ARTICLE
September 6, 2024
The Centers for Medicare & Medicaid Services (CMS) has begun the Plan Preview cycle with the release of Plan Preview 1. While Plan Preview 2 is still on its way, Plan Preview 1 gives Medicare Advantage and Dual-Eligible Special Needs Plans (D-SNP) the opportunity to review, validate and dispute Star Rating performance for the prior year.
Explore best next steps for staying ahead of the 2025 Star Ratings results and mitigate any issues while there is still time to impact SY2026.
6 Plan Preview Action Items
The most important thing to remember about the Plan Previews is that there is still time to impact the 2025 Star Ratings. Scores have not been finalized, and the Plan Previews give plans the opportunity to share any outstanding issues with CMS to improve the accuracy of the final Star Ratings. Teams can also gain a better insight into what the final scores will look like to guide in-year strategies to improve SY2026 performance and prepare for SY2027.
Make the most of the Plan Preview cycle and:
- Validate: Review Plan Preview 1 data sent by CMS for accuracy by comparing it against your internal dashboards, Maximus reports and Acumen reports. After Plan Preview 2 is released, validate that the Star Ratings results match cut point thresholds.
- Respond: Report to CMS any discrepancies within the timeframe provided after each Plan Preview.
- Reset: If Plan Preview 1 and 2 results do not match your internal data, re-evaluate your expectations for SY2025based on CMS’s projections.
- Inform: Update leadership about changes to Star Ratings projections and highlight strategies that can mitigate further issues if performance is lower than expected.
- Readjust: Adapt your goals for SY2026 based on updated thresholds.
- Deploy: Organize and kick-off a fourth quarter action plan to address measures that still need further improvement for SY2026.
Where to Focus Work Plans for SY2026 and SY2027
Using the Plan Preview results, teams can optimize their current SY2026 strategies for the rest of the year and prepare initiatives for SY2027 to improve performance in key quality areas.
Here is a timeline and action items for improving SY2026 measure results and getting ahead of SY2027 challenges.
Pave a Path to Success
End SY2026 and enter SY2027 with a data-driven action plan for driving ongoing improvements in Star Ratings. The path to 4 or more Stars is a year-round effort that needs to engage all areas within a health plan, but you do not have to do it alone. Healthmine is here to help.
Reach out to me at ana.berridge@healthmine.com with any questions on how to respond to the Plan Previews and where we can help you achieve your goals.