Topic: Star Ratings

Member Engagement and Experience are the New Risk Adjustment

John Gorman

In this new era of Star Ratings in Medicare Advantage and Part D, where a 4+ score is now do-or-die, health plan survival comes down to two things: member engagement and the member experience.  They’re the new risk adjustment when rates in 2014-2015 will be at their lowest levels in more than a decade, and a low-quality rating is a kiss of death in government programs.  Plans that can’t evolve into kinder, gentler, more coordinated and Member-Centric service providers are already beginning to disappear.

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Lighting the Path in the Golden Age of Government-Sponsored Health Programs: Join Us for the GHG Client Forum

John Gorman

More than 300 guests will convene on May 1-2 at the Red Rock Casino in Las Vegas for the 2014 Gorman Health Group Forum, our annual strategic retreat for leaders in government-sponsored health programs. This year’s gathering promises to be the most actionable, content-packed conference you could attend on how to succeed in this new Golden Age of government business. And when the learning and planning is done for the day, we will celebrate this unique moment in health care history as only GHG can in Vegas.  Here’s what’s happening this year and why you’ve got to join us: Read more

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Innovating in 2014

Regan Pennypacker

CMS has developed an Innovation Center to address health care payment and service delivery models. It is a great site to find information about current Innovation Model Partners, and a place to share your ideas on how care can be delivered and paid for in ways that will lower care cost and improve quality of care. As always, the service to beneficiaries is at the heart of these initiatives, and for the program to continue, partners must be innovative.

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2015 Medicare Advantage Draft Rate Notice is a Bear: Messy, Noisy, and Smells Like Roadkill

John Gorman

Friday after the close of business, CMS released the draft 2015 “call letter”, the rate announcement for Medicare Advantage.  As expected, it’s a bear: messy, noisy, and smells like roadkill.  It’s just about a worst-case scenario for flabby, distracted, uncommitted health plans in Medicare — the roadkill to come. The table is now heavily tilted against low performers who can’t keep up. Some topline observations: Read more

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Reading the Stars in Medicare in 2014-2015

John Gorman

Whatever you may think of healthcare.gov, CMS is killing it on the Medicare Star Ratings Quality Demonstration.

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Innovation and Quality must go hand-in-hand

Regan Pennypacker

Plan sponsors are waiting with anticipation for their 2014 Medicare Star Ratings to be released. Just yesterday, Tufts Health Plan in Watertown, Massachusetts released the news that their Medicare Preferred HMO plan was awarded 4.5 out of a possible five stars. It reminds me of the old Ford commercial jingle where they said “Quality is Job 1″. No truer words apply when it comes to maintaining high quality plan options for our nation’s Medicare beneficiaries.

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Healthy Outlook for Medicare Advantage and Part D from CMS in 2014

John Gorman

Last week amid all the ObamaCare drama on the Hill CMS released the 2014 data for Medicare Advantage (MA) and Prescription Drug Plan (PDP) bids. The numbers show a better-than-expected 2013 and a healthy 2014 ahead for Medicare health plans.  The market will see new service areas, lower bids, more zero premium plans, and more mainstreaming of Medicare Advantage as it approaches one-third of the program. CMS noted significant gains on plan quality measures, pointing out that more plans are receiving a rank of four -plus on Star Ratings, the minimum threshold for quality bonuses in 2015 when the quality demonstration expires.  Overall there is clear evidence that CMS quality incentives are working, and that MA will continue its steady ~10% growth in 2014.

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