Medicare’s star quality ratings are rapidly becoming a crucial strategy for any Medicare plan and its providers — and in today’s shifting landscape, these strategies must constantly evolve. CMS now is weighting measures to emphasize outcomes, introducing new measures and giving plans under sanctions lower ratings. In 2012, Part D services became a heavily weighted component of the overall rating for Medicare plans that offer drug benefits. And those plans that routinely score below three out of five stars could lose their Medicare contract altogether. With major revenue and competitive positioning at stake, Medicare Advantage and Part D plans must maximize their performance on the crucial CMS quality measures. But which provider and member engagement strategies are most effective? How should plans adjust their stars strategies as the measures change? And how can organizations effectively prioritize efforts around current measures while building an organization that anticipates new ones?
The On-Demand recording will be available immediately upon purchase* as a link within a PDF file of the accompanying written materials. CDs and printed materials are shipped via USPS.
CMS in late December laid out its preliminary plans for star-rating changes for 2013, including a proposed rating based on how much Medicare plans have improved at the individual-measure and contract level over multiple years, and new measures on comprehensive medication reviews and care coordination. The agency also said it planned to retire a measure on access to primary care.
Hear two Medicare executives detail new strategies that Medicare health plans are implementing to improve their star ratings. You’ll get reliable answers to questions like:
STEPHEN WOOD is a senior vice president at OptumInsight, where he leads the Government Programs Management and Strategy practice. His work in senior markets dates to the mid-1980s when he worked with hospitals to implement DRG payments by Medicare. Since that time, he has worked with organizations to review and develop strategies, conduct new product feasibility assessments, improve performance and implement new programs. Mr. Wood has over 25 years of experience in managed care, governmental programs, senior markets and strategic consulting in the health insurance industry. A frequent speaker and author, he was selected as one of the Top 25 Consultants of 2009 by Consulting Magazine. Mr. Wood graduated from the University of Chicago and holds a master’s degree from the Harris School of Public Policy at the University of Chicago.
DANIEL WEINRIEB is manager of clinical relationships at HealthNow New York, Inc., doing business as BlueCross BlueShield of Western New York and BlueShield of Northeastern New York. He is currently responsible for leading the organization’s Medicare Advantage STAR Quality Improvement Project and manages the company’s efforts to encourage provider and member engagement to drive quality of care and service to all HealthNow beneficiaries. Mr. Weinrieb received his undergraduate degree from Clarkson University. He is studying for an MBA degree from Canisius College in Buffalo, New York. Mr. Weinrieb began his career in health care in 2005, when he started the Medical and Healthcare Division for StraussGroup, Inc., a division of Management Recruiters International, a global executive search firm. He spent the next three years developing business and recruiting C-level clinical and non-clinical executives for health care organizations and medical device companies around the world. Mr. Weinrieb then moved onto the health insurance industry where he has specialized in physician and member engagement since 2008 with a primary focus on the Medicare population and improving the quality of care and service to Medicare Advantage Beneficiaries across New York state.
Moderator: Jill Brown, executive editor of AIS
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