the Centers for Medicare and Medicaid Services (CMS) has added several new provider telehealth billing codes for calendar year 2018.

2018 Healthcare Benchmarks: Telehealth & Remote Patient Monitoring delivers the latest actionable telehealth and remote patient monitoring metrics on tools, applications, challenges, successes and ROI from healthcare organizations across the care spectrum. This 60-page report, now in its fifth edition, documents benchmarks on current and planned telehealth and remote patient monitoring initiatives as well as the use of emerging technologies in the healthcare space.

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Which CMS 5-Star Quality Domains Are Best Candidates for Improvement?

March 5th, 2014 by Jessica Fornarotto

CMS Five-Star Rating

With an additional star in CMS Five-Star Quality Ratings System worth about $50 per member per month (PMPM), according to L.E.K. Consulting (when moving from a three- to four-star Medicare Advantage plan), health plans are anxious to fine-tune operational processes and improve their rankings. Joseph Johnson, vice president of L.E.K. Consulting, shares which of CMS’ Five-Star Rating categories could be improved.

There is some data that indicates that certain CMS Five-Star Ratings domains or categories are better candidates for improvement than others. All Medicare Advantage (MA) plans score similarly to the top 10 MA contracts, and perform better on measures directly under their control — particularly member experiences with health plans, member complaints and appeals, and customer service.

Given the relative underperformance of measures in managing chronic conditions, we believe this is an area ripe for innovation and improvement from prioritization initiatives. CMS has recognized the opportunity to further improve the measures under ‘managing chronic conditions’ and has increased its emphasis by weighting these measures more heavily relative to other domain areas.

Now I’d like to discuss how to best identify CMS Five-Star Quality Rating improvement initiatives in a rigorous and systematic manner, by looking at sample data from the performance of an HMO MA product, with thresholds for the three-, four- and five-star scores. Within a given CMS Five-Star Quality Rating measure, individual members or provider segments are seen within a given MA contract.

When looking at which providers do well, which ones see a large base of membership, and also more importantly, the measures where skew may exist across the member-provider segments or cohorts, the end goal is to drive overall performance to the next threshold. Diabetes/cholesterol control and diabetes eye exams are seen as potential good member and provider cohorts to focus on for targeted improvement opportunities. This approach lays the foundation for how to prioritize targeted star improvement efforts.

Excerpted from: A Strategic, Best Practice Approach to Improve CMS Star Quality Ratings, a 45-minute webinar

Ideas to Engage Providers and Patients in CMS 5-Star Quality Rating Improvement

September 17th, 2013 by Jessica Fornarotto

With an additional star in CMS’s Five-Star Quality Ratings System worth about $50 per member per month (PMPM),* health plans are anxious to polish their Medicare Advantage ratings. One area ripe for improvement is the management of chronic conditions, notes Joseph Johnson, vice president of L.E.K. Consulting — an area where both providers and patients can be recruited to help.

During a recent webinar on A Strategic, Best Practice Approach to Improve CMS Star Quality Ratings, suggested strategies for health plans to engage providers and patients in the management of chronic conditions.

Question: One area where health plans are struggling in is managing chronic conditions. What can health plans do to improve in this area?

Response: From a managing chronic conditions standpoint, operate under the guiding principle that these are in fact measures that are highly driven by the engagement of the provider network that a health plan utilizes. You also want to make sure that providers actually have aligned incentives, like creating profit-sharing goals for example, to the extent that a specific target for a given CMS Star Quality Rating measure within managing chronic conditions is met or exceeded, and then sharing part of the incremental revenue uplift with the providers that are part of that focused targeted improvement.

Also, provider report cards are another good tactic that we’ve seen health plans employ in order to help drive improved Star Ratings. Those are a couple of tactics that we’ve seen used in practices that did yield material results.

Question: Are there any success stories from plans utilizing house call programs to manage chronic conditions?

Response: We’ve seen a positive incremental yield on house call programs. Those programs can serve a dual purpose both with incremental revenue Star uplift, as well as an incremental improvement in coding initiatives and hierarchical condition categories (HCC) and Risk Adjustment Factor Type (RAFT) scores. To the extent that you know the algorithm is being used to target those house call programs are implemented effectively.

Question: Does the senior population participate in digital patient engagement programs?

Response: Yes, although many say that the senior population is not accustomed to digital communication channels. Increasingly, we’ve seen the senior population become more and more wired, so to speak. There are benefits for this type of communication channel; it can be an effective, low-cost way of engaging in some member outreach that can be effective, particularly when targeted at raising overall CMS Five-Star Quality scores.

Question: Can member engagement programs increase CMS Five-Star Quality Ratings?

Response: Certainly member engagement programs, when appropriately targeted and directed, can result in meaningful uplifts and improvements in Star Ratings. With the health plans that we’ve worked with, targeting mailings, telephonic outreach or other forms of outreach — with low performing member/provider cohorts — have been a great way of increasing overall performance in a way that does materially change and improve overall Star Ratings, to the extent that they are targeted efforts, as opposed to more far reaching or broad, blanket efforts across the entire member base. And the ROI and the yield are certainly higher.

*When moving from a three- to four-star Medicare Advantage plan, according to L.E.K. Consulting.