Improve Quality Scores with Cohesive Care for Comorbidities

While there are many uncertainties in the health care market, we are certain of the overwhelming Star Ratings changes coming as the Centers for Medicare & Medicaid Services (CMS) codifies measure and methodology over the next two to three years. These changes are going to require more intentional outreach and high-touch, coordinated approaches that treat the whole person, rather than addressing individual diagnoses. Here’s why and how health plans should approach treating members with comorbidities more cohesively to improve quality scores.

Why High-Touch Strategies are Needed

According to a recent CMS study about fee-for-service Medicare members, 69% of this member population has a diagnosis across three physical or mental conditions. With so many members with comorbid conditions and the current model of care, there is a risk for fragmented care and limited communication between providers and services. Historically, care is tracked by condition and lacked the cohesion needed to provide the highest level of quality care. They do not meet today’s need to share the right knowledge between clinicians and care providers for three or more different treatment plans.

Many health plans are realizing that now is the time for a smart and holistic approach. They’re finding they can positively impact member engagement, compliance and satisfaction, and improve Star Ratings in the process. This whole person approach is seeing more gaps in care closed and health issues addressed early to avoid increased cost and complications.

The Whole-Person Care Approach

The increase in comorbidities among Medicare Advantage members requires a much higher focus on case management and coordinated care. Especially during these times of intense change, health plans that want to see a steady improvement in Star Ratings need to combine a high-touch model with strategically developed initiatives.

High-touch models of care feature multidisciplinary teams that work together to address a wide range of factors affecting a patient’s health. But first, it must become standard practice for quality measures to be identified across multiple disease states. Plans that transition from the one-and-done mentality to an ongoing approach to care will bring multifaceted and cost-effective care to patients who require significant levels of care.

Health plans that treat the whole person using a high-touch model will find that integrating care activities delivers the right services at the right time for their members. Patients are visualized at the center of care instead of the focus being on the system. For example, with a high-touch approach, the provider and case manager within the health plan are in constant communication when a member admits to a hospital. They work in collaboration to ensure the member’s transition from inpatient to home or lower-level care facility is smooth and the potential for readmissions decreases. Without this high-touch approach, members often struggle with multiple readmissions, emergency room visits and the potential for other health issues to exacerbate.

These changes can be overwhelming, but creating a laser-focused approach to care for your members will lead to improved member experience, increased gap closure and a highly retained membership base. Navigating the healthcare journey is difficult for many Medicare Advantage members, thus increasing high-touch approaches through care management, it becomes a win-win for both the member and the plan.

How Healthmine Can Help

Healthmine’s expert advisors have subject matter expertise in Star Ratings and the many upcoming CMS measure changes. They will work with your health plan to understand where your knowledge gaps are and recommend the ideal go-forward strategy, including how Healthmine’s technology can expedite your plan’s goals.

Healthmine’s full suite of digital solutions help Medicare Advantage plans understand member risks as early as possible, not only influencing your members’ health outcomes but also your plan’s revenue. Get a more comprehensive picture of your member population and make high-touch initiatives that much easier.

Reach out to John.Willis@healthmine.com to get started.