Using Plan Preview 2 to Reassess Intervention ROI

Medicare Advantage (MA) plans have just received Plan Preview 2 results from the Center for Medicare & Medicaid Services (CMS). Plans are either celebrating or hunkering down to figure out how to improve their Star Rating, or both if the plan just barely made 4+ Stars.

Cut point trends remain unpredictable as the 4- and 5-Star cut points increased more in Stars Year (SY) 2024 than in SY2023 and as the Tukey outlier deletion rebased cut points across the board. Many previously highly rated plans are still evolving from the very dangerous false sense of security that pre-Tukey stability and COVID Extreme and Uncontrollable Circumstances (EUC) relief allowed.

This is an ideal time to reassess the effectiveness of interventions on all measures. It is important to be sure they are performing to provide a 5-Star result that can keep up with the trends versus what just met the pandemic-impacted cut points in the past.

3 Steps to Improve Quality

Here are three steps to take to make sure you are efficiently applying your resources to improve quality and continue to improve measure rates:

1. What are you doing?
   
   Compile a list of all interventions currently implemented with a primary purpose of improving Star Ratings.
   
   
2. Recognize it is okay to let go
   
   We often hear plans admit that they are throwing spaghetti at the wall to see what sticks. But once an activity or tactic is implemented, plans often struggle to stop them. The ones that don’t stick should be stopped to leave room for interventions that will stick. Identify the number of members impacted by these interventions and look at their experiences to see if there is any evidence the intervention under evaluation worked.
    
   • If there was improvement, consider keeping the intervention and further assess if there is any need to further expand, enhance or scale.
     
     
   • If there is no improvement or value identified, communicate reality. This may be the ideal time to stop funding or working on the intervention. This is very hard for health plans to do, since most plans simply add more interventions to Stars workplans without ever removing those that don’t work. As CMS tightens the financial structure in MA, plans must open the budget to fund new interventions that will work.
     
     
3. One size does not fit all
   
   MA plans are still adapting to the reality that every plan and every community is unique. Star Ratings success is a direct reflection of the degree to which plan leaders know their plan, know their service area, know their members, and spend limited time and budget doing what matters. Use Plan Preview 2 as a chance to identify, explore and evaluate new interventions that are more targeted and locally customized to what your members need. Be critical and do not just dive into an intervention that worked for another plan that is not like yours.

CMS has structured the entire Star Ratings program to rely on MA plans to continuously improve their quality. This type of critical self-evaluation is a vital element of the PDSA model of continuous quality improvement. Plan leaders often assume staff are doing this important work, though it often fails to occur due to daily operating pressures and competing priority. The nature and timing of doing this evaluation is key. We recommend this evaluation be performed right now; while you still have a chance to pause or stop spending time and budget on activities that are not driving improvement with enough time to shift the resources to positively impact Measurement Year 2023.

Our team of Medicare experts are skilled at working with plans to:

1. Assess and develop strategic and tactical approaches to improving Star Ratings by identifying performance challenges, breaking down the problems, and creating solutions that drive measure improvements.
   
   
2. Jumpstarting innovation to transition from monitoring, reporting and governance to focused, rapid problem-solving.
   
   
3. Aligning internal and external teams regarding new measures and requirements around health outcomes, health equity and the growing intersect between risk adjustment and Star Ratings.

Healthmine is here to help. To learn more contact me at Ana.Berridge@healthmine.com.