RISE 2017: Data, provider engagement powers star-ratings success for health plans

digitized stars
Engaging providers helped both Blue Cross Blue Shield of Michigan and UPMC achieve high star ratings on their Medicare Advantage plans.

NASHVILLE, Tenn.—To hear Suriya Grima tell it, the use of data is one of the key cornerstones of the star-rating success Blue Cross Blue Shield of Michigan has achieved for its Medicare Advantage plans.

“To us, it really comes down to having predictive modeling capabilities, as well as marrying that with a really strong ability to think about, how ... we interpret that data and use that data in a timely manner” to design appropriate interventions, Grima, the senior director of Medicare strategy and growth for BCBSM, said during a panel at the 2017 RISE Summit.

BCBSM, which has achieved at least four stars on its MA plans from 2012 to 2015, has found that other keys to achieving success include having a broad suite of product offerings with customization options, as well as conducting comprehensive and detailed reporting, Grima added.

Furthermore, the insurer has built a “war chest” of interventions over the years to engage both providers and consumers, she said.

Fellow panelist Colleen Walsh, the associate vice president of clinical affairs and quality improvement for UPMC, also stressed the value of engaging providers, saying “we try to support them in every way we can.”

UPMC has a dedicated quality, clinical and financial team that visits providers at least quarterly to conduct ongoing education on measures, thresholds and what the integrated system’s health plan arm is doing to help them be successful, Walsh said.

On the consumer side, UPMC has tools such a “prescription for wellness” that offers coaching to members based on their unique health goals, and a mobile van that facilitates events at physicians’ offices and community centers to offer preventive services with no copay for members.

A real-world improvement example

Despite BCBSM’s overall success in star ratings, the insurer observed several years ago that its clinical star performance for out-of-state members was much lower than for its in-state counterparts, Grima said.

So BCBSM launched a provider engagement initiative that embedded coordinators “into the fabric” of primary care practices to further better outcomes—and thus star ratings improvement—in the most non-disruptive way possible.

Working together, doctors and coders also reviewed the medical records of members to produce single-page alert documents that identified opportunities to boost star ratings.

As a result of the pilot, BCBSM saw improvement across all of the clinical measures used to calculate star ratings, Grima said, but it saw the largest amount of closure in BMI and diabetes control.  

“We saw significant revenue improvement as well,” she added.