Charles Baker, VP, Compliance Solutions

The recent CMS Plan Preview 2 brought a collective gasp across the Medicare Advantage world. With many healthcare plans still celebrating high Star Ratings from 2022 and 2023, CMS applying the Tukey Method of analysis that resulted in adjusted cut points felt like a bucket of cold water. Modeling experts had warned about this, and indeed, the impact was substantial: more than 50% of individual cut points increased, some by more than 20 points, sinking many plan’s Star Ratings.

However, the universe has a way of handing us opportunities disguised as challenges. As healthcare professionals deeply committed to community well-being, Medicare Advantage plans can grab this moment to reevaluate and reset.

ATTAC Consulting Group is working with our clients to:

Focus on the present and future to collaboratively revisit data

Don’t just look at the numbers, engage with them. This means involving key stakeholders and business unit leaders to holistically review the data and the resulting gaps that need to be addressed. Focus on developing integrated approaches that combine HEDIS, CAHPS, and risk adjustment interventions. Don’t merely close gaps­ — build bridges to better health outcomes.

Actionable steps:

  • Initiate focused meetings with stakeholders
  • Analyze data to identify possible root causes in various populations or geographies and create actionable tasks
  • Assign roles and responsibilities for design and implementation of new or revised HEDIS/PDE/CAPHS interventions

Prepare for a more equitable future and get a clear picture members’ unique needs

Jan 1, 2024, will see the implementation of the Health Equity Index (HEI). Addressing the HEI will require plans to gain a deeper understanding of low-income subsidy (LIS), dual eligible and disabled populations. The HIE requires new ways of looking at where members are located, which attributed providers are seen (or not seen), current quality delta compared to plan median, and specific patterns of care. This examination allows plans to better develop appropriate interventions for different communities, and address the unique needs of a population that requires special attention.

Actionable steps:

  • Develop multi-variant analyses that allow the plan to understand LIS, dual-eligible and disabled populations
  • Develop a roadmap to address the unique healthcare needs of these groups, prioritizing interventions that may actually move the needle on quality and care for targeted segments
  • Develop new data feedback-loops and teams that analyze results to allow the plan to rapidly determine if interventions are working as intended, and adjust as necessary to make an impact during the first data collection period

Understand that the clock is ticking on 2023 Annual Enrollment Period, and every inquiry is an opportunity

The Annual Enrollment Period is just days away. Focus on CAHPS initiatives and treat every member grievance or inquiry as an opportunity to demonstrate your commitment to a new or potential member’s well-being. Speedy resolution improves satisfaction and could very likely reduce your disenrollment rates.

Actionable steps:

  • Train customer service teams on quick and empathetic issue resolution
  • Monitor and track the types of grievances to identify trends and areas for improvement

Need more guidance?

ATTAC Consulting Groupan industry leader with more than 20 years of consulting expertise, stands ready to help your plan develop strategies tailored to meet 2024 goals. We partner with our clients in a shared journey toward better healthcare for all. The changes may be new, the challenges imposing, but the opportunity to make a difference remains as promising as ever.