70 5 STAR - An All-encompassing Approach for Success by Carlos Arias

5 STAR - An All-encompassing Approach for Success by Carlos Arias

September 18, 2017

A push for 5 STARs takes multiple approaches.  Here are some things that we did that did bring us to 5 STAR:

Launch a targeted member outreach. Call it a surgical strike if you will. Use analysis to find beneficiaries that need single or multiple gaps and utilize a team support effort (i.e. physician communication with patients, CCC (call center), case managers, quality department, etc.).  And be prepared to handle as many reasons for non-compliance from the patient population as possible, including lack of transportation to and from the offices.  Be prepared to arrange multiple locations to host events and to provide transportation, if necessary.

Hold weekly, biweekly and monthly meetings with team players, quality teams, providers, health plan representatives and executive leaders. At the meetings, review star ratings and focus on a couple of key areas within the measures that could be improved upon with some brainstorming (Creation of quality committee).

Review current star ratings as soon as reports are available. Use champions for each measure (i.e. Dr. Vennamanei, in many measures such as RA, DMARDS, and fractures) and encourage collaboration throughout the company.  Identify other challenges and ways to overcome them such as the acquisition of DEXA scan machines and retinal cameras, mobile clinics for gap closure in specific measure weak areas.  We found that we had large opportunities in diabetic retinal exams, flu shots, and fractures versus osteoporosis. So we purchased equipment and went on the road holding clinics specific to those measures.

Enhance the beneficiary experience. We used a multi-strategy approach, everything from calling the offices, improving appearances and operations through committee meetings and action plans (such as Dr. Maria initiated with the Chief Compliance Officer, also comment cards, survey monkey, CAHPS and HOS outreach)

Engage providers. Incorporation of providers in strategies through education, POD meetings, including the health plan’s suggestions and plans for improved star ratings. Improved workflows in the practices including PCMH. And the consistent and constant communication with concurrent data to providers working detailed reports with them.

We got the entire team involved. Every person was a big help in improving several of the clinical and operational star-ratings measures, including flu shots, colon cancer screening, CAHPS results help with adherence and medication therapy management, educating members about gaps in care and use of cost-effective generics (plan implementation on Part D drugs with physicians, videos, patient education on donut hole in Part D)  Incentivized the discussion, incorporating star ratings into goals as a company and individual having an effect on individual offices and personnel evaluations.

Empowered our customer care Coordinators. They were critical in helping resolve a beneficiary’s concerns. They provided that interested ear with empathy and the soft touch thus improving our engagement with patients as we asked them to join us and to participate in their own plans of care and closure of gaps for their own best health outcomes.