Star Ratings: The Moving Target

Recently announced changes to the Star ratings program continue to present Star Ratings as a moving target for Medicare Advantage organizations. While the Centers for Medicare & Medicaid Services’ (CMS’) recent memo and request for comments on the 2016 Star Ratings program changes illustrates CMS’ continued commitment to rapidly driving better care for patients, better health for communities, and lower costs, the proposed changes will simultaneously usher in a new era of accountability and integration within Medicare Advantage health plans.

CMS announced plans to reintroduce three previously-removed measures (breast cancer screening, beneficiary access, call center/TTY), add the long-awaited CMR completion rate measure, retire three HEDIS measures (two LDL screening measures and the LDL control measure), and make a lengthy list of changes to existing measure specifications in the 2016 ratings. CMS also laid the groundwork for the 2017 addition of measures related to asthma, depression and opiod-overutilization.

Since the new 2017 Star measures will likely be officially announced as 2016 Display Measures later this year, and will be computed based upon services provided throughout 2015, the 1st quarter of the year is an optimal time for plans to adjust population health tactics for 2017 Star Ratings success. With the nature and extent of the 2016 and 2017 changes, Medicare Advantage organizations will want to be very strategic as workstreams are developed or adjusted to accommodate CMS’ proposed changes.

Given the complex clinical and social issues associated with asthma, depression and overuse of opiods, integrated activities and coordinated services among providers, clinical teams, case managers, and retail pharmacies will help plans achieve Stars success. Executive leaders will want to understand the nature of CMS’ new focus areas, and operational and budgetary decision-makers will want to be poised to rapidly understand the changes, as well as deploy new or adjusted tactical workstreams in early 2015 to best ensure Stars success.

This blog was originally posted on blog.gormanhealthgroup.com.
John Gorman: Under John’s leadership, Gorman Health Group has become the leading professional services and solutions firm for government-sponsored health care, providing thought leadership and expert strategic, operational, and technology-based solutions. Read more.