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Strategies for Engaging Clinical Teams With Upcoming Star Program Changes

May 19, 2023

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The rapidly evolving Medicare Advantage (MA) Star Ratings Program will require teams across the plan to align strategies and move in the same direction to achieve ongoing success. Seizing every opportunity to gain momentum with each measure will be critical and require continuous communication, education and engagement with clinical teams.

The Role of Clinical Teams in Stars Performance

MA plans can find it challenging to keep frontline clinical teams up to speed on new and evolving regulatory requirements. Your frontline clinical teams play a pivotal role in developing tactical solutions to address these requirements. Plans often struggle to inform clinical teams about what is needed from them while also explaining the rationale behind these requests. Without a clear understanding of how their day-to-day work impacts Star Ratings performance, clinical teams can struggle to address new and emerging measures.

However, these are the very teams that most often engage with members, providers and community resources, all of which are key stakeholders of an organization’s quality improvement efforts. To ensure frontline clinical teams are aligned, engaged and prepared to react to future requirements, education, communication and engagement is critical.

Preparing Clinical Teams for Star Challenges

There are multiple processes that can be implemented to ensure clinical teams are well-positioned to identify and implement tactical solutions that will advance future Star Rating success.

When educating frontline clinical teams, providing them with short snippets of information via emails can enable them to quickly review regulatory updates. Plans should follow up with additional information and more robust discussions through staff meeting. During these meetings, present a standing agenda item that reiterates the new Stars changes, answer questions and solicit feedback on tactical solutions the clinical team may implement to enhance the organization’s performance.

Below is an example of information regarding the recently released final rule that could be provided over a four-week period to front-line clinical teams:

Hot off the press! The Centers for Medicare & Medicaid Services (CMS) recently released the 2024 Final Rule, and it is laser-focused on efforts to ensure a more equitable healthcare experience for marginalized enrollees. There are multiple changes coming to the Star Program that are geared at improving health equity. Over the next four weeks, we will provide you with some communication that highlights some of the changes that were finalized in the most recent final notice released in April 2023:

  • Week 1: CMS is adding a Health Equity Index (HEI) to the Star Ratings program. Historically, plans who performed well in the Stars program received a boost in scores through the Reward Factor when they had ongoing performance within Stars. This reward factor will be removed in the future and replaced with the HEI. The HEI will provide plans with boost in their overall Star Ratings when they achieve higher equity among specific marginalized populations in select Star measures. While the shift of the Reward Factor to the HEI will not go into effect until Star Ratings Year 2027, CMS will begin using data in 2024 to calculate the HEI. Because clinical teams play a crucial role in building trust with members and coordinating needed care services to close care gaps, they will be invaluable in helping health’s plan achieve success with the HEI.
  • Week 2: CMS is dedicated to ensuring provider network directories are more user-friendly, particularly for non-English speakers, limited English proficient individuals and enrollees who use American Sign Language (ASL). Hence, CMS is requiring plans to include provider’s cultural and linguistic capabilities in their provider directories. Often, when clinical teams are assisting members access needed healthcare services, they may assist members with navigating the network directory. Over time, you will notice enhancements to the provider directory that will include the ability to filter providers by the languages they are fluent in. This will help to ensure members can easily identify providers that can best support a member’s cultural and language needs.
  • Week 3: There is growing evidence that disparities in telehealth access are the result of low digital health literacy, especially among populations who already experience health disparities. To address these disparities, CMS will require MA plans in January 2024 to develop and maintain procedures to identify and offer digital health education to members with low digital health literacy and assist with accessing medically necessary telehealth benefits. Clinical teams will play a key role in helping members sign into platforms to access digital health modules, manage conditions and receive preventive care reminders. Be prepared to provide feedback and solutions on how clinical teams can help our plan achieve success with this new requirement.
  • Week 4: As part of CMS’s goal in improving health equity among MA enrollees, CMS is aligning programs to ensure organizations are committed to promoting a more equitable health care experience for its enrollees. As part of the Final Rule, CMS will require MA plans to incorporate one or more activities into their overall quality improvement program to reduce disparities in health and healthcare among their enrollees. As clinical teams develop new ideas for future quality improvement projects, consider how you can incorporate health equity priorities into these initiatives. For example, if a project is geared toward improving colorectal screenings for members, be prepared to measure any disparities between races in screening rates and to develop specific strategies to address inequities identified in marginalized populations.

Do not underestimate the critical role clinical teams have in interactions with members, especially the most sick and vulnerable populations. Equipped with the right information and education, these teams can positively impact Stars Ratings.

Our Expert Advisory Services team has a proven track record of guiding MA plans through years of complex regulatory changes. Reach out to us to explore strategies to ensure continuous Star Ratings success. Contact me at Donna.Simon@Healthmine.com for more information. Stay tuned for more strategies for proactively engaging clinical teams with upcoming Star Ratings changes.

Donna is a Registered Nurse with over 28 years of clinical experience, 22 of which have been in healthcare administration. She focuses on using innovative approaches to improve the care delivery system by ensuring clinical teams understand and leverage data and information systems to identify, manage and provide quality-based care efficiently. She is passionate about developing strong and efficient teams that optimize patient outcomes and experiences.

She has worked with both large hospital systems and payers, which provides her with insight of multiple perspectives within the healthcare industry. She has worked closely with these providers and systems to promote value-based care opportunities and a medical neighborhood concept. Donna has also consulted with multiple organizations to provide expertise related to various NCQA accreditation and certification programs.

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