3 Actions to Take Today to Boost 2019 Medicare Star Ratings

It’s go time. 2018 Medicare Star Ratings are now officially out from the Centers for Medicare & Medicaid Services (CMS), but there’s no rest for the weary.

Time to give a final push for 2019 and get a jump on 2020. Yes you heard that right. Today is not the time to pause—in fact, any delay can significantly limit a plan’s ability to improve in the following year.

But where exactly should you start? Here are three actions you can take today that can make a big impact going forward.

  1. Understand where you landed versus your expectations. Did you achieve the rating you were expecting? Were you surprised about your raw scores? Because of CMS’s moving cutpoints—this year, 14 of 34 measures showed at least one cutpoint with a double-digit swing—not to mention improvements by competitive plans, movement can often be a guessing game. Predicting the outcomes often means, taking every detail and every datapoint into consideration. And looking across the spectrum of health plans, at both historicals and current activities to prepare for the future. Technology, backed by machine learning and data science, is helping many plans get ahead and prepare. Understanding why surprises occurred and what caused your estimates to be inaccurate can help ensure you are on top of changes moving forward.  As a bonus, this activity can even help influence HEDIS and CAHPS for this year.
  2. Set this year’s expectations and next year’s goals. August and September shouldn’t be surprising times inside Stars organizations. In fact, if you are like most health plans, the word “surprise” is one of those words you just want to avoid altogether. And you can. If you’ve communicated clearly, and managed expectations, you’ll be in the driver’s seat, ready to steer the ship forward. That means communicating both predicted scenarios, as well as your needs—technology, partners, resources—to ensure alignment. Use this time as an opportunity to ensure everyone knows their roles. Of course, you should celebrate the wins, but at the same time, start addressing the losses and planning for January 1. Make sure every knows that no matter what the outcome was—status quo is not good enough. As we all saw, 24 of 34 Part C measures changed at least one percent or more to get or keep five Stars. With other plans improving, you must as well.
  3. Prioritize your resources and investments. Know exactly where you stand and adjust accordingly. Look at your recent results—but don’t evaluate in a vacuum. Couple them with current year measurements, predicted cut points, peer performance and your own ongoing implementations already in place. Take weight, cut point proximity and historical measure movement at your performance levels into account and set realistic goals. Be honest with yourself. If you are eight points away from raising the Star and you’ve consistently achieved the same score, unless you are making drastic changes or seeing significant trends, it is likely an area where you should not focus the bulk of your resources. If you don’t have a good idea of where you stand, use this time to assess your strengths and weaknesses. Too many plans get caught up in what they “should do” rather than what they “can do”. Align your team, internal and external partners. Make sure you are making the right investments, and ensure that you are in a good position to achieve desired results.

Today’s release of the 2018 CMS Stars Ratings isn’t an end point, instead it’s a critical time for assessment, planning and action. Getting a jump on 2019 can make a huge impact on what’s ahead. The Hyperlift team is here, ready with free assessments to help you clearly understand where you are, and what potential is ahead.

Sign up for your free Stars Contract Highlights Report today and get a personalized Stars Measure Assessment summary; range of likely Star Ratings for 2019; top 3 most impactful measures for your contract(s) and a detailed measure analysis for your top three measures.

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