In a previous blog on best practice groupings (read here), I shared why grouping Star measures into six buckets enhances ROI by getting more out of the same resources through leveraging common improvement strategies. These buckets are:
- Clinical
- Drug
- Complex Clinical
- Survey/Member Satisfaction
- Operational
- Improvement
While these groupings offer a powerful framework, there’s an additional opportunity: cross-group collaboration. By linking strategies across buckets, you can maximize impact and accelerate Star rating improvements. Operationally this calls for teams to strategize together on how to improve two or more groupings.
Here are two examples to illustrate how this works:
Use Case 1: Connecting Complex Clinical and Drug Adherence Measures
At Lilac we find that the three medication adherence measures are impacted by both short and long gaps in prescription fills. And a long gap can kill any chance of a member hitting the required 80% or greater adherence rate in a given year.
These long gaps tend to be tied to major life events, such as exacerbation of a disease state, trips to the emergency room, and an inpatient stay. So building some medication adherence strategies into complex clinical measure improvement can also drive improvement in the drug measure grouping.
It likely starts with a primary care visit and a medication reconciliation from a physician or clinical pharmacist. They will look at old and new medications for appropriateness and when chronic medications can be re-introduced post-surgery. But if the health plan flags the member for ongoing medication follow-up (calls and other written or electronic outreach) and monitoring for all reintroduction of medication fills at the retail level, long medication adherence gaps would go away and more members would hit required medication adherence rates.
By addressing these long gaps, health plans can improve multiple complex clinical and drug adherence measures—without breaking the bank.
Lilac’s Care Transition’s functionality allows a health plan to track interventions and improvement across the complex clinical and drug measures to avoid long fill gaps.
Use Case 2: Linking Survey Insights to Operational Improvements
Several operational measures give you insight into member dissatisfaction, including member disenrollment and complaints. Furthermore, you can combine call center, appeals, and grievance data to further inform where enterprise deficiencies could be hurting member and even provider satisfaction.
The collaboration between staff remediating the two groups of measures can help establish root causes and member-specific and enterprise remediation strategies. In this way disenrollment and complaints measures are improved but so are member satisfaction survey results across Part C and D!
Lilac’s comprehensive approach to data aggregation allows plans to seamlessly link member mock survey results, primary care and other servicing providers, and enrollment, call center, grievance, and appeals data.
——————————————-
If you want to explore how Lilac can help you, reach out to us via the form in this link to start the conversation.
