Blair Uses Advanced Analytics to Increase Medicare Stars Rating to 4.5*

Heather Lavoie, Chief Strategy Officer, Geneia, LLC

Truth be told, I thoroughly enjoy writing about the healthcare leaders using our Theon® advanced analytics platform to achieve their organization’s goals for improving healthcare. There’s nothing more gratifying than knowing our solutions help those on the frontlines of healthcare change.

To refresh your memory, we’ve shared stories of:

  • Val – A health plan leader who trimmed claims cost by two percent
  • Sam – A health plan IT leader who saved $3.1 million by sunsetting legacy software
  • Dr. Allen – A primary care physician who saves 90 minutes a day
  • Cary – An ACO administrator who exceeded quality measures and earned shared savings
  • Jody – A health system leader who reduced out-of-network referrals by five percent in year one and emergency department visits and hospitalizations in year two
  • Curt – The VP of human resources for a Fortune 500 company who identified $500,000 in employee medical costs savings in just 20 minutes

Today I want you to meet Blair. She works as the Stars director for a medium-size health plan. The health plan hired her four years ago because of her track record of increasing health plan star ratings.

At the outset of her tenure, the health plan’s rating was three stars. Today it’s four-and-a-half stars, and she credits much of her success to the plan’s decision to use the Theon® platform.

In Blair’s words,

“I’ve worked as a health plan Stars director for nearly a decade. Because star ratings touch nearly every aspect of a health plan – the provider relations, member relations, quality, compliance, pharmacy, and customer service areas, all of which are owned by others in the plan – it’s always been very challenging work to increase star ratings.

For the first time, the Theon® platform has given my health plan and our participating providers a clinically-focused, meaningful dashboard to easily identify and close patient gaps in care – and the information is aggregated by patient and provider.

Equally important, the Theon® solution helps simplify and streamline performance measurement. It also serves as the organizational foundation for creating, executing and managing our continuous improvement strategy.”

Anyone who’s held a position like Blair’s knows she is always juggling lots of unknowns – where will CMS set the cut points, whether a quality metric will be a display or full measure, the weighting of new and existing measures, and more. That’s why she is such a fan of the Theon® platform’s dashboard. The platform collects and aggregates timely information from more than 25 sources and efficiently presents open care opportunities. In other words, at any moment Blair knows exactly how close her plan is to the coveted five-star rating and which are the best measures to focus on to attain four or more stars.

Like our other health plan clients, Blair followed a three-step process for using the Theon® platform to increase her health plan’s rating to four-and-a-half stars.

Download our case study to learn about the three-step process Blair and other Stars directors have used to attain a Medicare stars rating of four or more stars.

*Blair’s experience is an illustrative example based upon the actual experience of a Geneia client. This information is provided for illustrative purposes only. Blair is fictional and not intended to represent any specific person. Any direct similarities to any real person are purely coincidental and unintentional.

This blog was originally posted by Geneia, LLC. See related posts at https://www.geneia.com/Blog.


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