Client Challenges Today
The Centers for Medicare & Medicaid Services (CMS) publishes the Star Ratings each year to measure quality in MA and Part D plans. As a result, STAR Ratings are driving improvements in Medicare quality. Plans are evaluated for performance across member services, chronic disease management, and appeals and grievances management to name a few. Plans are under constant pressure to perform optimally in order to earn higher CMS reimbursements and bonuses. On the other hand, maximizing the enrollment base and payout are critical to stabilize revenue. As CMS plans a reduction in reimbursement rates, payers are fighting for a bigger share of a smaller prize.
Solution and How We Work
Capgemini’s A5STAR service offering helps payers Assess, Analyze, Aim, Act and Achieve through our proprietary A5STAR visualization tool for advanced analytics. The tool compares STAR HEDIS and quality performance ratings for Medicare Advantage and prescription drug plans at a granular level. It also facilitates „what-if“ analysis on enrollment, enrollment penetration, rebates and bonuses based on a Plan’s STAR measures to maximize reimbursements. The A5STAR tool also provides market enrollment study to focus marketing efforts to maximize enrollments.
STAR ratings comparison of contracts by region, state, county and lines of businesses
Drill down of STAR ratings by domain and measure
Demographic enrollment data illustration with what-if analysis of payments and rebates
Plan premiums illustrated across counties for analysis of premium vs. payment numbers
Where the A5STAR tool targets improvement, our A5STAR services drive to achieve your improvement goals:
Key STAR domains and measures are mapped to the internal processes that impact them
Internal KPI’s are defined for those core processes
CMS data is integrated with claims, clinical and operational data to derive improvement areas
A roadmap is defined to address improvement areas
A closed loop system (process, technology, governance) is designed and implemented to track progress and performance based your goals
Consulting, BPO, ITO and application management services can be leveraged wherever needed to drive STAR excellence
Contact us today at email@example.com or connect with one of our experts.