Star AdvantageTM: An advanced solution to achieve targeted improvements in CMS Five-Star Ratings
Health plans achieve meaningful and timely improvements in member health, financial performance, and quality scores by using proven analytics to target effective interventions based on the patient’s health status and behavior. Leveraging nationwide quality performance data insight, member behavior, predictive analytics, and a deep in-market intervention infrastructure, MedAssurant provides an end-to-end capability to achieve meaningful results.
Star Advantage focuses on the measures that cost-effectively impact outcomes, and applies analytics to identify the right members to target with the right interventions based on member behavior and history. With one of the industry’s largest health care datasets, we are able to compare a client’s data to national and regional benchmarks and create intervention strategies specific to each patient and their historical patterns of compliance. MedAssurant partners with clients to set star rating targets, analyze data, identify care gaps, and implement interventions that improve quality and financial outcomes.
Aggregate relevant data
Data collection begins by understanding and identifying clinical and non-clinical measures to be analyzed and improved. MedAssurant integrates data from HEDIS®, HOS and CAHPS; and accepts native health plan claims and encounter data from various and disparate systems through a secure, seamless transfer that requires minimal client IT involvement.
Analyze results to identify care gaps and target measures
MedAssurant analytics rely upon advanced algorithms and proprietary datasets to identify which measures to target, who to target, with which intervention and when. A baseline and variance analysis provides the compliance history of each measure, and a root cause analysis identifies the factors that influence the care gaps of each measure and the necessary members who need to become compliant in order to make interval changes in ratings. MedAssurant’s analytics engine incorporates many variables such as member behavior, regional benchmarks and physician profiles to determine the likelihood of member compliance, creating a list of members to target for each measure.
Inform through ongoing monitoring and reporting
Continuous analysis guides intervention priority and intensity throughout the year. Intervention intensity for members may increase over time to improve compliance on targeted measures; from a simple letter to a phone call, or even an in-home assessment to support those most in need. Return-on-investment is recalculated every month throughout the year to ensure program goals and benchmarks are achieved.
Improve star ratings and care quality
More than simply an analytics and reporting program, Star Advantage also provides the resources needed to directly impact care and strengthen member/physician relationships. Monthly analysis and program reviews throughout the year ensure a positive, continuous feedback loop guiding program success and member care improvement. More important than simply improving five-star ratings, Star Advantage offers health plans the ability to apply this same data-driven approach to care enhancement across their quality improvement programs.