Drive Stars Performance By Using Best Practice Groupings
When remediating measures in Medicare Advantage (MA) Star, many plans often think of categorizing measures by Part C and D, by Star domains, or they tackle them one at a time.
But one of the best practices to drive results is to think about Star “buckets” or groupings of common measures. While every measure is indeed unique and needs some individual attention, the six buckets or groupings allow plans to take advantage of certain common characteristics and streamline their improvement strategies.
The six buckets or groupings are:
1 — Clinical measures: These are your basic NCQA HEDIS measures that are member-based. Remediation approaches can be similar. You may do a measure campaign event, but you may also reach out to members and their providers when these member-based clinical measures are non-compliant. Bundling or nesting these make sense for global communication.
2 — Drug measures: These are your three highly-weighted Medication Adherence measures (in Part D) and your two other statin measures (one in Part C and one in Part D). While not exactly alike, all of these need similar pharmacy claim information to help remediate. The medication adherence measures need things like the PDC %, the current gap days, 90- vs. 30-day supplies, mail order vs. retail, and more. Bundling or nesting these make sense for global communication as well.
3 — Complex clinical or event measures: These measures are similar in that they are anchored by clinical events and ask plans to intervene to better outcomes after such events. They use admission, discharge, and transfer (ADT) or clinical notifications to begin the tracking. Medical economics data can also be useful to improve these measures over time. These have complex remediation strategies.
4 — Survey measures: These are your CAHPS and HOS measures. Plans may perform mock audits for both in order to get a baseline as well as member and provider details on these measures. Plans may also mine member and provider call center, complaint, grievance, and appeals data to tie dissatisfaction to operational deficiencies. This remediation strategy is very unique.
5 — Operational measures: These are the myriad of plan performance measures. Admittedly each one is unique and has a different remediation strategy. These could also include mining of plan data. But these measures can be tracked and evaluated together across the health plan enterprise.
6 — Improvement measures: Don’t forget the two heavily-weighted improvement measures. These need constant evaluation to help boost overall Star performance.
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Lilac Software is developing a cloud-hosted, data aggregation and analytics solution for health plans’ most complex problems. Our Star Performance Management Platform gives unprecedented insight into all aspects of the Medicare Advantage Star program, including individual measure performance, best practice remediations for all measures, and forecasting of aggregate scores and revenue. Lilac automatically groups and calculates measures to enable seamless tracking based on the remediation strategies discussed above.
If you are looking for a solution to the Star complexity and best practices, reach out here to start a conversation with the Lilac team.
