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 (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 and more!

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

• 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.

Chairperson’s Opening Remarks

Achieving and Sustaining Strong Star Ratings in the Constantly
Changing and Increasingly Competitive MA Market

Discuss known and potential Star Ratings program changes

• Review measures being added, removed and adjusted (including NCQA’s Transitions of Care and Plan All-Cause Readmissions HEDIS measures)
• Share successful strategies to deal with weighting changes for the difficult-to-impact member experience measures
• Share strategies to successfully focus on member experiences and health outcomes through integrated Star Ratings and Risk Adjustment interventions
• Review other potential regulatory changes under consideration

Panel Discussion: The New Epidemic: Loneliness & Social Isolation -- Programs that Produce Real ROI

• Medication Adherence
• Depression
• Gaps in Care
• Neediness & Impact on Member Services

Moderator:

Panelists:

An Efficient Way of Reporting Supplemental Data in Closing Gaps in Care

Learn how healow Insights partnered with Trusted health Plan and assisted with chart retrieval and supplemental data aggregation. This was done without any practice disruption, practice workflows were streamlined and the health plan received the data which was used towards closing care gaps. Find out how to decrease costs, save time and resources, increase quality scores.

• Reduce Chart Chase Cost
• Reduce Supplement Data aggregation Cost
• Saving Time, Money, and Resources
• Improve Quality Scores

Improving Member Communications

Combatting the Opioid Epidemic – Strategies to Engage Patients and Providers

The opioid epidemic is affecting communities across the country, yet engagement of patients and providers by health plans can be challenging. This session will explore strategies implemented by UCare to address gaps and move towards safer opioid utilization.

Improving Star Ratings through Better Patient Engagement

This presentation will focus on patient-centric approaches to member engagement as key elements of successful strategies to improving quality measure performance. The presenters will address innovative communication options for reinforcing medication adherence and closing gaps in care.

Digital Transformation: The Risk Adjustment Benefits of a Multi-faceted "Digital First" Retrieval Initiative

Learn more about the state of the technology, key considerations, overcoming barriers, and paths to success when extracting medical records from EMRs.

• Understand how digital and traditional retrieval work hand in hand, and one does not replace the other
• See how a broader population of providers and integrations maximizes your access to records while reducing wait time and costs
• Ask questions you may have on how to modernize your medical record retrieval effort

Close of Module #3

Chairperson:

Cross Functional Member Engagement to Boost Patient Experience

Engaging our members and improving their experience with both the health care system and their health plan is critical to success in the Stars program as well as retention and controlling medical costs. This requires collaboration both across your organization and with provider, vendor and community partners. Building and maintaining these alliances is rewarding, but can also be complicated. Let’s explore this topic a bit more.

Influencing CAHPs and HOS Scores

Extreme and Uncontrollable Circumstances in the 2022 Star Ratings

Any MA plan serving members affected by a disaster knows the difficulty faced in restoring service quality to pre-disaster levels. CMS’s Extreme and Uncontrollable Circumstances (EUC) policy is designed to prevent plans from receiving a temporary drop in Star ratings caused by a disaster.
Additionally, the EUC excludes from cutpoint calculations any plans with a majority of members affected by a disaster. We will share the implications this cutpoint policy may have on plan performance in the 2022 Star ratings in light of the public health emergency.

Developing A Provider Incentive Program for the Delegated Model -- Developing Structure, Participation Agreements and a Pay Out Model that Works to Get Buy-In from Your Provider Groups

Don't be out prioritized by other health plans, learn how to develop a robust incentive program. A well designed incentive program can enhance the quality of care and improve Medicare Star rates.  Learn how to create alignment within your organization and with your providers.  A well-developed incentive program with a provider-friendly payout foundation can achieve the results you are looking for.

• Learn how to select metrics that align with your strategic goals while making it feasible for your providers to keep the provider incentive process simple
• Benchmarking performance is critical, determine how to use benchmarks that are achievable and recognizable whether they are internal or the CMS Thresholds
• Display measures are an integral part of setting the stage for the provider group to begin to prepare for measure changes.  Why including display measures in your incentive program can improve star rates
• How to develop a Tier Payout that will get your small and large groups engaged

Close of Module #4

Chairperson:

Moving to Digital Quality Measures – NCQA Keynote Session

NCQA is working to make HEDIS® measures digital, moving away from claims-based quality measures to automated digital quality measures (dQMs) that streamline reporting. Join us to learn how dQMs can reduce burden, improve accuracy, provide better feedback and measure more of what matters. You also can participate in an open discussion and Q&A, bring your questions.

Risk Adjustment 101 and the Future of Risk Adjustment Data Submission – Moving from RAPs to EDPS

Medicare Advantage Organizations (MAOs) are required to submit risk adjustment data through RAPS and EDPS but as promised, RAPS is being phased out – are you prepared? Many organizations have faced challenges with EDPS data submission, but this crucial role has a significant impact on Medicare Advantage revenue. UPMC Health Plan will explain the importance of complete and accurate data submission, review the HCC Models and the financial impact between RAPS and EDPS, and finally discuss the evolution of risk adjustment data submission as we shift from RAPS to EDPS.

Key Interventions to Improve HEDIS Measures and Drive Star Ratings

HEDIS measures are a key input to Medicare Star Ratings and can be some of the easiest measures to report on. They should also be the easiest to improve – especially compared to member survey measures, outcomes measures, or medication adherence measures – just close a gap in care. But they’re not. This session will explore key interventions to improve HEDIS measures rates, maximize quality department budgets, and boost Star Ratings.

Aligning Provider Incentives Through Risk Adjustment and Quality

The provider incentive program is designed to promote early detection and on-going assessment of chronic medical conditions for our members.  The program is aligned with the CMS strategic quality initiatives that focus on members receiving the highest quality of care and customer service by creating metrics designed around the measures from HEDIS and CAHPS.  Risk Adjustment aligns with these metrics through Care Coordination by providing Primary Care Physicians with historical data around patient chronic conditions and suspected conditions based on clinical indicators for the PCP to address during the calendar year.  The goal of these three components of the program is identifying and rewarding primary care providers that provide favorable clinical outcomes and the highest patient satisfaction for our members.

Overcoming Barriers to Achieving High Performance Scores from an Equity Perspective

There is no one-size-fits-all approach to access. For the limited English proficient consumers, lack of meaningful language access leads to well-documented suboptimal health outcomes. There’s often a misconception that having an interpreter is enough to ensure that consumers understand how to navigate the health system and can communicate their own health needs. To truly engage with consumers and cultivate well-being, it’s important to recognize that interpreters have a distinct role as part of the multi-disciplinary team. Through conversation and active engagement, this workshop will allow participants to explore the art of serving limited English proficient consumers and other marginalized populations.

• Understand how to hear the voices of marginalized populations and include them in the decisions about their own health.
• Through a trauma-informed framework, improve the experience of limited English proficient consumers.
• Recognize how effective interpretation impacts the power, privilege and access to communication and information.

Aligning the Quality Cosmos: One Health Plan’s Efforts to Integrate HEDIS and Stars

Many would call those who love working in HEDIS® chart chase a little crazy. Unlike with other components of STARs, HEDIS® chart chase allows us a retrospective view into what has happened with our member quality. And although we cannot change the past, we are profoundly focused on using these results to influence the future. This session will showcase UnitedHealthcare’s Quality Solution Delivery team’s innovative approach at influencing quality outcomes through operational acumen, data, and technology, in order to drive better STAR ratings and more importantly, help our members live healthier lives.

From Garage Band to Rock Stars… How We Made it Happen

How we transformed from a new MA plan with unsophisticated strategies to achieving our first set of 4.0 ratings.  Topics will include establishing accountability and ownership, member engagement and the continued evolution of our strategy.

Engagement Centers: Integrating Primary Care, Urgent Care, Behavioral Health and Social Determinants

• Enhance patient access to Primary Care and Behavioral Health in a non-judgmental supportive environment
• Decrease Inpatient Utilization and Readmissions through engagement and intervention
• Improve quality measures through partnerships in the community.

Close of Module #5

Chairperson:

Transitions of Care Measures – Innovative Approaches to Working with Providers

When members are discharged from a healthcare facility, providers and payers have the opportunity to work together to ensure a successful transition to home for members. Engaging members and providing support at the right time during the transition is key and incorporates team members from multiple areas to create a holistic approach and better member experience.   During this session, you will learn more about how an integrated health system works collaboratively to better support members to reduce readmissions.

• Learn the strategies we have incorporated using Care Coordination to improve readmission rates.
• Hear how our health plan incorporates a multi-disciplinary approach to working collaboratively with provider systems.
• Understand how to capitalize on varied approaches, data sets, and addressing SDoH barriers to achieve Star Rating improvement

Make Your MTM Program Work for You to Improve Medication Adherence, Star Ratings and Provide Quality Care to Members

This session examines a hybrid program where a dedicated internal MTM pharmacist enables the health plan to work more effectively with their external MTM company. It has been successful in reducing cost as well as improving member satisfaction, and the health plan has achieved a 5-Star rating on MTM for the past 2 years.

• Using medical and pharmacy claims data to enable the health plan pharmacist to target higher risk MTM qualified members for specific interventions
• Working with the case or disease management nurse to improve medication adherence and member understanding of prescribed medications
• Collaboration between the MTM pharmacist and the quality improvement team to improve Part C measures
• Strategies to improve Medication Adherence for your members

Electronic Clinical Data Systems: Ensuring Connectivity to Gather 100% of Data from Multiple Sources

The Health Care Industry continues to struggle with comprehensive integration of electronic health data resulting in the inability to access health information when and where it is needed, regardless of where the care was initially provided. For 2020, the Pennsylvania Department of Human Services (DHS) tasked Pennsylvania’s Medicaid Managed Care Organizations with reporting requirements which include mandatory quality measure submission using Electronic Clinical Data Systems (ECDS).  This presentation aims to share UPMC Health Plan’s data integration journey towards ECDS from a clinical, non-technical perspective working with our regional health information exchanges and network providers of varying levels of technology capabilities. There are currently seven Medicare quality measures in the HEDIS ECDS domain available for 2020 reporting. Has your MCO begun the journey towards ECDS?  Please join this discussion of the opportunities and challenges.

Member and Provider Outreach to Close Gaps in Care: Breaking Down Silos

Operationalizing Complex Care Management

This session will outline a systematic process for implementing a comprehensive Complex Case Management program. The presenter will focus on methodology, population target, system needs, assessment, self-management planning and documentation.

Provider Data Retrieval

In order to be successful at HEDIS chart collection, you first have to know your providers. Provider data is the key to a smooth chart collection season, and that often goes beyond the data that is typically collected and stored by health plans. Knowing your provider data, how your providers are setup and how they function, can help to make the HEDIS chart collection season much smoother.

Projection Model Driven HEDIS Improvement

Care First Community Health Plan and Health Data Decisions, a consulting firm focused on improving quality rates and results, join together to discuss the ins and outs of forecasting and projecting rates and outcomes. Accurate rate tracking and forecasting is the foundation for HEDIS® performance improvement. We will explore assessing organizational readiness to project both rates and benchmarks/cutpoints.

How a Provider-Based COPD Program Interacts With a Local Insurer to Improve Outcomes

Learn how a local insurer uses Quality Bonus money from STARS to work with a provider to improve COPD outcomes.

•   Collaboration  between provider and insurance company pharmacy department improves outcomes and member satisfaction
• Pharmacotherapy Management of members improves by referrals between both departments
• Program results show a decrease in Emergency Room and Hospital admits

Enabling the Disabled: Strategies to Boost Quality Results for Populations With Disabilities

With growing attention on addressing Social Determinants of Health, developing innovative supplemental benefits, and staying ahead of the quality curve it is important to develop an effective strategy for engaging disabled populations. Hear from a high performing DSNP / Medicaid plan regarding strategies to impact this population to achieve continued success, innovate for the future, and adopt to constantly changing program requirements.

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