Agenda

Stars 101: The Star Ratings Program

This module will include in in-depth review of:

• The technical Star Ratings framework and data sources
• Methodology for calculating summary and overall Star Ratings
• The financial implications of Star Ratings
• The impact of measures being added, removed and adjusted
• Weighting changes for the difficult-to-impact member experience measures
• Other potential regulatory changes under consideration and more!

Workshop Leaders:

Stars 101: The Star Measures

This module will include a detailed review of the technical specifications for measures used in Star Ratings, including:

• HEDIS measures
• CAHPS measures
• HOS measures
• Administrative measures
• Pharmacy measures

During this workshop, we’ll review the technical construct of the Star Ratings program. From measure specifications to financial impacts, we’ll cover the full spectrum of technical aspects of Star Ratings. This workshop will include in in-depth review of:

• The technical Star Ratings framework and data sources
• Methodology for calculating summary and overall Star Ratings
• The financial implications of Star Ratings
• A review of the various measures included in the Star Ratings program

Get specific tools and strategies for:

• The impact of measures being added, removed and adjusted (including the Transitions of Care and Plan All-Cause Readmissions measure)
• Weighting changes for the difficult-to-impact member experience measures
• Other potential regulatory changes under consideration

This hands-on, interactive workshop allows plenty of time to ask questions from the leading experts in the Star Ratings field today! Workshop participants will be able to share their own knowledge and experiences, and industry colleagues will weigh in with insights on what they are focusing on, and how they are identifying and solving their challenges in pursuit of 4+ star ratings and seizing opportunities along the way.

Workshop Leaders:

Welcome & Introduction

Chairperson:

Star Ratings Landscape: Where We Are Today & What’s on the Horizon for 2021 and Beyond

CMS’ release of the 2021 Star Ratings gave us our first glimpse into the most recent performance data for Medicare Advantage plans across the nation. Underneath the data are many trends worth noting (and watching closely), including even more emphasis on the importance of member experience. This session will include an overview of the 2021 Star Ratings for MA plans and provide attendees with data-driven guidance on the right areas of focus for 2021 and beyond. After this presentation, you will:

• Understand the key takeaways from the 2021 Star Ratings, supported by notable data points and exclusive analysis
• Have critical insight into current market trends, proposed policy updates, and future changes to Star Ratings
• Learn how to leverage technology to build successful member experience and quality improvement strategies

Panel Discussion: Impact of the Pandemic & the Election on Star Ratings – How Plans are Reacting and Changing

Panelists:

Moderator:

How the HEDIS Stars are Aligning

Mean resampling. Access and Experience measures weight increase. Guardrails. Tukey outlier removal. These are just a few of the changes coming to Medicare Star Ratings for measurement years 2021 and 2022. But while CAHPS and statistical mathematics are taking up most of the conversation, HEDIS measures are also rapidly shifting. Let’s review what measures are coming and going (and coming back) over the next two years and talk tools and strategies to maximize your HEDIS stars.

Build a Strategic Plan to Engage Your Whole Company on the Path to 5 Stars

Corporate Education & Awareness: Building a Stars Culture

Developing and maintaining a high-performing Medicare Stars program can be a daunting challenge. With constant regulatory guidance, measure specification, and industry changes, it can be just as difficult to achieve success for the first time as it can be to maintain it over time. This session will explore proven tactics and innovative strategies to address a critical building block to Star Rating success: Corporate Education and Awareness.

• The science behind adult learning and how to tailor a strategy to your company’s needs
• The fundamental differences between Awareness, Education, and Ongoing Education
• Innovative techniques to deploy and engage employees that maximize participation and results
• Case study: 7 years of innovative programs that yielded results across 2 plans

Opening Remarks

Chairperson:

Improve Member Satisfaction Scores and Reduce Complaints – Stars Best Practices

As you begin working on your 2021 strategies, join this session to gain insights from two senior healthcare consultants with years of experience advising Medicare Advantage health plans. They’ll share recommendations to help you improve member satisfaction scores and reduce health plan complaints. You’ll hear actionable insights to inform your strategy and plan your programs to help you achieve higher star ratings or maintain your current status. Specific areas to be covered, include:

• Member Engagement
• Customer Service
• Grievance and Appeals
• Medical Management
• Provider Relationships and Aligned Incentives
• Actionable Data

Panel Discussion: CAHPS & HOS: Innovative Solutions to Engage Members to Boost Scores

Panelists:

Internal Team Collaboration: Getting Member Outreach into Gear and Figuring Out How We All Fit Together

Year after year, we see multiple departments within organization come up with their own strategies for reaching out to members. Here's how we developed one team, to communicate with one voice. We’ll discuss:

• Developing oversight over multiple areas internally
• Prioritizing projects and course-correcting when necessary
• Protecting the member experience, by preventing over-communication and mixed messaging

Panel Discussion: Member Engagement Now and Post Pandemic

Panelists:

Prioritizing Member Experience – How UCare is Addressing Member Needs and Star Rating Goals

It is more important than ever for health plans to have a solid understanding of what their members want, need, and expect from them in order to deliver a seamless, rewarding experience that will engage and retain them as members.  As CMS shifts focus of Medicare Star Ratings to include a heavier emphasis on member experience/access and complaints measures, health plans must strategize and increase efforts on optimizing personalized member care and support in order to come out on top. This session will review how UCare is approaching this shift and provide some tested strategies on how to prioritize member needs and experiences.

Becoming a CAHPS-Centric Organization

• Uncovering the drivers of member dissatisfaction within your organization
• How CAHPS impacts other Star measures
• Leveraging a number of data points to build actionable CAHPS personas
• Navigating the engaged vs. the unengaged
• Effective CAHPS program planning and budgeting
• Becoming a CAHPS-centric organization

Leveraging Flexible Technology to Improve Quality Scores and Drive Provider Engagement

In this digital age, payors must leverage flexible technology to optimize provider engagement and drive quality improvement. UPMC will provide the results they achieved after partnering with Novillus to deploy a provider facing solution that enabled bilateral data exchange to close gaps in care and improve outcomes. You will learn how the innovative technology coupled with best practice engagement techniques resulted in increased HEDIS® scores and unparalleled provider engagement across all lines of business at UPMC Health Plan.

• Optimize Provider Engagement through automation of customized communications
• Achieve improved Quality/HEDIS/Stars scores through bilateral data exchange and information delivery capabilities, powered by Novillus
• Learn how to leverage complete, accurate and current data exchange technology to support provider incentive and value-based program reporting and outcomes
• Discover opportunities to improve plan performance through best-practice provider engagement technology solutions

Opening Remarks

Increasing Star Measure Performance Ratings by Improving Outreach Efficiency and Effectiveness 

• Identify and prioritize measures and areas for improvement
• Avoid pitfalls of fixing the wrong problem
• Gain leadership support
• Case study demonstrating how to create more streamlined, standardized and meaningful member experience

Feature Presentation

Encouraging Adoption of Telehealth Among Providers and Members – Exploring Opportunities and Limitations

As technology has continued to evolve at a blistering pace over the last few decades, many have asked themselves “Why hasn’t healthcare and the way we administer services changed?”. This has been glaringly true when it comes to embracing the use of telehealth.  Despite having limitless potential at increasing access and possibly lowering the cost of care, telehealth had been utilized by less than 10% of Americans in 2019… then came COVID-19. The emergence of the coronavirus in 2020 while helping expedite the adoption of telehealth has also highlighted some of its limitations when it comes to quality of care management, what is currently considered acceptable treatment paths, and even what is being tracked from a quality perspective and the landscape of healthcare changes. This session will showcase United Healthcare’s innovative approaches at furthering the adoption of telehealth with both our providers and our members, while also discussing the opportunities and limitations which have been uncovered through the rapid 2020 adoption and our commitment to their enhancements.

The New Normal: Face to Face Visits and Telehealth in the COVID-19 Pandemic

The face of in-person visits and tele-health has changed dramatically with the COVID-19 Pandemic.  Whether it’s for closing HEDIS/STAR related clinical-quality gaps in care, Flu vaccinations or for Risk Adjustment Assessments -- PPE and Technology as well as alternative member engagement strategies must be leveraged. This presentation discusses the New Normal approaches taken by one health plan to manage the care of Seniors during the pandemic.  That approach includes:

• Protocols for when to perform telehealth visits and observations to be made via video chat
• Guidelines on how to conduct Virtual visits
• Criteria for making face-to-face visits
• Staff person and member pre-visit screening protocols
• Procedures for appropriate use of PPE and for conducting in person visits
• Post-visit notification of potential exposure or confirmed COVID-19 protocols

Opening Remarks

How to Manage a National Pharmacy Network to Success

Learn how proven member engagement and communications technologies can measurably improve health outcomes, adherence and quality measures. The key is leveraging a national pharmacy network with intelligent clinical solutions and omnichannel digital communications tools to drive health plan performance and member retention.

Technology-Enabled Pharmacy Services: A New Solution to Address Medication Use Among Medically Complex and Vulnerable Medicare Members 

Join RxAnte, a leading analytics and clinical services company, for a discussion on how a technology- enabled pharmacy service is transforming the pharmacy care experience for MAPD plans and their members. In a session led by Kerri Petrin, VP of Strategy and Business Development at RxAnte, discover how RxAnte’s newest solution, Mosaic Pharmacy Service, is making taking multiple medications simpler, safer, and more affordable for the most at-risk Medicare members. This session will highlight Mosaic’s clinical outcomes and discuss how identifying at-risk members and optimizing complex medication regimens can support a model of patient-centered pharmacy care.

• Understand how analytics can be used to identify a target population of complex/vulnerable members in need of comprehensive pharmacy support to improve medication use
• Learn how technology can support patient-centered pharmacy care
• Discover how the combination of analytics and comprehensive pharmacy services can improve member experience, clinical quality, and financial outcomes for health plans and their members

Part D: Boosting Star Ratings through Innovative Member Outreach Programs Now and Post- Pandemic

Medicare members are impacted daily by the coronavirus. Many have not left the safety of their home. New ideas are being tried to help members with their health care during this pandemic.
Learn how a health plan teamed up with two National Chain pharmacies to provide flu vaccines outside in a drive up environment. Find out how a corona relief package sent to members helped them pay for medical and pharmacy related expenses. And, gain insights on how expanded services offered members other alternatives to stay healthy.

Integrating Social Determinants of Health with STARS and Quality Initiatives

Return of Readmissions with Observation – Impact on Administration and Utilization

The Readmission measure will “count” again in a few weeks. What are some of the changes that have occurred with the measure over the past two years, and how do we as plans respond to those changes? Have you been tracking your status during this hiatus – I hope so! What impact do we see from adding Observation stays and removing some of the outliers? For this first round, it will be only a weight of one, but, as an outcome measure, it will return to its weight of three in CY2022. Let’s look at some data and have a discussion.

Close of Conference