Building a robust Star improvement strategy

The CMS Star ratings for Medicare Advantage plans have a significant financial impact, as achieving higher ratings helps them generate substantial benefits in the form of bonuses or rebates. Also, with the rise of consumerism, a higher Star rating is now a must-have to boost member enrolment. However, the dynamic and complex nature of the CMS Star program makes it difficult for health plans to strategize improvement programs, as the measures, weights, and cut-points change year-on-year, making it comparable to aiming at a continually moving target.

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Moreover, due to recent regulatory changes, there has been a significant increase in weightage of member-experience factors, expediting the need for intelligent solutions. These persistent challenges present a significant opportunity for health plans to leverage advanced analytics-based solutions to obtain better data clarity and streamline decision support for star measures.

 

CitiusTech Stars Decision Engine

CitiusTech Stars Decision Engine combines our healthcare expertise, data science proficiency, and Embedded Intelligence Framework to deliver substantial improvements across the clinical value chain, ensuring holistic Star rating improvement. Stars Decision Engine leverages the power of Machine Learning and Artificial Intelligence to help health plans with:

 

  • Single view to track performance across all contracts along with performance trend & benchmarks 
  • End-of-Year Performance Projection to help identify target measures and align goals
  • Recommended Goals for Star Score taking into account business intuition for optimal resource & budget planning
  • Recommended Goals for Measures based on ‘what-if’ analysis of influencing factors and suggestions on optimal path to reach the Stars goal
  • Prioritized Provider & Member list attuned to the Stars goal, having high potential for performance improvement