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The Stars ratings are meant to ensure that every health plan is providing adequate services for members. For payers, meeting these ever-changing measures can be a challenge.
Meera Sundram, MSSW, LCSW, vice president of client program management at Change Healthcare presented “An Innovative Strategic Approach to Stars Improvement,” at Qualipalooza, the second annual RISE quality leadership summit in San Antonio, Texas, June 29 to 30. Managed Healthcare Executive (MHE) talked with Sundram in the days before the conference about her presentation and discussed how payers can use their existing data to target efforts for increasing Star ratings.
MHE: There are so many measures in the Star rating system. How can payers focus on which measures to address first?
Sundram: Take a look at national averages. If you’re trying to get from 3.5 to 4 stars but it’s a measure that a provider can only get a little movement because nationally no one is improving on, then it might not be worth spending time on. Look to areas where you can actually make improvement. Which are the most likely measures you can move, what are the best interventions, and what is the best way to implement and measure these interventions.
MHE: How do analytics help plans target Stars improvement?
Sundram: Analytics is a word everyone tosses around, but they are saying they want to look at new ways to look at available data and trends. Most take claims data and put it through an algorithm that allows them to see how members access care and what types of interventions might affect their pattern of use.
MHE: In your presentation you are discussing how to take this a step further. Tell us about advanced analytics and what that means?
Sundram: Advanced analytics could mean a lot. Mostly we are talking about ways to layer information to drive new interventions. When we talk about advanced analytics, I prefer to think about them a little more concretely. What I try to think about is how you take information and layer it. If you’re starting with claims data, how do you layer that with what else you know about a member (compliance, program participation, access, etc.).
MHE: Is this another way to use advanced analytics, by layering data?
Sundram: Layering starts with a Stars optimizing model that allows payers to plug in ‘what if’ scenarios and layer with historical performance measure by measure, then national averages. You can then layer in market specific performance-how competitors are performing-in that market.
I think sometimes what happens with Stars is there are 47 measures that are always moving around. Plans tend to kind of throw things at the wall to see what sticks. Without a full organization strategy to look at and analyze all that information, you’re only hoping to cross that line. Spend your time and money wisely in ways that you know can make a difference.