SAaaS for Health Plan Partners

We offer a very specialized type of outsourcing. It’s concierge-style consulting, but we made it simple and packaged it up like a software subscription. (the software, of course, is also included) You get all the benefits of an in-house team for a fraction of what you’d spend on a single FTE. If your business helps plans boost their Star Ratings, you’ll want to make sure you’re marketing the right thing to the right plans and get credit for the impact you have. We can help you do that.

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Consultants

Our Star Applications

BHA empower health plans and consultants with tools to boost Star Ratings and improve member outcomes. With interactive dashboards and predictive analytics, you can make confident, data-driven decisions to stay ahead in the healthcare market.

Use Case

  • You know which measures you help improve but don’t know which plans might benefit financially from them.
  • You know the mechanics of your programs but want a Stars/HEDIS®/CAHPS expert to help build out the Stars piece.
  • You’re making a pitch to a specific plan and want a deep dive on their Stars and public financials to help preparation.
  • You want to find out where particular plans are clustered, where particular measures are underserved, etc.
  • You want to understand what the financial return is for closing gaps in care so that you can get a sense of the ROI from your offering.
  • You’re interested in similar analysis for Duals, SES characteristics, SDOH indicators, etc.

Use Case

Use Case

  • You know which measures you help improve but don’t know which plans might benefit financially from them.
  • You know the mechanics of your programs but want a Stars/HEDIS®/CAHPS expert to help build out the Stars piece.
  • You’re making a pitch to a specific plan and want a deep dive on their Stars and public financials to help preparation.
  • You want to find out where particular plans are clustered, where particular measures are underserved, etc.
  • You want to understand what the financial return is for closing gaps in care so that you can get a sense of the ROI from your offering.
  • You’re interested in similar analysis for Duals, SES characteristics, SDOH indicators, etc.

Use Case

Interactive Planning Tool

Our Interactive Planning Tools simplify strategic decision-making with scenario testing, trend analysis, and predictive dashboards. From calculating Reward Factors to managing multiple contracts, these tools provide actionable insights to optimize Star Ratings.

Stars Planner

Stars Planner

Test out the 'What Ifs' for different scenarios – if a measure improves, if CMS changes the rules, etc.

Reward Factor Calculator

Calculate the Reward Factor and adjusted Star Ratings for all Stars Planner scenarios.

Reward Factor Calculator
Scenario Manager

Scenario Manager

Define timeseries , compare results under different scenarios, apply improvements to multiple contracts at once.

Crosstab Analysis

Analyze the relationship between different measures.

Crosstab Analysis
Cutpoints and Outliers

Cutpoints and Outliers

View cutpoint changes over time. Identify Tukey outliers. Make your own cutpoint predictions.

Score Upload & Dashboards

Upload monthly predictive data. Report results over time.

Score Upload & Dashboards

Stars Planner

Test out the 'What Ifs' for different scenarios – if a measure improves, if CMS changes the rules, etc.

Stars Planner

Reward Factor Calculator

Calculate the Reward Factor and adjusted Star Ratings for all Stars Planner scenarios.

Reward Factor Calculator

Scenario Manager

Define timeseries , compare results under different scenarios, apply improvements to multiple contracts at once.

Scenario Manager

Crosstab Analysis

Analyze the relationship between different measures.

Crosstab Analysis

Cutpoints and Outliers

View cutpoint changes over time. Identify Tukey outliers. Make your own cutpoint predictions.

Cutpoints and Outliers

Score Upload & Dashboards

Upload monthly predictive data. Report results over time.

Score Upload & Dashboards

Market Research

Our Market Research tools provide deep insights into Medicare markets, competitors, and contract performance. Analyze Star Ratings, financials, and enrollment trends to identify opportunities and drive strategic growth.

Company-State Analyzer

Company-State Analyzer

Pull key information about parent organization, competitors, financials, county enrollment.

Stars Explorer

View county level maps of Medicare enrollment, Star Ratings, Display Measures, Impacts of pending CMS Star Ratings changes, etc. Filter and display based on flexible criteria.

Stars Explorer
Plan Screener

Plan Screener

Define “your measures” prioritize all 700+ contract ids based on your ability to deliver financial value to the Medicare organizations.

Contract History Browser

See Star Ratings data over multiple years for all contracts within a parent organization, view plan growth and contract mergers.

Contract History Browser

Company-State Analyzer

Pull key information about parent organization, competitors, financials, county enrollment.

Company-State Analyzer

Stars Explorer

View county level maps of Medicare enrollment, Star Ratings, Display Measures, Impacts of pending CMS Star Ratings changes, etc. Filter and display based on flexible criteria.

Stars Explorer

Plan Screener

Define “your measures” prioritize all 700+ contract ids based on your ability to deliver financial value to the Medicare organizations.

Plan Screener

Contract History Browser

See Star Ratings data over multiple years for all contracts within a parent organization, view plan growth and contract mergers.

Contract History Browser

Real-World Use Cases

All of BHA’s senior leaders have worked at major health plans, and we continue to support plans with our other tools and consulting services. Along the way, we’ve had repeated requests for consulting projects from vendors because of our Stars expertise. Here are some real examples of projects big and small that we’ve done for various clients.

Case 1

Client had developed their own ROI spreadsheet to use with their health plan clients. They wanted feedback – within 2 days – on whether it was reasonable and covered the right measures.

Client had developed their own ROI spreadsheet to use with their health plan clients. They wanted feedback – within 2 days – on whether it was reasonable and covered the right measures.

Case 2

Client had extensive data collection on clinical forms. First we reviewed their forms to identify which Star measures (and other HEDIS® measures) could be closed. Then we helped select CPT codes for their interface with health plans.

Client had extensive data collection on clinical forms. First we reviewed their forms to identify which Star measures (and other HEDIS® measures) could be closed. Then we helped select CPT codes for their interface with health plans.

Case 3

Client had data showing that their program improved the underlying scores of two HOS Star measures. They wanted to show potential venture capital investors the potential market. BHA analyzed and calculated the potential Stars value for those two measures. They got their funding.

Client had data showing that their program improved the underlying scores of two HOS Star measures. They wanted to show potential venture capital investors the potential market. BHA analyzed and calculated the potential Stars value for those two measures. They got their funding.

Case 4

Client had an opportunity to present to a health plan consortium – but the topic had to be Star Ratings. BHA gave a 1-hour presentation to about 20 health plans using BHA’s Stars Planner. For an encore, BHA gave a second presentation to the same group with suggestions for Stars work in the first quarter of the year.

Client had an opportunity to present to a health plan consortium – but the topic had to be Star Ratings. BHA gave a 1-hour presentation to about 20 health plans using BHA’s Stars Planner. For an encore, BHA gave a second presentation to the same group with suggestions for Stars work in the first quarter of the year.

Case 5

(A really hard project) Client wanted to know 'what is the value of closing one gap' to help them price their product appropriately. BHA crunched publicly available Medicare bid data, population data, and Stars results to calculate the incremental revenue per incremental 1% score on each Star measure. We estimated plans’ measure denominators for a per-gap result for all measures for all contracts, then analyzed how these were distributed.

(A really hard project) Client wanted to know 'what is the value of closing one gap' to help them price their product appropriately. BHA crunched publicly available Medicare bid data, population data, and Stars results to calculate the incremental revenue per incremental 1% score on each Star measure. We estimated plans’ measure denominators for a per-gap result for all measures for all contracts, then analyzed how these were distributed.

Case 6

(Child’s play) Client was negotiating a pilot with a specific multi-contract health plan. They wanted to know how to tune their pitch to highlight the financial value and the measures the plan was most likely to be worried about. BHA analyzed their historical results to classify each contract’s likely goal (e.g., achieve 4 Stars, maintain 4.5 Stars) and cross-referenced the clients’ favorite measures with the plan’s Stars history.

(Child’s play) Client was negotiating a pilot with a specific multi-contract health plan. They wanted to know how to tune their pitch to highlight the financial value and the measures the plan was most likely to be worried about. BHA analyzed their historical results to classify each contract’s likely goal (e.g., achieve 4 Stars, maintain 4.5 Stars) and cross-referenced the clients’ favorite measures with the plan’s Stars history.

Case 7

Client wanted their field staff to be more Stars savvy. BHA developed and presented a 2-part training course on Stars basics up through measure calculation and using BHA’s free Stars Planner.

Client wanted their field staff to be more Stars savvy. BHA developed and presented a 2-part training course on Stars basics up through measure calculation and using BHA’s free Stars Planner.

Case 8

Client wanted a strategic evaluation of their entire clinical program and its impact on Stars. BHA reviewed all of their data collection practices and forms for 3 lines of business. We’ve done similar evaluations for several clients, actually, but this one resulted in a 30-page review.

Client wanted a strategic evaluation of their entire clinical program and its impact on Stars. BHA reviewed all of their data collection practices and forms for 3 lines of business. We’ve done similar evaluations for several clients, actually, but this one resulted in a 30-page review.

Case 9

Client wanted to know what pending changes CMS had announced and what that impact would be on Star Ratings. BHA created a quick calculator in Excel.

Client wanted to know what pending changes CMS had announced and what that impact would be on Star Ratings. BHA created a quick calculator in Excel.

Case 10

Client wanted to know which MAPD plans would benefit the most from their programs. We invented and validated a system to rank the plans based on Stars value and measure history for client’s target measures. This is now one of our automated tools (Plan Screener).

Client wanted to know which MAPD plans would benefit the most from their programs. We invented and validated a system to rank the plans based on Stars value and measure history for client’s target measures. This is now one of our automated tools (Plan Screener).

Frequently Asked Questions

  • Consulting
    • We’ve had many requests for consulting projects from vendors because of our Stars expertise. The scope of projects could include Defining stars strategy, Quantifying stars impact, Increase ROI for clients, Navigate the Stars regulatory changes, Help with business development and targeting, etc.
  • Stars Suite Subscription
    • This a longer-term relationship where we “mentor” your company by providing concierge style advisory support and all of our Stars tools including Stars interactive planning tools and Stars Insights and analytics tools. Initially this is very hands-on but evolves into self-service with BHA tools

Many vendors in the health industry recognize that their products can help Medicare Advantage plans achieve higher Quality (Star) Ratings. However, they often lack the expertise and tools to integrate these benefits into their offerings and effectively showcase their value to MA Plans. In this increasingly competitive landscape, vendors need to stay on top of their Stars capabilities

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