The 2024 Star Ratings have been released. Health plans have had time to review the data. The Tukey Outlier Deletion methodology has been applied for the first time, and now plans are scrambling to readjust their internal goals for Measurement Year (MY) 2023. We are sitting in the middle of the always dreaded Q4 push and each day is passing quickly.
What do you need to do to ensure that you are ready for the end of yet another measurement year and reaching your goals for the 2025 Star Rating? Following the release of the Final Star Ratings, I have asked the experts in Stars consulting and leaders at high-performing plans for their tried-and-true strategies, initiatives and tactics they would deploy to ensure success. Here’s what we know works and should be top of mind for Star leaders across the country.
What You Should be Doing Now
- The Foreign Language/TTY study is just around the corner. Plans should be updating their education and training and prepping their staff for the study. Consider adding a sample of test calls between now and the beginning of the study to ensure your staff is ready. This will be the last year the measure is 4x-weighted, so performing strong is a must.
- Identify member issues as they arise and address them promptly before the next CAHPS survey. Identify members impacted by the same issue and provider outreach and resolution.
- Focus on HEDIS measures that are closest to your plan goals and drive gap closure in those measures first. Always look for the lowest hanging fruit.
- Create a targeted list of members needing just one more fill to meet 80% proportion of days covered (PDC) and focus on those with urgent and needed outreach.
- Review Annual Enrollment Period performance to be prepared for potential influx of Q1 Health Risk Assessments (HRAs) needing completion. We realize this is a Stars Year 2026 play, but resources and staffing will need to be addressed.
- Implement rapid outreach to members who may be changing plan as a possible “win back” to your plan.
- Proactive outreach should be conducted to members that will be negatively impacted by negative benefit changes or formulary changes.
- Analyze, identify, and close any gaps in supplemental data for HEDIS.
- Monitor your Independent Review Entity (IRE) cases weekly and submit re-openings for error correction as soon as you identify them. Ensure someone in your organization is calculating the two appeals Star measures using the Maximus data consistently throughout the year (at least monthly).
- Review your Complaints about the Health/Drug Plan (CTM) rates in HPMS and validate CMS is using the correct average enrollment volumes. Use the CMS Monthly Membership Report by contract for your denominator.
- Complete HEDIS test runs in November and December, including HEDIS Medical Record Review (MRR) samples.
- Allow 14 weeks on MRR hybrid chart review. This means starting MRR no later than January 29, 2024.
- Plans must have a strategy to identify and exclude non-diabetic members in the Diabetes Measures that were pulled into the denominators due to GLP-1 medications for weight loss. It is also advised to increase the oversample population in these measures.
- Consider a Q4 “pay for quality data” push for HEDIS Star measures to increase supplemental data capture.
- Prioritize members with multiple gaps in care.
- Encourage providers to scheduled Annual Well Visits (AWV) for multi-gap in care members when appropriate and give providers AWV guidance, such as needed labs and services, medication adherence, pain screening, medication review or blood pressure check when greater than 140/90.
- In addition to the 10-year look-back for Colorectal Cancer Screening (COL/COL-E), load OMW historical medical claims and pharmacy claims to cover the OMW required exclusionary period.
- For any Admission Discharge Transfer system, Health Information Exchange (HIE) or shared Electronic Medical Record (EMR) system meeting the admit notification and/or discharge Information Transition of Care requirements fully, load this data as TRC standard supplemental data. Have an auditor validate TRC data as early as December so that HIE charts from non-contracted providers can be obtained before the supplemental data deadline.
While the list of activities you should be doing now seems overwhelming, when broken down into tasks and divided across teams and workgroups in your organization, the job can be easily be completed. Plans have 10 weeks to ensure their MY2023 goals are met. Time is not on our side at this point and ensuring your Stars workplan includes the previously mentioned items is key to finishing the year strong.
At Healthmine, we are prepared to help you reach your goals. Reach out to us for help with your strategy. Contact me at John.Willis@healthmine.com.