It's the beginning of the year and by now the 2023 Star Ratings have been analyzed every which way. It's now time to dive into the next set of improvement tactics for the 2024 and 2025 Star Ratings.
Although work is already underway to engage with members and close care gaps, we encourage plans to take a pause. Take the time to spend a few days to critically review your Stars structure, workplans and procedures through the lens of the time-trusted proven approach of the 3 Ps: people, process and product. Evaluate what worked, what didn’t and why, and adjust accordingly for measurement year 2023.
People: Are the Right Ones Involved?
Ask yourself if you have the right Star Ratings committee structure to guide your 2023 quality improvement strategies. Ensure you have measure owners that are empowered to make quick changes and have budgets for the right investments to adapt your Stars program to the changing landscape. The voice of the member should be at the center of all activities, and your cross-functional Stars committee should act as their advocate with every decision through their department’s lens.
Do you have all the right players in the development of your three-year Star Ratings roadmap? Have you included experts in data management; digital measures; diversity, equity and inclusion (DEI) and health equity? It has never been so important for IT stakeholders to be part of Stars committees, workplans and accountability tactics for Stars-centric platforms to have long-term, sustainable success, especially with the transition to digital quality measures on the horizon.
Process: Can You Optimize Your Workflow and Reporting Methods?
Do you have a clear and easy process to manage Star Ratings end-to-end and measure-by-measure? Do you have regular, refreshed and accurate data for the measure owners to track and report rates? Are Star measure owners prepared to escalate dips in rates to C-Suite with quick action plans for improvement?
Work with measure owners to set goals that will drive 4+ Star Ratings, that account for the Tukey methodology and guardrails, and that are reported out at Stars committee meetings with year-over-year comparisons to really understand performance trends. Remember: the path to 4+ Star Ratings is paved by data-driven and mathematically informed strategies, and having the right data and reporting standards in place in early 2023 will set the stage for streamlined quality improvement activities.
Product: Do You Have the Right Workplan and Tracking Documents to Drive Accountability?
Revamp your quality and performance improvement plans to revolve around the looming Stars changes, including the move away from hybrid measures, incorporating safety measures and the elimination of disparities. Focus this work especially around any contract measures identified as performing lower than the national average in the CMS low-income subsidy and dual eligible (LIS/DE) risk stratified tables and Health Equity Summary Scores (HESS) reports.
Tip: Invest in enhancing your population health assessment to not only meet NCQA health plan requirements but to incorporate more robust data and ensure you understand your members' needs. These enhancements will enable you to create and innovate programs and engagement strategies to truly meet your members where they are in their care journey. Further investments in collection of direct data for Healthcare Effectiveness Data and Information Set (HEDIS) and National Committee for Quality Assurance (NCQA) reporting requirements.
Work with leadership to ensure Stars is in both the corporate goals and every employee personal goal and that progress is monitored through the workplan and processes listed above. Stars end-to-end operations must be managed methodically, cohesively, and be nimble to adjust for performance dips, regulation and market changes.
January is the perfect time to review the three Ps with fresh eyes, and give yourself permission to start, stop and enhance structure, workplans and improvement initiatives.
If you need assistance determining where to start, do not hesitate to connect with our Expert Advisory Services team. Healthmine’s consultants have worked in Star Ratings since its inception and have experience guiding quality teams through the many changes in the program. We provide insights into short-term and long-term strategies for Stars success to prepare you for the challenges coming in 2023. Reach out at Kimberly.Swanson@Healthmine.com for more information.