Challenge

The Centers for Medicare and Medicaid Services (CMS) developed a Star Quality Program to measure and report to consumers on Medicare Advantage plan abilities to drive quality and high levels of service, and to promote improvements across the board for service metrics.

A large, multistate health plan needed to develop a strategy to help improve its performance in the CMS Stars Program and partnered with Accenture to help develop a multi-phased program to optimize its Stars strategy and increase engagement.

Working with Accenture, this health plan achieved significant improvements in its Stars rating program. And the plan’s early results indicate it is on a positive trajectory to achieve further improvements in the future.

Strategy and Solution

Integrated solution

Accenture helped this health plan develop a multi-phased program to update its Stars strategy and performance, leveraging prior insights with the CMS stars program as well as operational preferred practices. The following practices were implemented:

Developed investment scenarios

Developed an investment scenario analytics capability to help assess ROI and better compare the cost of investing to help achieve higher star ratings.

Employed stars optimizer analytics tool

The tool helped organize measures for operations management, drive governance priorities across contracts and identify owners for improvement plans.

Performance assessment

Assessed the current state of the health plan’s performance in the Stars program by analyzing previous Stars scores.

Transformation

The health plan’s early results indicate it is on a positive trajectory with its Stars Program performance. The organization continues to employ Accenture’s Stars Optimizer tool to help identify and execute on ways of improving its performance in the Stars Program. With this capability, this large health plan is better able to identify and prioritize Stars measures that may require attention, target its improvement efforts at those measures and instill a culture of continuous improvement within its organization.

Positive results

The measurement of plan performance of CMS ratings and bonus payouts is nearly two years. Despite this long lead time, the health plan saw early improvements in its plans’ ratings.

+1

The program gained incremental increases on various measures ranging from one-half Star to one full Star, a significant improvement in performance.

50%

The health plan saw across-the-board improvements in specific Stars Program measures, including a 25-50% increase in medication adherence in health plans in six different locations.

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