About 10 years ago, CMS invented a star-rating system for Medicare’s private insurance coverage to improve care for patients. Each year, companies are assigned a star measure rating from one to five stars. If health plans provide high-quality care to Medicare beneficiaries, it’s likely they will fall into the four to five-star spectrum and earn a five percent boost to their monthly per-member payments from Medicare. For those who receive three stars or below, there is no bonus. In fact, low performers with star ratings of 2½ or fewer are placed on a “low performer” list and encouraged to make improvements to the quality of their plan or face more severe penalties.
Unfortunately, determining Star measure outcomes can be difficult. As of now, health plans try to predict the impact of a benefit plan by making evaluations based on a number of intersecting factors, across multiple Star ratings measurements. Even consistent improvement year-over-year can be hard to achieve — and a higher Star rating is not always guaranteed.
According to Modern Healthcare, this year’s star ratings reveal that insurers’ performance has remained relatively unchanged, with there being a slight drop — about five percent — in high-performing plans at four stars or higher.
Caring for patients with complex care needs that require multiple medications and coordination from the care management team can be a huge challenge. By taking a holistic and multi-disciplinary approach, health plans want to not only increase Star ratings, but improve health outcomes and overall population health. In order to predict Star measure outcomes, a plan needs a comprehensive but customizable approach to understand how all unique data sets and HEDIS/Part C/PartD measures interact to influence a Plans’ overall Star rating.
PharmMD’s StarTracker solution empowers Plan leadership to understand in real-time how targeted interventions and care management programs are performing. By modeling specific scenarios at the measure-level, inclusive of budget allocations, StarTracker provides visibility to final Star rating and “i-Factor” input at the individual measure. Plans then have a dynamic month-over-month look at how each measure is performing, which measures are most important, and the suite of reports to take targeted action to close gaps in cares.
The ability to incorporate real-time data sets into targeted intervention scenarios provides the ability to improve quality of care and health outcomes across all Star measures. Developing a performance-based partnership with PharmMD means your investment is tied directly to the success of the PharmMD solutions. By delivering a comprehensive and holistic solution with StarTracker, PharmMD can offer a unique partnership that is focused on creating healthier lives, while improving outcomes in the process.
About PharmMD: For Health Plans or risk-bearing entities that want to improve member and employee health measurably, PharmMD is the proven choice for pharmacy quality solutions. Founded by healthcare and pharmacy innovators, PharmMD’s outcomes-driven reporting, priority on personal touch, and scalable network are backed by performance-based pricing that guarantees fast results. Areas of expertise include: HEDIS, Part D Stars, Medication Therapy Management, Medication Risk Management.