In October, the Centers for Medicare and Medicaid Services (CMS) released its 2016 Star Ratings for Medicare Advantage (MA) plans. The good news is the Star Ratings for plans with prescription drug coverage (MA-PDs) climbed from an average of 3.92 out of 5 stars last year to 4.03 this year with approximately 49 percent of MA-PDs earning four stars or greater overall.
Although seniors don’t seem to care much about Star Ratings when enrolling in a MA plan, the ratings can impact the plan’s revenue by millions of dollars, especially since this was the first year CMS raised its 5 percent per-month bonus qualification for MA plans from three to four stars.
Whether you need to improve or maintain your quality performance going into the New Year, consider these Star Ratings and HEDIS management tips.
1. More efficient chart reviews. As a Medicare Advantage plan, you likely already perform member medical chart abstractions for Hierarchical Condition Category risk adjustment purposes. Those same chart reviews should be leveraged for HEDIS and Star Rating data capture and analysis as well. With a little extra preparation and time spent abstracting and reviewing, your field staff can gather all information needed for both programs in one stop or electronic file transfer.
2. Year-round analysis. Star Ratings are based on year-round performance, so they also require consistent data capture and analysis year-round. For example, MA plans must be able to track and monitor HEDIS and Star rates monthly, both on a shifted-year (rolling 12 months) and month-to-date basis, to identify and remedy negative trends. The underlying data—including administrative, supplemental and chart-based data—should also be updated monthly for valid trending.
3. Member engagement. Star Ratings, which are based mostly on quality measures, including HEDIS, are highly dependent on your members’ engagement levels and care plan adherence. A consolidated member education and engagement program using live and automated phone outreach can help encourage members to follow their providers’ recommendations to avoid costly adverse events that can negatively impact Star Ratings, HEDIS and outcomes.