With the recent CMS changes announced to the Star Program on April 6th, now more than ever plans must fully understand the impact of these program changes while keeping in mind that Medicare Advantage (MA) plans will be impacted due to limitations on data collection for Star Ratings. There is limited opportunity for plans to impact their 2021 Star Rating, as CMS will be utilizing CY2019 HEDIS and 2019 CAHPS.

Additionally, COVID-19 will change the way members engage in care and rate their health plan. Pro-active engagement and the ability to over-communicate with your members to get the right care when it’s appropriate will be key to the success of your members’ outcomes, plan rating outcomes and financial performance tied to your population.

2022 Star Ratings— It is imperative to act now

  • CMS is anticipating big changes in the Star level cut-points:
    • CMS is removing the guardrails to enable true measurement of plan performance without penalizing plans due to COVID-19.
      • This will cause the entire bell-curve to shift and there will be uncertainty in the final ratings.
    • CMS will expand the hold harmless protection— previously applied to high performing plans on the improvement measures— to all health plans, in order to limit the negative impact of year-over-year measurement performance declines.
      • This means the result will be calculated with the Health Plan Improvement and Drug Plan Improvement (5x Weighted Measures), as well as without the HPI and DPI 5x measure; then the higher rating will be applied.
      • The winning plans will be those that show improvement in these measures.
  • Medication Adherence for Chronic Conditions: This should be a top priority. Getting needed medications and refill reminders will be key to helping Part D triple weighted measures. Additionally, Statin Use in Persons with Diabetes (SUPD) is a 3x weighted measure for 2021 and 2022 Ratings. The four Medication Adherence measures will be 43% of the Part D score and a large component of the overall Drug Plan Improvement measure.
  • Digital mock-CAHPS survey/NPS: This will help you keep a pulse on member satisfaction, during a time when people are going to need more support.
  • Preventive services: The window for preventive services will be diminished due to non-critical care delays during COVID-19. Plans will need to engage their members in a timely and strategic manner to maximize performance during the 2020 calendar year. The ability to reach your members digitally and timely will be key in maximizing your incentive and reward strategy.
  • Chronic Conditions: Members with chronic conditions may prolong their appointments in fear of contracting COVID-19. Therefore, plans may need to increase usage of test kits, in-home services and mobile units, and also need the ability to reach appropriate segments of the population.
  • Blood Pressure: Controlling blood pressure is returning to the 2022 Star Rating. Be sure you can collect your members’ self-reported BP readings and highlight the uncontrolled members and engage them further.

5 steps HealthMine is applying and using with clients right now:

  1. Strategically modeling opportunities to maximize plan performance in areas that need attention due to the changes, and directly engaging health plan members in the following areas:
    • a. Medication refill reminders
    • b. Mock-CAHPS surveys
    • c. Net Promoter Score
    • d. Health Action Reminders (HEDIS)
    • e. Incentives and Rewards Fulfillment & Distribution
    • f. Chronic Condition Program Support and Supplemental Benefit Support
  2. Supplement and/or enhancing plan’s member engagement and incentive & rewards strategy.
  3. Providing mock-CAHPS functionality and information to address the satisfaction of the member at the plan and local provider level, in a digital and timely manner so they can create actionable, pro-active improvement.
  4. Capturing a real-time Net Promoter Score and comments from plan members and a digital feedback loop to share through an end-user interface in real-time.
  5. Quickly setting up a plan’s ability to collect member’s self-reported BP reading, as well as finding and informing uncontrolled members to further engage and incentivize them to report.

In this uncertain time, keep in mind the importance of proactively identifying and engaging members during and following the pandemic, to better help them navigate their healthcare, and offer up a little peace of mind. Please feel free to contact me for additional information – Amy.Lung@www.healthmine.com.

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About Amy Lung

Amy Lung joined HealthMine as the Chief Operating Officer. She brings 14 years of healthcare experience focused on Quality Improvement through data-driven member and provider engagement strategies. With extensive experience working between health plans and provider organizations, Amy has designed multi-year, sustainable quality improvement programs for several organizations and has a keen interest in utilizing data and technology to expedite results.

In previous roles, she led high performing health plans to achieve and sustain a 4.0 Star Rating in Medicare Advantage, 4.0 NCQA Medicaid Health Plan Ratings, led top-rated Medicaid Plan Performance, collaborated to win two state Medicaid RFPs and has captured significant revenue return in Medicaid Withhold Programs.

Amy is certified as an Improvement Advisor from the Institute of Healthcare Improvement and holds a LEAN for Healthcare certification through UCLA extension. She also holds a B.A. in Biology from the University of Wisconsin— Eau Claire.