Achieving and maintaining high Star ratings is a strategic priority for Medicare Advantage (MA) plans. Given the breadth and complexity across the 40+ active MA Star measures and pending display measures, achieving a 4+ overall rating requires plans to take a multidisciplinary approach to Star management. The most effective plans leverage their internal teams, provider networks, and data capabilities to drive sustained improvement. Here’s a breakdown of best practices to enhance Star performance across various measures.
Leveraging Multidisciplinary Execution
High-performing plans embrace a cross-functional approach. They bring together different departments—clinical, pharmacy, provider relations, and data analytics—to collaboratively address Star measures. This enterprise-wide commitment ensures alignment in strategies and execution. Key components include:
- Star Steering Committees: These committees should include representatives from various departments, as well as providers, to continuously evaluate and refine performance strategies.
- Comprehensive Clinical Engagement: Tailor interventions based on member complexity. High-risk members may require more intensive outreach, while lower-risk populations may benefit from lighter touchpoints.
- Pharmacy Integration: With one-third of Star measures now tied to Part D drug measures, integrating pharmacy into the multidisciplinary approach is essential.
Grouping and Cross-Pollinating Measures
To drive efficiency, consider grouping related measures together:
- Member-Based Clinical Measures: These include HEDIS measures, which benefit from frequent data refreshes and proactive outreach.
- Drug Adherence: Combining medication adherence strategies with care transition initiatives can enhance results across multiple measures.
- Clinical Event-Based Measures: These are the Transitions of Care, Readmissions, and Follow-up After Emergency Department Visit measures. Similar approaches can be used for transitions and follow-up.
- Survey-Based Measures: Member experience surveys (CAHPS) are influenced by multiple factors, including pharmacy interactions, provider experiences, and operational efficiencies.
- Operational Measures: Analyze plan data and CMS data to appropriately forecast ratings and identify discrepancies that need to be raised and corrected with CMS as quickly as possible.
Data-Driven Risk Assessment and Stratification
Health plans can improve Star outcomes by leveraging data analytics and risk stratification techniques. Key strategies include:
- Health Risk Assessments (HRAs) and Social Determinants of Health (SDOH): These insights help tailor engagement strategies, particularly as the Health Equity Index (HEI) comes into play in 2027.
- Multimodal Engagement: Digital outreach works for some members, while others respond better to traditional communication methods. Understanding member preferences improves engagement success rates.
Best Practices for Star Measure Execution
Member-Based Clinical Measures (HEDIS)
- Conduct frequent HEDIS calculations and updates.
- Implement weekly remediation lists for member services and provider outreach.
- Align value-based care (VBC) incentives with HEDIS compliance efforts.
Event-Based Measures (Transitions of Care, ER Follow-Up)
- Leverage real-time prior authorization (PA) and Admission-Discharge-Transfer (ADT) data to improve follow-up compliance.
- Ensure providers receive timely alerts to close gaps within seven-day and 30-day follow-up windows.
Pharmacy Measures (Part D Adherence)
- Use real-time pharmacy claims data instead of relying on lagging CMS PDE reports.
- Implement daily refill reminders and missed refill alerts to improve adherence.
- Develop a CMS data reconciliation strategy to identify and address discrepancies in drug measure calculations.
Survey and Operational Measures
- Conduct mock CAHPS surveys and pulse surveys to track member sentiment.
- Analyze call center data, grievances, and appeals to proactively address member concerns.
- Reconcile internal operational data with CMS reports to ensure accurate measure tracking.
Enterprise-Wide Best Practices
Member Education and Engagement
Top-rated plans invest heavily in member education. Providing resources on social determinants of health (SDOH), health literacy, and disease management fosters proactive health behaviors and improves Star performance.
Provider Collaboration and Education
- Educate providers on Star measures, as many may not fully understand their role in performance outcomes.
- Implement provider report cards to offer comparative insights and performance benchmarks.
- Align value-based incentives with Star-driven quality improvements.
Internal Team Alignment
- Ensure all departments understand Star ratings and their role in achieving higher performance.
- Define escalation pathways for addressing non-compliance or performance challenges.
Final Thoughts
Achieving a high Star rating requires an enterprise-wide commitment, blending strategic planning with tactical execution. By integrating multidisciplinary efforts, leveraging data analytics, and engaging both members and providers effectively, plans can drive sustained performance improvements.
At Lilac Software, we provide advanced analytics solutions designed to optimize Star measure tracking and performance strategies. Contact us to learn how our platform can help elevate your plan’s ratings.
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If you want to explore how Lilac can help your plan align organizationally and drive effective multidisciplinary Star program management, check out our Star Solution page or start a conversation by reaching out to us via the form in this link.
