By Martha Butler, Senior Vice President, Health Plan Operations
Autumn is in full swing—the leaves are changing colors, pumpkin spice lattes are everywhere…and CMS just released the 2018 Star Ratings for Medicare Advantage (MA) plans. How did your organization fare? If you’re like the 56% of MAPD plans rated below 4 Stars, you may be wondering how to improve.
At Lumeris, we have created a high performing operational platform focused on delivering improved outcomes—as evidenced by Essence Healthcare’s Star Ratings of 4.5-5 Stars for seven years in a row. Below are three key tenets that we adhere to in order to drive sustained high Star performance.
- Align all of your operations – Everyone should know about Star. From the CEO to the customer service associate, the entire organization needs to understand the importance of Star Ratings. By keeping Star at the top of mind, everyone can focus on driving member satisfaction and delivering the highest quality service across departments. However, this is easier said than done. If MA is not a large proportion of your overall business, it may suffer from lack of attention. Moreover, it is essential to ensure your operations align with Medicare Advantage—there are many specific requirements put forth by CMS and differences in the market that impact how plans succeed in MA versus other lines of business.
- Collaborate with physicians – Star Ratings are not just a focus for the health plan. The member’s experience during patient care is becoming more and more important. Partner with your physicians to innovate. Create new ways to deliver the best member experience. Tying physician programs and incentives to metrics that promote improved quality of care aligns all parties—the plan, the providers, and the members. However, providers need to be empowered to succeed. They need actionable information, programs designed for value-based care, and collaborative support to engage effectively with patients and deliver improved outcomes. Aligning all parties around clinical and operational metrics that later feed into Star Ratings helps everyone work toward a common goal of improved care.
- Drive continuous improvement – Success in Medicare Advantage comes from the long game. Work today is rewarded much later than tomorrow. For example, clinical work delivered this year impacts Star Ratings two years from now. Thus, if your Star Ratings are lower than you like, trying to fix them today is already too late! Instead, consider how your organization can reshape not only how it will improve performance, but how it can monitor and track it for feedback to continuously adapt (e.g., advanced analytics, new programs, innovative culture). Because quality standards rise each year, and CMS raises the bar on the evaluation process, it becomes harder and harder to be a top performer.
Remember – Star isn’t just a season. Every associate, across every function, must be engaged all-year round. Don’t know where to start? Let us help you create a plan together to deliver on the promises of the Triple Aim +1™ – improved care for all, at a lower cost, with increased consumer satisfaction and engaged physicians.