CMS created what is known as the Five-Star Quality Rating System to assess Medicare Advantage Part C and Part D programs. Performing well can yield significant benefits for a plan in the form of bonus payments, the ability to charge more than benchmark payments, and a leg up on marketing to and enrolling new members. Performing poorly does not simply mean a plan fails to achieve these benefits: It can face civil monetary penalties, suspension of marketing and enrollment activities, or even termination of the program.
As with every quality measurement program, the key to success is reducing care gaps. Plans must be able to:
Manual spreadsheets can’t keep up. Plans need access to a dynamic flow of information so they can act confidently and be sure that their Star Ratings initiatives will achieve the desired results.
Star Navigator is a quality improvement solution that helps Medicare Advantage plans determine the most direct path to higher Star Ratings, then track and communicate their progress toward goals. With Star Navigator, health plans gain the insights necessary to efficiently close care gaps, enlisting providers as partners in quality improvement while providing a better member experience.
Capture higher Medicare reimbursement rates
Attract Medicare beneficiaries who demand a high-performing health plan
Reinforce best clinical practices to drive down the cost of care
Keep your finger on the pulse of Star Ratings trends, with minimal IT lift
Star Navigator collects, aggregates, supplements, and synthesizes Star Ratings data straight from Cotiviti’s Quality Intelligence solution and CMS data files to populate provider and member dashboards and reports. Tight integration between Quality Intelligence and Star Navigator allows for a quick implementation and reduces health plan IT support needs. Cotiviti implements CMS’s annual updates to measures, weights, and cut points each year, easing this effort for plans.
Results modeling to identify the right strategies
Plans can use Star Navigator’s modeling tools to determine the impact of each Star Measure on their contract’s Overall Ratings, which helps identify the best improvement strategy. In addition to clarifying the butterfly effect of a single measure’s rating on the contract and plan, Star Navigator also displays the projected revenue generated by CMS bonus payments if the plan achieves its Star Ratings targets.
Star Navigator leverages Cotiviti’s proprietary logic to identify measure-specific recommendations for improving Star Ratings via intervention techniques that improve member engagement. This feature also provides details when the plan is close to a Star Rating improvement, enabling the plan to focus on quick wins and actions with the highest ROI.
Once goals are set in the system, Star Navigator helps plans track progress. Plans can customize their own dashboards to keep close watch on flagged measures for the contract, assess the impact of outreach campaigns on care gaps through rate trends, and create custom cut points to better predict their Star Ratings.
Identifying who to target for interventions and care manager follow-up is critical to improving ratings. Star Navigator generates lists of non-compliant (gapped) members by measure or across all measures to help with outreach.
Star Navigator users can create dashboards for an individual provider, provider group/site, or parent health system. Plans can easily share dashboards with providers to communicate measures with eligible members and the corresponding rate, their overall Star Rating, and the number of hits needed to achieve the next star value.