Editor's Note: The following is an excerpt from one of the stories in a special report about the recent RISE West Conference. Click to read the full version of this story and others in our Rise West Roundup report.
SCOTTSDALE, Ariz.—Because the target is always moving on star ratings, there is one fact that Ana Handshuh wants Medicare Advantage plan leaders to remember even when they do well.
“What got you there isn’t going to keep you there,” Handshuh, Ultimate Health Plans’ vice president of managed care services, told participants in a workshop at the RISE West conference. “You’ve got to keep moving and doing new things,” she added.
Medicare Star Ratings for MA and Part D plans are just one prong in the Centers for Medicare & Medicaid Services’ overall strategy to improve healthcare quality, lower costs and move from volume-based payments to value-based payments, Handshuh noted.
The agency updates the metrics it uses to calculate star rating scores because it is constantly trying to improve how it measures quality, she said. But the general goal of the ratings program is to influence beneficiaries’ plan choices and incentivize MA-PD plans to offer higher quality, more efficient care.
Attaching bonuses to quality ratings had been a game-changer for MA-PD plans, as knowing the financial benefits has gotten the attention of many a C-suite—including at Ultimate Health Plans.
A “half-star swing” on 6,000 members meant a difference of $2 million for the boutique, Florida-based health plan, Handshuh pointed out, so the financial impact is considerable. And getting that rebate pays dividends for both health plans and their members, as it translates to being able to provide richer benefits.
That, she said, “gives you a huge competitive advantage if you can do it.”
Click through to read the full Rise West Roundup report.