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When I visit Nashville in March for the annual RISE Summit, I fully expect to be surrounded by stars.
Surprisingly, I’m not talking about country music stars—though I expect their influence will also be hard to ignore. The stars that are going to fill my days are of the variety handed out by the Centers for Medicare & Medicaid Services to top-performing Medicare Advantage plans.
If that sounds decidedly less exciting than the prospect of a crooner in a cowboy hat, well, I can’t blame you. But as all health plans know, star ratings are nothing to sniff at; because they are tied to government bonuses, they have become a really big deal for insurers in today’s healthcare landscape.
What's more, a previous study confirmed that when Medicare Advantage plans have a higher star quality rating, they enjoy greater enrollment numbers.
In fact, many health insurance brokers have begun steering members only toward MA plans with four stars or higher, said SCAN Health Plan Vice President Dave Meyer, who will present at several sessions during this year’s RISE Summit. The conference, which will take place March 6 to 8 at the Omni Nashville Hotel, will cover topics including risk adjustment, star ratings, quality management, financial compliance, care management, performance analytics and engagement strategies.
“The industry is realigning itself because of quality, and that is having a bigger ramp-up than we would have guessed,” he said in an interview.
Case in point: When CMS issued its latest star ratings for Medicare Advantage plans back in October, the fact that Humana and Cigna’s ratings dipped drew big headlines in the business world. Both insurers cited CMS audits as the primary reason, but they also indicated they felt the lower ratings didn’t accurately reflect their plans’ performance.
Cigna CEO David Cordani echoed that sentiment on the insurer’s most recent earnings call with investors, saying: “We're working with CMS literally as we speak to try to gain a shared understanding of the results we're delivering and arrive at a different outcome for 2018.”
Michael Kavouras, vice president of star ratings at Aetna, previously put it another way: "Getting to four stars is really, really critical," he said.
So suffice it to say, star ratings are a major concern for any health plans that want to thrive in the booming business that is Medicare Advantage. That just leaves the not-so-simple task of actually achieving those coveted four- and five-star designations.
For Rise Summit attendees who just want to get the basics down, Meyer and Ana Handshuh, vice president of managed care services for Ultimate Health Plans, will lead a preconference workshop titled “Mastering the essentials: An intro to risk adjustment and star ratings.”
Meyer said he’s been leading such introductory workshops for a few years now, and at one point he started to doubt whether the basics were still necessary. But then he realized that with so many professionals constantly moving into the quality-improvement realm, “people want a continual stream of 101, refresher course kind of sessions,” he said.
For those a bit more advanced, though, look out for sessions such as “Lessons learned from 4 & 5-star plans,” in which leaders from Ultimate Health Plans, UPMC and Blue Cross Blue Shield of Michigan will teach attendees about “making the difficult climb to the top.”
As for me, I’ll be looking to pick up as much stars-related knowledge—both basic and advanced—as possible in order to inform health plan leaders about how they can be successful in the increasingly important realm of quality improvement.
And who knows, maybe I’ll even bump into a musical star or two. — Leslie @HealthPayer