Q&A with ProspHire’s Andrew Bell on Stars Performance Improvement

Andrew Bell

Senior Manager

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Why are Medicare Stars Performance Ratings important?

Medicare Stars Performance Ratings are important because they provide a measurement of the quality of care offered by Medicare Advantage plans. From the perspective of the member, the ratings help compare the quality of different plans during enrollment periods. For Health Plan leaders, the Medicare Stars Program is important because it affects both the financial performance of their plans and their ability to attract and retain enrollees. Higher ratings can lead to higher enrollments, improved financial performance and more favorable reimbursement levels.

What are the biggest challenges your clients are facing regarding Stars Performance?

When we first engage with a client on a Stars project, they are typically lower performing or are at risk of falling below the 4.0 Stars QBP threshold. There are several commonalities in these circumstances. The first and biggest being a lack of organizational-wide awareness and priority in Stars. If Stars isn't given the time and dedicated attention it requires and isn’t a priority of the leadership at your organization, you will be hard pressed to succeed. The second is data: data integrity and data availability. Succeeding in Stars is largely based on a plans’ ability to aggregate data and synthesize it down into an actionable plan to improve ratings.

How do organizations improve their Stars Rating?

Success in Stars starts with proper governance, accountability and data-backed decision-making capabilities. When we work with clients, we seek to understand their specific plan challenges and structure. With that as a starting point, we advise implementing a cross-functional governance structure with accountability at the domain and measure-level. We have worked with clients to onboard them onto our proprietary forecasting and projection technology. This technology enables clients to have real-time insights into contract performance and allows leaders to make informed decisions with measure-level goal setting.

How can Stars leaders gain momentum and partnership across their organization?

One of the biggest challenges that Stars leaders have within an organization is remaining a priority. Every plan has competing priorities and strategic initiatives. As a best practice, Stars programs that remain at the forefront and an integral part of the business functions will gain leadership buy-in. It is extremely beneficial to have the backing of Senior Leadership. They will help break down barriers and ensure that the organization is aware that Stars is a priority to them.

What do health plans need to know about Star Year 2024 and beyond?

When I speak with clients and folks within the Stars and Medicare world, the Tukey Outlier deletion for SY2024 is what keeps them up at night. This methodological adjustment paired with the somewhat surprising, proposed rules for Medicare Advantage and Stars are keeping people thinking. These changes are likely going to have quite a substantial negative impact on Star Ratings industry-wide.

Can you offer insights on what can be done now to prepare for the Tukey Outlier?

At this point, most health plans and Stars leaders are aware of the Tukey outlier deletion modifications. What leaders should be doing is conducting thorough measure-level analysis to understand what measures will be impacted by Tukey and then begin to mitigate against potential measure score drops. With so many measures simultaneously in play, strong data analytics can help enable Stars programs to target the right measures for their plan to achieve their stated contract goals.

What do Stars leaders need to be thinking about in the years ahead?

To stay ahead of the Medicare Stars Program changes, Health Plan leaders need to consider several innovative strategies, including:

  • Investing in technology and data analytics to better track and evaluate quality performance, including predictive analytics and intervention effectiveness
  • Focusing on customer satisfaction, including offering telehealth services and addressing social determinants of health through community engagement or enhanced benefit offerings
  • Collaborating with healthcare providers to improve the quality of care and to gather more comprehensive data on patient outcomes
  • Regularly reviewing the Medicare Stars Program and making necessary adjustments to stay ahead of the curve and to maintain a high level of quality

Is there any risk for Stars Leaders to delay their strategy implementation 6-months or a year?

As we all know, the Medicare Stars program is a complex overlapping cycle, with two Star performance years simultaneously in play at any given moment. The truth is, that the best time to start implementing a Stars improvement plan is yesterday. Any consequences to a delay in action will not be felt immediately; however, the downstream consequences of those delays in decisions will most certainly impact the plans ability to achieve the quality bonus payment and other stated goals.

How Can ProspHire Help?

Since our inception, ProspHire has been supporting health plans in Medicare Stars. We work collaboratively with your team and seek to understand the unique circumstances at your health plan. By leveraging contract specific data and on the ground insights into plan operations and capabilities, our healthcare experts will deliver a Customized Contract Capability Assessment in tandem with a tailored Stars Strategic Roadmap and Playbook. This support will empower plans to take control of their Stars Program and enable Stars leaders to feel confident about their math-path to success and corresponding intervention plans.  

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