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How Health Plans Can Ensure a Successful Quality Season in 2019

September 10, 2018

Nearly 75% of Medicare Advantage (MA) enrollees were enrolled in plans rated at 4-Stars or higher in 2018, but the percentage of health plans that received a quality bonus for reaching four or five stars dropped from 49% to 44% — a decrease that may be cause for concern in light of the industry’s focus on patient-centered care.

While just one in five patients report using the CMS Star ratings to make healthcare decisions, patients nonetheless are frequently selecting plans with high ratings — a trend that is only expected to increase as more patients are empowered to take greater control over their healthcare, including selecting their health plan. With the number of Medicare eligible patients who are more comfortable with technology also steadily increasing, health plans will need to strategically invest in improving the patient experience. This may include introducing digital tools to improve communication with members, and ensuring that the digital data captured during these engagements is appropriately leveraged to inform quality measure performance goals and strategy.

Take Action Now to Prepare for 2019

With the results of this year’s CMS quality data submission little more than a month away, health plans across the country should have launched their quality strategy to face the variety of obstacles they must overcome each year to ensure a successful quality reporting season. And given steep — and growing — competition among health plans in the MA space, there’s no time to waste as health plans consider how best to stay ahead of the curve when it comes to future quality outcomes improvement.

Here’s what health plans need to know for success in 2019.

2019 Quality Reporting Season: Checklist for Success

Identify & Implement Lessons Learned from 2018

  • Work with your auditor early to understand HEDIS® 2019 deliverables, requirements and timelines
  • Implement incentives NOW to reap benefits for HEDIS® 2019
  • Ensure policies and procedures for identifying and addressing data inconsistencies and incompleteness are up-to-date
  • Update provider demographic data (addresses, phone numbers, specialties, etc.) early, to streamline provider clean-up efforts during the 2019 season
  • Determine and test chart pursuit logic; tweak logic, as needed
  • Test and QA projects thoroughly to confirm sample sizes are robust enough to remain above the minimum required sample size

Know the Regulations

  • Identify and understand your reporting requirements for 2019
  • Identify new and incomplete data sources
  • Stay current on new data requirements
  • Understand NCQA’s HEDIS® 2019 timeline and incorporate critical dates into your overall timeline

Understand New Measures

  • Evaluate data variable and data source requirements
  • Run baseline rates and benchmark against historical rates
  • Discuss audit requirements and implications with your auditor

Begin Preparing Now!

  • Engage your auditor for 2019 planning
  • Generate prospective rate runs, identify non-compliant members and outreach, as needed
  • Develop a complete project plan, encompassing all internal, HEDIS® and audit deliverables
  • Initiate early completion of the 2019 NCQA Roadmap
  • In preparation of the NCQA HEDIS® audit, review and update policies and procedures, as necessary
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