Recent guidance from the Center for Medicare and Medicaid Services (CMS) indicates that even during the pandemic that is Covid-19, they expect MAPD health plans to continue to emphasize clinical and service quality. CMS also indicates that they expect data collection for HEDIS® measures to “return to normal” in 2021.
Whether there is a return to normal or not, it is clear that CMS expects that health plans will be able to generate HEDIS® reports in 2021 related to care given in 2020. Plans need to be taking action now to both assure members are gett
The Covid-19 pandemic has had a sudden and far-reaching impact on Medicare Advantage Star Ratings. CMS will shortly publish 2021 Star Ratings including numerous adjustments for data that was not collected due to the pandemic. CMS has also shared their plans for 2022 Star Ratings - how they will score the quality of care and service occurring in this unprecedented year. In this post, Baltimore Health Analytics shares the key points of the communication and guidance from NCQA® and CMS regarding this year and what levers may still be pulled in the
Baltimore Health Analytics (BHA) is announcing the development of our Supplemental Data Source tool to assist health plans with raising HEDIS® rates. The tool utilizes medical records that health plans may have have in house. The BHA tool, known as Ocular, uses Optical Character Recognition (OCR) to allow scanning of medical records for keywords specific to HEDIS® measures. From there it is an efficient matching process to members with gaps, quick review and data validation and conversion in to a HEDIS® compliant Supplemental Data Source.
With the uncertain
BHA creates innovative tools for managing Star Ratings. Our leading product, the Stars Planner is free to use and we just added our first video tutorial!
The Stars Planner is all about visualizing the way individual measure goals fit together to impact the plan’s Star Rating and CMS bonus. It’s interactive -- start with published CMS star ratings data for your plan and your competitors -- then use it to figure out where to improve. It keeps tally, shows historical trends, and allows experimentation with measure goals to get the best plan f
Introducing BHA’s Rover-Transitions.
When it comes to Stars and HEDIS®, health plans can’t always assume the network is addressing every gap in care. Sometimes you need your own staff to work the phone to get the job done. You can try to run a campaign from spreadsheets, or you can try to adapt an overly complex care management system that doesn’t really solve the right problem. But if you want to maximize results with minimal effort, the best solution is a system that is designed specifically for the campaign yo