Becker’s Payer Issues Podcast Boosting Star Ratings: The Key to Health Plan Success
Apr 30, 2025
A sharp decline in Star Ratings is raising alarms for health plans, impacting Medicare Advantage enrollees and financial performance. The conversation highlights how real-time data can enhance care coordination, helping providers close key gaps. Experts discuss the need to adapt to evolving CMS metrics, emphasizing transitional care to improve patient outcomes. Listeners learn what it truly takes to boost performance in a highly competitive healthcare landscape.
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Major Drop in Star Ratings Impact
- Star Ratings for major health plans dropped significantly recently due to raised CMS standards and increased competition.
- Lower ratings reduce income, restrict extra benefits, and start a cycle of declining care quality and member loss.
Boost Ratings Through Care Transitions
- Focus on improving clinical outcomes and transitions of care to boost Star Ratings.
- Prioritize measures like follow-up after ED visits and reducing readmissions at critical healthcare moments.
Leverage Real-Time Data Proactively
- Use real-time clinical data instead of claims data to act quickly during critical patient moments.
- Be proactive by coordinating care immediately after hospital encounters to close gaps and reduce readmissions.