Impact of The New Administration & the Pandemic on Star Ratings & Quality Assurance: How are Plans Reacting & Changing?

After about six months under a new administration and a few months out of pandemic lockdown, plans are thinking about their Stars day jobs through a brand-new lens. While we haven’t seen that many granular programmatic or regulatory changes since the Biden administration has taken place, we have seen some important signals coming out of Washington and from other plans coming out of the pandemic.

In a recent presentation at the SSN Medicare Stars, HEDIS, Quality & Risk event, Melissa Smith, EVP of Consulting and Professional Services, shared exclusive insights into how Stars teams are reacting during this critical time and what to expect as the industry shifts from a “check-the-box” process to one that makes dramatic changes in the lives of individual members and their experiences.

In this presentation, Melissa discusses changes that will dramatically shift the way Stars teams operate including:

• A rapidly changing industry landscape, including the tipping point towards digital transformation
• How the new administration’s commitment to improving and expanding access to care will impact financial pressures on the Stars program
• New legislation proposals to add biosimilars measures to Stars in 2022
• A move towards digital quality measurement including HEDIS and patient experience surveys as NCQA moves away from antiquated paper surveys and telephonic outreach
• MedPAC’s proposed MA Value Incentive Program including budget neutrality for MA quality payment programs
• Today’s unique CAHPS challenges and engaging ‘OK’ members to improve quality measures and solve access challenges
• A data-driven approach to Stars work planning that integrates all measures in one place

We are seeing more interest in digital engagement and technology solutions in healthcare than ever before. When the pandemic forced plans to solve access issues for members who couldn’t leave home, telehealth and digital outreach became a necessity – Now, we’re seeing the need for digital transformation carry over into a post-pandemic world. This presentation will help you understand how other plans are reacting and changing to what’s being thrown at us in 2021, and help you stay proactive in the quest for healthier members and better Star ratings.