We’re over halfway through 2019—how are you tracking against your quality and satisfaction goals?
If you’re confident about your in-year data…
That’s great! However, you won’t know until October where the cutpoints for each measure are going to land, or how you performed relative to other plans. By then, it could be too late to make the changes needed to optimize performance by year-end.
It’s also worth noting that some cutpoints tend to be more volatile than others, moving up and down by as much as 9 percent from year to year. Even if you’re on track in the measures that tend to see greater shifts, by the time October rolls around, there’s still a chance your projections could miss the mark.
We know of one large health plan that used sophisticated modeling to project where they’d land, and in some measures, their actual performance fell short by as much as 3 percent—which can be the difference between moving up or falling back.
Bottom line: even if you’re feeling good about your performance thus far, you still may need to implement some short-term strategies to ensure you meet your targets.
If you fell short last year or are not confident about your in-year data…
Now’s the time to pull out all the stops—especially if you’re struggling to achieve or maintain a 4-Star (or higher) rating.
Staying above that 4-Star threshold is more important than ever. Three out of every four Medicare members choose plans with quality ratings of at least 4 Stars, and that number continues to grow. Members have increasingly more options, and they’re moving to highly rated plans that deliver a high-quality experience.
If you need to boost performance by year end, it’s critical that you pull the correct levers. Some plans, upon realizing they’re behind, implement what we call the “kitchen sink” approach: rewarding all members for completing any healthcare activity. Not only is this expensive, it’s also inefficient. You don’t need every member to complete every activity to positively impact quality; you need the right members to complete the right activities.
Other plans employ what we call a “binary” approach, which is sending a breast cancer screening letter to members eligible for that screening, sending an A1C letter to members eligible for that screening, and so on. These campaigns are either on or off; there’s no in between. And there’s also no prioritization or personalization. You might see some incremental lift, but likely not enough to truly move the needle.