This is an AArete Healthcare Payer insight

Situation

A health plan decreased to a 3.0 Medicare star rating for the first time in plan history. AArete partnered with the health plan to assess its Medicare Advantage department structure, current state performance, and reporting capabilities to assist the plan with their overarching stars program goals.

Approach

Over 10 months, a thorough current-state assessment was conducted using a custom trending analytics dashboard to identify both short-term, quick wins and long-term sustainability opportunities. A stars program governance framework dedicated to implementing the recommended strategies and interventions was created and AArete provided implementation support for identified recommendations and strategies.

Results

The client increased their rating to 3.5 stars to capture increased rebates. AArete also developed a targeted future-state roadmap to achieve 4.0 stars and the associated bonus payments. A dedicated Medicare stars program governance structure was established, and implementation plans with custom dashboards to continue monitoring performance were provided to facilitate swift adaptation to future market and member population changes.

Learn more about AArete’s Quality Service solutions