Medicare Stars Is Changing. The Plans That Adapt Will Win.
The Medicare Advantage Stars program is entering a period of significant change.
CMS continues to shift the program away from administrative and process measures and toward outcomes, clinical performance and member impact. For health plans, that means the strategies that drove success in the past may not be enough to sustain performance in the future.
In Episode 3 of Soaring to New Health, Bill Rayball, Vice President of Government Quality at Highmark and ProspHire’s Andrew Bell discuss what these changes mean for plans and where leaders should be focused now.
Stars Success Is No Longer a Quality Team Responsibility
One of the strongest themes from the conversation was that Stars performance cannot live within a single department. Quality teams may lead the strategy, but success requires alignment across clinical operations, provider networks, member experience, customer service, analytics and executive leadership.
As Stars becomes increasingly tied to outcomes, plans that create stronger cross-functional accountability will be better positioned to maintain performance.
HEDIS Modernization Is Reshaping the Future
Both guests pointed to HEDIS modernization and digital quality measurement as one of the most important shifts underway. As healthcare moves toward greater interoperability and FHIR-enabled data exchange, plans will need more than strong abstraction teams and supplemental data strategies. They will need modern data infrastructure, better clinical data acquisition and the ability to turn information into actionable insights.
The plans investing in these capabilities today will have a significant advantage tomorrow.
Stability Is the New Strategy
For years, Stars organizations focused on continuous improvement and incremental gains. That mindset remains important, but the environment has changed. Regulatory shifts, evolving measures and increasing performance pressure mean many plans are now focused on protecting performance as much as improving it.
According to Rayball and Bell, the organizations that will succeed are those with strong leadership, clear priorities and the discipline to focus on the initiatives that truly move the needle.In a time of constant change, stability may be the most valuable capability a health plan can build.
Hear the full conversation with Bill Rayball and Andrew Bell as they discuss the future of Medicare Stars, HEDIS modernization and what health plans should be doing now to prepare for what’s next. To listen to the entire episode, click here.
