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Webinar Details

  • Pub Code: C3A06-11WEB
  • Speakers
    • Kristian J. Marquez, CFA
    • April Goss

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Medicare Star Ratings: Key Steps to Prepare for Changes in 2014 and 2015

February 20, 2013 Webinar - Listen On-Demand or Get a CD!

Achieving high Medicare star ratings has become a crucial strategy for any Medicare plan and its providers — and in today’s shifting landscape, these strategies must constantly evolve. Learn the specific steps your organization must take now to be ready for the star ratings changes CMS is planning for 2014 and 2015. Are you ready for a new emphasis on comprehensive medication reviews and care management in Medicare Advantage Special Needs Plans? Would your complaint-resolution process stand up to a new measure assessing performance there? With major revenue and competitive positioning at stake — including the possibility of losing your Medicare contract altogether if you score fewer than three stars — MA and Part D plans must take every step possible to maximize their performance in relation to these quality measures. Find out how to adjust your stars strategies to succeed under current measures while building an organization that anticipates new ones on the horizon.

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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.

Sponsored by Atlantic Information Services, Inc., publisher of Medicare Advantage News, Drug Benefit News and Health Plan Week

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:

  • Which new measures — and changes to existing measures — will pose the biggest hurdle to Medicare plans?
  • How will the potential change to using percentage scores rather than stars in calculating summary and overall star ratings affect your organization’s score?
  • How high will your organization have to perform to hit four-star ratings on key measures such as cholesterol screening, controlling blood pressure, diabetes treatment and medication adherence in the cardiovascular and diabetes arenas?
  • What steps should your organization take to prepare for 2014 display measures that may be used in calculating star ratings in 2015?
  • Which three high-scoring ratings may CMS move to the display page, where they’ll be collected and monitored but will not be used in calculating star ratings?
  • What specific steps should plans take in provider contracting to prepare for CMS’s possible introduction of a measure on the use of highly rated hospitals?
  • What other measures are likely to be adopted in the future? How should plans begin preparing for them today?


KRISTIAN J. MARQUEZ, CFA is vice president of the Clinical & Quality Outcomes (C&QO) department at Inovalon, Inc., a leading health care technology solutions company that focuses on health care data analytics and improvement in clinical and quality outcomes, care management and financial performance throughout the health care industry and community. In this role, he oversees Inovalon product and technology solutions for client engagements that span 50 U.S. states, the District of Columbia and Puerto Rico. His leadership has been a key driver in the successful development of several Inovalon products including CCS Advantage, HEDIS Advantage and Star Advantage. He has also been responsible for several key facets of product execution and innovation that have resulted in the successful launch and implementation of new commercial, Medicaid and Medicare technology solutions for many of the largest U.S. health plans. Mr. Marquez brings in-depth knowledge of various quality management programs, such as CMS’ Star Ratings methodology and NCQA’s HEDIS and state reporting requirements. Mr. Marquez has been recognized as a national thought leader in health care quality measurement, improvement and reporting, and has served on numerous committees and speaker panels for leading industry associations and forums. Earlier in his career, he held a number of senior roles in accounting and investment management services. He earned a Bachelor of Science degree in General Engineering from the United States Naval Academy and also holds the Chartered Financial Analyst designation.

APRIL GOSS is senior manager, healthcare operations at Inovalon. She is responsible for facilitating a comprehensive root cause analysis process focused on cross-functional efficiencies within a health plan’s operational departments that support CMS Star Rating and Health Plan Management System Display Page Measures, as well as for providing effective administrative recommendations in support of Inovalon’s Star Advantage solution. Prior to joining Inovalon, Ms. Goss held successive regional director positions for more than 15 years within the healthcare industry at organizations that include Kaiser Permanente, MAMSI and Dental Benefit Providers. As a strategic administrator, she was accountable for the day-to-day operations in various departments, managed annual budgets up to $9 million, and led staffs of up to 130 union and non-union employees. Ms. Goss led the stabilization of under-performing departments including member services, provider relations and contracting, and contract and benefit administration, and Claims Administration. At Kaiser Permanente, Ms. Goss also launched new employer client services and case installation departments focused on cross-functional end-to-end process improvements.

Moderator: Jill Brown, executive editor of AIS

Designed Especially For

  • Health plan CEOs, CFOs, chief operating officers, government affairs and compliance directors, marketing executives, medical and clinical services managers, directors of provider relations, contracting executives, product directors, accountants and actuaries.
  • Hospital and medical group CEOs, CFOs, administrators and directors of managed care contracting
  • Pharmaceutical company and PBM executives
  • Insurance agents, brokers and third-party administrators
  • Health information technology company executives and marketing directors
  • Attorneys, consultants and actuaries

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Medicare Star Ratings: Key Steps to Prepare for Changes in 2014 and 2015

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