Topic: Star Ratings

Relief for Plans Serving Dual Eligibles?

Olga Bronnikova

It seems as though the Centers for Medicare & Medicaid Services (CMS) may be taking a detour in their position on the effect of socio-economic characteristics of a plan’s enrollees. Last week, CMS announced plans to release a proposal to change Star Ratings for plans with significant low socio-economic beneficiaries, in a forthcoming request for comment for updates to the program in 2017. CMS stated the agency will release this request for comment by early November.

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2015-2016 CMS Program Audit Protocols Update

Regan Pennypacker

It’s Christmas in October (and Hanukkah, too) if you’ve been waiting for the revised 2015-2016 Program Audit process and protocols. Let’s get right down to it!

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Considering Network Expansion? The Role Network Adequacy, Risk Adjustment, and Star Ratings Play

Elena Martin

The leaves are changing colors, pumpkins are out on every front stoop, and the brisk weather signifies fall is in full swing.  It also means we are in the midst of application season for health plans wanting to expand their geographic footprint.  The Centers for Medicare & Medicaid Services (CMS) has put provider networks front and center under the bright spotlight, and Medicare Advantage (MA) plans need to be even more vigilant in managing their largest asset.  Regardless of the size and scope of the organization, your plan’s network adequacy and accessibility is a cornerstone of any new initiative.

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The 2016 Star Ratings: Finding Calm in the Chaos

Melissa Smith

All great changes are preceded by chaos, and the Centers for Medicare & Medicaid Services (CMS) release last week of the 2016 Star Ratings certainly introduced a great deal of chaos for Star Ratings teams throughout the industry.  With approximately 5% of additional reimbursement tied to ≥4-Star performance, health plan leaders are either taking a deep breath this week (if they earned ≥4 Stars and qualified for Quality Bonus Payments) or doing their best to quell the inevitable panic if the 4th Star eluded them.

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2016 Star Ratings are Working, and the Bar is Rising

John Gorman

The Centers for Medicare & Medicaid Services (CMS) released the 2016 Medicare Advantage (MA) Star Ratings early this year, on Thursday morning.  The usual practice is to wait until Friday after the close.  It was a shift designed to move markets, and the news was mixed. Overall, Star Ratings are working to improve quality in many areas of health plan performance, but insurers and their provider and pharmacy benefit partners are struggling on a similar number of metrics. What is clear is that Star Ratings are now the fulcrum of competition in government health programs – and man, this stuff is hard and getting tougher.

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The MA-VBID Model: Key Takeaways

Nancy Djordjevic

Now that you have digested the Centers for Medicare & Medicaid Services’ (CMS) announcement on the proposed demonstration for high-value benefit designs, the clock is ticking on determining an optimal set of benefits prior to the CMS deadline of November 15, 2015.

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Star Ratings Plan Preview #2

Melissa Smith

It’s hard to believe, but it’s that time of year again.  Yes, it’s football season—and it’s also the beginning of Star Ratings season.

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