We helped the client achieve their first four-Star rating and built a custom HEDIS® tool that resulted in $2.5m in savings.

Challenge

The client’s contract was at risk of closure due to their low Medicare Stars rating and inefficient HEDIS® measures. They needed to analyze and improve their HEDIS® measures, increase cost efficiency, establish a dedicated Stars department and increase their Stars rating.

Solution

Over six months, ProspHire conducted a thorough current-state assessment of the client’s post-season HEDIS® measures. The assessment included a change readiness analysis of the organization’s current financial model, data and reporting accuracy and systems capabilities. Leveraging the results, the team identified barriers and developed a Medicare Stars Playbook to improve HEDIS® outcomes, track key organizational KPIs and achieve and sustain an increased Stars rating. The engagement team provided a clear road map to achieve new growth opportunities, cost savings, improved sustainability and enhanced marketability for the organization.

Result

As a result, the client increased their Stars rating from a 3.5 to 4.0, saved $2.5m and eliminated the risk of contract closure. ProspHire built a custom tool that enabled them to bring their HEDIS® outreach and chart retrieval procedures and capabilities in-house, thus streamlining processes and increasing efficiency. The client also established a dedicated Stars department using ProspHire’s Medicare Stars Playbook of recommended program interventions and implemented a new financial model and staffing changes

Outcomes

  • Medicare Stars Playbook
  • Increased Stars rating
  • Cost savings
  • Custom HEDIS tool
  • Increased efficiency
  • Organizational alignment

Client Overview

The client is a managed care organization (MCO) that provides health services to members within Pennsylvania. They are one of the largest Medicare programs and the largest D-SNP in the state.

Testimonial

The ProspHire team was an integral part of our successful transformation. Their experience and industry acumen provided the perfect level of support and leadership that has helped build a foundation for sustainable success.
VP, Medicare and Medicaid Quality Programs

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Andrew Bell

Manager
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