What are you doing to improve your Star Ratings?

As you checked your plan data that will be displayed on Medicare Plan Finder (MPF) for accuracy during the recent second plan preview, were you happy with your Star Ratings?

If not, what are you doing to improve your Star Ratings?

A majority of plans use Excel spreadsheets, telephone calls, and provider outreach to close care gaps to drive Star Ratings measures, manage health care costs, and capture risk adjustment revenue. Existing member interactions are manual and disorganized.

BluePeak leverages a tool that automates this process at both the plan and member level. Utilizing data from medical and Rx claims, electronic/health medical records (EMR/EHR), labs and biometric screenings, health risk assessments, and medical and fitness devices.  This process identifies health risks and disease conditions, determines gaps in care, and delivers personalized health actions and incentives to drive engagement.

BluePeak can help you prioritize your resources to get the largest improvements for your dollar, as well as assist with project planning and strategies to enhance your Star Ratings across all of your Part C and Part D measures. We can share best practices across the 4- and 5-Star plans that make them successful.

Star Ratings Impact Your Bottom Line

5-Star plans can market year-round. Beneficiaries can join these plans at any time via a special enrollment period (SEP).

Medicare Advantage (MA), Medicare Advantage-Prescription (MA-PD) and Prescription Drug (PD) plans achieving a 4-Star or greater Star Rating receive a 5 percent Quality Bonus Payment (QBP) per member per month (PMPM).

Below a 3-Star Rating is considered poor performing by the Centers for Medicare and Medicaid Services (CMS), and if repeated for three years in a row, could possibly lead to contract termination.