Having an effective clinical quality reporting suite is essential for all health plans. Timely and accurate quality reporting is crucial for health plans who develop and manage value-based provider reimbursement contracts. The need for effective quality reporting is also true for Medicare Advantage plans looking to maintain their CMS 5-star rating as well. This also applies to those plans who want to realize the enrollment and revenue benefits of improving their current Medicare star rating.
Approximately 51% of Medicare Advantage plans with prescription drug coverage collectively earned 2023 ratings of 4 stars (above average) or 5 stars (excellent). While most MA members are enrolled in above average plans, there is still an opportunity for low-rated plans to improve their star ratings if they consider these IT analytics questions during their quality improvement planning cycle.
As a best practice, many health plans endeavor to implement a year-round CAHPS and Star Rating quality reporting improvement plan. As a first step, plans should ensure that these three questions are considered during their next planning cycle opportunity.
Gartner®, Clinical Data Integration: IT Readiness Assessment and RFP Questions for U.S. Healthcare Payer CIOs, September 2022