Medicare Advantage Star Rating

Asking the Right Question

Health Quality improvement 101, emphasizes cycles of "Plan-Do-Check-Act". Before even going into planning, you need to identify your opportunities. Here are some questions to ask

Our Ratings

Where Are We Heading?

Are our ratings getting better or worse?
What’s the trend versus prior year?
What are future trend predictions and the financial impact?
How much uncertainty is there in the prediction?

Improvements

Could We Do Better?

Which measures can increase?
Which measures can be solidified?
What are the improvement measures?
Are potential areas of improvement being correctly identified?

Success Rate

What Are We Doing?

Member campaigns year in flight.
Campaigns year to date.
Provider incentives and other contacts.
Member incentives, internal training, benefits, and process improvements.
Where are we most likely to succeed?

Opportunity

What Should We Be Doing?

Are non-impacted measures and closable gaps being identified?
How can unreached members, providers groups, member pockets, and counties be reached?
What are potential interventions?
Are there non-converting members?

Efficiency

Are We Efficient?

What is our ROI to date?
What is our ROI of potential future actions?
What is and isn’t working? What processes should be terminated or continued?
Is the potential benefit worth the cost?

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