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Season 1, Episode 1

 

 

SHOW NOTES

“Maintain the spirit of continual improvement across the organization. Even though there is uncertainty, CMS rewards heavily for improvement year over year.”
 

2021 was the first year that CMS shifted away from clinical metrics and skewed the weight towards member experience. Health plans will need to address matters such as how well members understand their benefits, the ease of the experience surrounding the use of benefits, and resolution of issues with paying for services—to name a few examples. Member experience is the summation of the entire scope of interactions for a member with their health plan and providers. We're talking with Erica Krieger about what plans can do in 2022 to boost Star Ratings.

In this episode we'll discuss: 
 
2:47 Unpredictable nature of Star Rating calculations
 
3:12 Unique challenges for larger plans
 
4:11 Tactics for improving CAHPS survey scores
 
5:06 Why communication technology is essential
 
6:15 Largest reason for member dissatisfaction
 
8:22 Data interconnectivity's influence on Star Ratings
 
9:25 The role of care management in HOS scores
 
10:26 Advice for new plans and startups



Guest: Erica Krieger is the Vice President of Quality for Advantasure, a front runner in the Medicare Advantage plan operation space. Krieger has more than 20 years of experience—spanning strategic informatics, management of Star program reporting, HEDIS operations, forecasting models for HEDIS improvement initiatives and scoring methodologies.

Resources:
Age of MA plans plays role in success:  (2021). Fact Sheet - 2021 Part C and D Star Ratings. https://www.cms.gov/files/document/ 2021starratingsfactsheet-10-08-2020.pdf 

By 2030, the entire baby boomer generation will be older than 65:  (2018, March 13. Revised 2019, Oct 8). Older people projected to outnumber children for first time in U.S. history. https://www.census.gov/newsroom/press-releases/2018/cb18-41- population-projections.html 

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This podcast is sponsored by Advantasure—managed service and technology solutions for government-sponsored health plans.