A Stars Program Analysis and development of a “Math Path” and roadmap to achieve and sustain 4.0+ Stars

Challenge

The client, forecasting at 3.0 Stars or lower, was unable to report on critical Stars data points and overall performance, as well as lacking a formal governance structure to proactively manage and stay ahead of Stars’ performance. One of the biggest barriers the team faced was the task of improving outcomes given the unique and challenged member population. This primarily urban and special needs focused population required the team to think creatively and really focus on the cross-functional and interconnected moments our members experienced to drive home the messaging and experience they desired. The client engaged ProspHire to conduct a Stars Program Analysis and develop a “Math Path” and roadmap to achieving and sustaining 4.0+ Stars.

Solution

The team conducted a comprehensive 6-week Stars Program Assessment utilizing our proprietary assessment framework which focuses on uncovering improvement areas to their overall Stars outcomes and improve visibility across the organization. With a combination of individual stakeholder interviews, focus groups, surveys, data aggregation and analysis and observation exercises, we were able to develop a deep understanding of the health plan and their unique challenges. We conducted measure level goal setting sessions to develop a “Math Path” to 3.5 and 4.0 Stars.

Result

As a result of the assessment, our team identified key issues related to data reporting, traceability and cross-functional communication that has led to teams operating in silos and data reporting errors. In addition to the Math Paths and roadmaps to improve their Star ratings, our team recommended our proven Stars Governance, Oversight, and Accountability Model which includes domain-level workgroups to provide clear guidance to business stakeholders and cross-functional partners.

To improve data accuracy and reporting, the team worked to uncover several critically missing or insufficient supplemental data feeds. This finding led us to recommend and establish standardized data governance and reporting to drive increases in overall Stars performance. Tailored interventions at the member, provider and operational level were developed to make impactful changes across all domains and measures, with the goal of driving accountability and improving member experience.

With the full backing of executive level support, the team worked to develop 40+ uniquely tailored interventions to drive performance increases across measure. Following the delivery of our Stars Program Assessment Findings and Long-Term Strategic Plan, the client requested we remain embedded within their Stars Program and serve as interim Stars leaders to drive performance and accountability, including the implementation of our long-term strategic plan.

Deliverables

  • Stars Program Playbook
  • Short- and Long-Term Strategic Plans
  • Measure Level Goal Analysis
  • Contract Specific Math Path Insights
  • Stars Program Governance and Accountability Structure
  • Individual Intervention Charters

Client Overview

The client is a Midwest based, growing health plan that is new to the Medicare marketplace, with less than 10,000 members. They focus on special needs populations and members with high needs, in particular the C-SNP population.

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Andrew Bell

Senior Manager

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