2023 Star Ratings and Quality Improvement Summit

7:15am – 8:00am
Conference Registration & Networking Breakfast 

8:00am – 8:15am
Chairperson’s Opening Remarks 

8:15am – 9:00am
How Prioritizing Health Equity Can Improve Star Ratings for Health Plans
With a commitment to advancing health equity and addressing inequities within their policies and programs, in 2022 CMS has announced several proposed changes to the Star Rating program focused on health equity. This announcement’s significant theme and focus is around how the healthcare industry can realign incentives and commitments to better support health equity goals. Potential changes would be implemented as new measures and calculations, and methodology changes. When devising Star strategies, health plans should not focus on one specific new potential measure but consider health equity broadly. This session will explore how to help members overcome barriers to equal healthcare opportunity by meeting them where they are, and how health plans can improve patient experiences, health equity, and Star Ratings.

Margaret Rehayem
Vice President
National Health Alliance 

9:00am-9:45am
How to Optimize Medicare Advantage HEDIS Star Ratings: Setting Up Your Plan for Success in 2023 and Beyond
HEDIS Star measures become more important again in MY 2024, when the Patient Experience, Complaints and Access measures decrease from a weight of four to a weight of two. This shifts the emphasis from Experience and Operations to HEDIS and Part D measures and creates a more balanced Star Rating.  This session will help your plan master the HEDIS Star measures, including the shift of HEDIS Star measures to Electronic Clinical Data Systems (ECDS) measures. The shift to ECDS reporting includes retiring the HEDIS hybrid option for some Star measures. For other HEDIS ECDS measures, Medicare plans will need to obtain electronic data for adult immunizations, depression screenings, and social need screenings and interventions. We will discuss best practices for obtaining this electronic data.

Julianne Eckert RN BSN, CCM, CMCN, ACMP
Senior Director, Clinical Quality Programs
Clover Health

9:45am – 10:15am
Networking & Refreshments Break 

10:15am – 11:00am
How to Optimize Star Ratings in the Medicare Advantage Market
As health plans flood the Medicare Advantage market, it is increasingly challenging for payers to compete.

In this competitive environment, the CMS Five-Star Quality Rating System is now more important than ever when it comes to proving value. Used as a benchmark for prospective members, these ratings are key in plan comparison and, ultimately, decision, with higher scores driving recruitment and revenue. Incremental shifts in ratings have both benefits and consequences. This session will explore strategies for payers to elevate Star Ratings in the Medicare Advantage market.

Stephen P. Winn, CPHQ
Senior Director, Quality
Permanente Medicine
Mid-Atlantic Permanente Medical Group 

11:00am – 11:45am
Creating a Culture of Quality from the Top Down
To successfully improve and maintain high Star Ratings, health plans must employ an ongoing commitment to creating a culture of quality from the top down. Leadership must make Star Ratings a focal point of their organization. This session will examine how to empower a multi-departmental team responsible for developing and implementing a comprehensive Star Ratings strategy that includes objectives, goals, resource management, frequent evaluation and management updates. 

Nikki Hungate, MS, MHA
Director, Medicare & Government Programs Product Strategy
MVP Health Care 

11:45am – 12:30pm
Sponsor Session 

12:30pm – 1:30pm
Luncheon 

1:30pm – 2:15pm
Survival of the Fittest
Health plans need to secure high Star Ratings to survive in the world of Medicare Advantage. The growing success of Medicare Advantage stems from the ability of consumers to choose the best plan for their needs in an open marketplace. Beneficiaries place very high value on the ability to shop around for services—and with an average of almost 40 plans to choose from, members are often quick to rebuff plans falling short of expectations. The Medicare Advantage Star Ratings system is intended to provide a data point as a reference for consumers when choosing a health plan for their healthcare insurance needs. The ratings condense dozens of complex quality, member experience and other plan performance factors into a simple give-star graphic members can use to inform their choice. In addition, Star Ratings affect plans’ rebate percentages. This session will explore plans need to know about the Star Ratings and how can they outperform their peers to thrive in this challenging environment.

2:15pm – 3:15pm
Panel: Strategies for Star Ratings Success
Improving Star Ratings can be difficult as each year CMS develops cut-points based on the performance of all plans for each measure over the previous year. Maintaining performance year after year is not enough to sustain a high Star Rating. As all health plans improve their quality, the distribution of scores shifts toward a more high-performing end. Therefore, it becomes increasingly harder for a plan to move from four to five stars because the threshold is also rising. This session will explore how an organization-wide commitment that

is focused on patient experience, preventive health, care coordination, and customer service can lead to Star Rating success.

Andre Bliss, Ph.D., MBA
Director, Medicare STARs
UPMC Health Plan 

Stephanie Harju, MSN, RN, CCM
Staff VP, Clinical Quality and Health Equity Improvement
Elevance Health 

Jennifer I. Lee, MD
Vice Chair for Quality and Patient Safety (QPS)
Associate Professor of Clinical Medicine
Weill Department of Medicine
New York-Presbyterian/Weill Cornell Medicine

3:15pm – 3:45pm
Networking & Refreshments Break 

3:45pm – 4:30pm
Part D Star Ratings and Other Regulatory Changes, Including In Light of the Inflation Reduction Act
This session will discuss recent and likely forthcoming changes to the Part D benefit in light of quality system refinements, updates to approaches to formularies, and the Inflation Reduction Act. 

Margaux J. Hall
Partner
Ropes & Gray LLP

4:30pm – 5:15pm
Roadmap for Digital Quality Measurement and Conversion to HEDIS ECDS Methodology
CMS’ National Quality Strategy includes a commitment to fully transition to digital quality measurement (dQM) as part of a long-term strategy. But the shift to digital quality measurement (dQM) is already under way by NCQA and will begin to impact Star ratings for the current 2023 measurement year. Measures like Colorectal Cancer Screening (COL) will shift from traditional HEDIS hybrid methodology to ECDS (Electronic Clinical Data Systems).  New ECDS measures such as the Social Needs Screening and Intervention are being added to HEDIS reporting.  To be competitive quality leaders will need to pursue new data sources and methodologies for reporting. This session will cover the new digital quality lexicon of FHIR, dQM, data aggregator, interoperability, ECDS, etc. We will discuss strategies for payers to improve ECDS measure performance and creating an overall digital quality roadmap. 

Dwight Pattison
Principle
Quality Performance Advantage 

5:15pm
End of Day One

7:15am – 8:00am
Networking Breakfast

8:00am – 8:15am
Chairperson’s Remarks 

8:15am – 9:00am
How Member Engagement Can Improve Star Ratings
Medicare Advantage carriers typically focus their business development efforts on annual enrollment sales for growing new members. But while the annual enrollment period is certainly important, smart health insurers are beginning to provide proactive, knowledgeable and skillful member engagement tactics throughout the year to improve member satisfaction and retention, and ultimately, improve STAR ratings. This session will explore best practices to ensure member satisfaction and retention all in a strategic effort to improve STAR rating.

Jamie Galbreath, PhD, MPH, CHES
Quality Improvement Director
UCare 

9:00am – 9:45am
Building a Scalable Care Delivery Model for Addressing Social Health Needs in a Large Healthcare System 

The limited impact of clinical medicine on overall health is well-understood. Consideration must be given to social, behavioral, and environmental factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age. Atrium Health has developed a comprehensive Social Impact Strategy with a focus on addressing our patients’ health related social needs by fully integrating SDOH screening into our care delivery to identify risk  and then connect our patients with the community-based services and resources they need through the Community Resource Hub (CRH) powered by Findhelp. FIndhelp is a digital referral tool that connects patients with community-based services and resources who can offer assistance such as food resources, transportation, shelter, domestic violence support, housing support, or assistance for other needs. After a referral is made, support and wrap-around services are provided and assigned through a data-driven process of patient stratification based on an individual’s level of risk and support needs. This approach leverages the scale  and efficiencies of a large healthcare system to develop a scalable model that enables providers and care managers to reach beyond the traditional healthcare constructs to meet the whole-person needs of patients. This session will explore how to implement a uniform, standardized SDOH screening tool across a large healthcare system, improve access to community-based resources and services, and reduce total cost of care and utilization.

Janelle White, MD, MHCM,FAAP
Medical Director Community Health
Division of Community and Social Impact
Regional Medical Director, General Pediatrics
Atrium Health Levine Children’s 

9:45am – 10:15am
Networking & Refreshments Break

10:15am – 11:00am
Telehealth Impact to Star Ratings and Risk Adjustment for Medicare Advantage
Providers have continued to rely on telehealth to deliver care to many of their patients. To make delivering care via telehealth easier, CMS has relaxed requirements related to the use of telehealth for Medicare Advantage populations. This session will provide insight on the impact of telehealth visits for Star Ratings and risk adjustment. Learn how telehealth can help health plans improve Star Ratings by actively engaging members and delivering better, more frequent care. 

Dr. Vipul Bhatia, MD, MBA
Associate Chief Medical Officer, Post-acute and Continuing Care Services
WellSpan Health 

11:00am – 11:45am
How Medicare Advantage Plans Can Boost Star Ratings with Proactive, Data-Driven Care
In order for Medicare Advantage plans to achieve the highest possible Star Ratings, it is important that they leverage clinical data and high-quality healthcare providers to offer proactive care in an efficient, convenient, and consumer-friendly way. This session will examine the following topics:

• Using data to identify opportunities to improve care delivery
• Curating a high-quality provider network built for success
• Proactively engaging beneficiaries in their care 

Les Jebson
Regional Administrator
Prisma Health 

11:45am – 12:30pm
Incentive Programs: Best Practices to Improve Member Health
Implementing a compliant incentive program that impacts Star Ratings is no easy task. For health plans to differentiate themselves, incentive plans need to take their cues from consumer loyalty programs—healthcare is more about the individual than ever before—and missing the mark on a consumer engagement strategy can result in a budget deficit, or even fines. This session will examine best practices for successful incentive rewards programs that impact Star Ratings. Topics to be discussed will include how to implement an incentive program and incentivizing with savings and experiences.

12:30pm
Conference Concludes

12:45pm – 2:45pm

Workshop

How to Adequately Identify and Improve Quality Measures to Improve Star Ratings
Financial incentives and increased enrollment are some of the benefits associated with a health plan having strong Medicare Advantage (MA) Star Ratings, but knowing where to start and how close they may be to reaching the next Star can be tricky. With CMS making regular adjustments to MA Star Ratings, it is common to see measures increase or decrease in weight and be added and retired over time. However, while these changes have come to be expected, plans are still challenged with keeping up with these changes and building a strong quality team that can accurately measure compliance. In addition, plans need to consider finding efficient methods of closing quality gaps on non-standard supplemental data, unstructured data that are buried in medical notes that are most often overlooked when data is abstracted manually. This session will explore how to adequately identify and improve quality measures to improve Star Ratings.

Luis Cerda
Stars Consultant
Rex Wallace Consulting, LLC