EY Medicare Advantage Stars Terminal

Using an end-to-end approach with intuitive insights through dashboards and last-mile integration, our data-driven platform demystifies how plans can boost their Medicare Advantage star ratings for CMS bonuses and rebates.

Related topics Health Sciences and Wellness Health

The team

Kaushik Bhaumik

Kaushik Bhaumik

EY US Health Technology Leader

Sumitro Sarkar

Sumitro Sarkar

EY Global Nexus for Health Leader

Abby Johnson

Abby Johnson

EY Americas Health Consulting Leader

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What EY can do for you

For Medicare Advantage health plans, star ratings across about 45 key performance indicators can make all the difference in securing a larger share of the market — and a bonus from the Centers for Medicare & Medicaid Services (CMS) to the tune of $29 to $35 per member, per month, among other benefits. Yet each measure is weighted differently, and the cut-point thresholds for star ratings in each measure are not shared in advance.

Using an end-to-end approach with intuitive insights through dashboards and last-mile integration, the EY Medicare Advantage Stars Terminal platform demystifies how plans can boost their star ratings, leveraging data to avail CMS bonuses and rebates. It’s your conduit for turning these difficult, abstract and disparate measures, based on many data sources, into improved star rankings, better care and greater performance, with quantifiable returns.

A range of variables shown below, including the Consumer Assessment of Healthcare Providers and Systems (CAHPS), Healthcare Effectiveness Data and Information Set (HEDIS), Health Outcome Survey (HOS), Prescription Drug Event (PDE), Independent Review Entity (IRE) and Admin, are assessed and analyzed, helping to uncover areas for targeted intervention and optimization, reveal impactful steps to drive results and measure progress for continuous improvement. It’s a three-step process:

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    1. Planning

    Diagnostics help identify the right set of contracts to focus on to achieve four- or five-star ratings, and they evaluate whether the existing member- or provider-facing programs are effective. Organizations can focus on specific measures and align the programs to meet those goals. The dashboard excerpt below shows relevant contracts for an organization worth focusing on to improve star ratings, adjustable by variables such as membership levels and plan types.

    Enriched with publicly available data, the platform also allows you to benchmark contracts against others from competitors, according to the factors that matter most to your organization.

    2. Mobilization

    Predictive capabilities illustrate how the programs are impacting the portfolio measures — in which direction and to what extent. Not only are measures projected based on trends and patterns, but they’re compared against projected cut-points to assess the probability to an expected star rating.

    The platform not only analyzes how well key measure groups such as CAHPS and HEDIS are performing, but it also reflects trends over a historical period and uses that information to forecast measure, cut-point and gap-closure trends (below).

    What if you want to know the potential rebate and bonus amounts in dollars for moving to a higher star rating? Our platform demonstrates that value to make the case for change and to surface potential quick wins.

    3. Execution

    Now it’s time to target specific members and providers to close gaps. We assess which members are most engaged from the total eligible population, establish incentives to motivate them, and use surveys and focus groups to surface opportunities around member experience. We also identify which providers (starting with systems) are the most effective at closing gaps in care and target them for incentives. The platform allows plans to assess various contracts for targeted intervention to increase their probability in achieving a higher star rating.

    This platform is available as a managed service, and it helps you understand your ecosystem of members and providers better — and, just as importantly, helps members understand you better.