Star Ratings are getting complicated with Hold Harmless Measures, Guardrails, Tukey Outliers and more. We can help you stay on top and achieve your goal.


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Quality Improvement Measures

Attention all MA plans! Don't let the new Tukey outlier removal methodology catch you off guard in 2024. The upcoming years will be challenging as CMS moves towards a more stringent Star rating system, which means improved performance from contracts is necessary to maintain existing ratings. This can be a significant financial burden, especially for plans that are still struggling with quality initiatives following the pandemic.

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Quality Improvement Measures

But fear not, because quality can become a source of competitive advantage for programs that successfully adjust to the new rating system. Plans that prioritize quality will have a significant advantage in better serving their members and retaining a Star rating of four or above. This will benefit plans in being financially stable, providing rich additional benefits to members, and competing for enrollees who place a high value on Star ratings.

The upcoming changes mean that MA plans need to act now to avoid potential reductions in Star ratings. With a two-year lag between the performance and rating period, plans must anticipate the rise in difficulty and pick up speed now. The good news is that plans can take specific actions to address at-risk indicators, such as establishing a team dedicated to certain measures or developing midyear efforts aimed at improving performance.

patient outreach and call center services
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Plans should also think about creating a systematic approach to quality spending or boosting expenditure if they currently have one. The return on investment of such investments will likely grow in the future as cut points become more difficult and less erratic. Successful plans have provided front-office workers with quality-focused training, used engaged text messaging, and utilized predictive analytics to initiate call campaigns targeted at patients’ medication adherence.

Don't let the new rating system catch you off guard. Act now to ensure your plan is successful in the future. Contact Saince today to learn more about how our cutting-edge services and expert team can help you streamline your process and improve your MA plan's Star rating. Our customizable services cater to your specific needs, ensuring that you only pay for what you need. Trust us to help you stay ahead of the competition and succeed in the new rating system.

Part C Measures

Breast Cancer Screening

This measure's weight is 1 (medium importance)

Ratings and Thresholds:

1-star
⭐
<42%
2-stars
⭐⭐
<61%
3-stars
⭐⭐⭐
<69%
4-stars
⭐⭐⭐⭐
<76%
5-stars
⭐⭐⭐⭐⭐
>76%

Control Blood Pressure

This measure's weight is 3 (medium importance)

Ratings and Thresholds:

1-star
⭐
<51%
2-stars
⭐⭐
<62%
3-stars
⭐⭐⭐
<75%
4-stars
⭐⭐⭐⭐
<82%
5-stars
⭐⭐⭐⭐⭐
>82%

COA Pain Assesment

This measure's weight is 1 (medium importance)

Ratings and Thresholds:

1-star
⭐
<55%
2-stars
⭐⭐
<61%
3-stars
⭐⭐⭐
<87%
4-stars
⭐⭐⭐⭐
<96%
5-stars
⭐⭐⭐⭐⭐
>96%

COA: Rx Review

This measure's weight is 1 (medium important)

Ratings and Thresholds:

1-star
⭐
<48%
2-stars
⭐⭐
<71%
3-stars
⭐⭐⭐
<84%
4-stars
⭐⭐⭐⭐
<95%
5-stars
⭐⭐⭐⭐⭐
>95%

COA: Functional Assesment

This measure's weight is 1 (medium importance)

Ratings and Thresholds:

1-star
⭐
<%
2-stars
⭐⭐
<%
3-stars
⭐⭐⭐
<%
4-stars
⭐⭐⭐⭐
<%
5-stars
⭐⭐⭐⭐⭐
>%

Colon Cancer Screening

This measure's weight is 1 (medium importance)

Ratings and Thresholds:

1-star
⭐
<49%
2-stars
⭐⭐
<62%
3-stars
⭐⭐⭐
<71%
4-stars
⭐⭐⭐⭐
<80%
5-stars
⭐⭐⭐⭐⭐
>80%

EED Diabetic Eye Exam

This measure's weight is 3 (very important)

Ratings and Thresholds:

1-star
⭐
<52%
2-stars
⭐⭐
<62%
3-stars
⭐⭐⭐
<71%
4-stars
⭐⭐⭐⭐
<79%
5-stars
⭐⭐⭐⭐⭐
>79%

HBD HbA1C Control >9%

This measure's weight is 1 (medium importance)

Ratings and Thresholds:

1-star
⭐
<59%
2-stars
⭐⭐
<62%
3-stars
⭐⭐⭐
<71%
4-stars
⭐⭐⭐⭐
<79%
5-stars
⭐⭐⭐⭐⭐
>79%

Osteoporosis Management

This measure's weight is 1 (medium importance)

Ratings and Thresholds:

1-star
⭐
<27%
2-stars
⭐⭐
<40%
3-stars
⭐⭐⭐
<50%
4-stars
⭐⭐⭐⭐
<68%
5-stars
⭐⭐⭐⭐⭐
>68%

SPC Statins Therapy

This measure's weight is 1 (medium importance)
Moderate to high intensity Statin Therapy Cardiovascular Disease males 21-75, females 40-75

Ratings and Thresholds:

1-star
⭐
<81%
2-stars
⭐⭐
<85%
3-stars
⭐⭐⭐
<88%
4-stars
⭐⭐⭐⭐
<92%
5-stars
⭐⭐⭐⭐⭐
>92%

TRC: Medication reconciliation post discharge

This measure's weight is 1 (medium importance)
Moderate to high intensity Statin Therapy Cardiovascular Disease males 21-75, females 40-75.

Rating and Thresholds:

1-star
⭐
<47%
2-stars
⭐⭐
<45%
3-stars
⭐⭐⭐
<63%
4-stars
⭐⭐⭐⭐
<76%
5-stars
⭐⭐⭐⭐⭐
>90%

TRC: Member engagement after discharge

This measure's weight is 0.5 (medium importance)
Moderate to high intensity Statin Therapy Cardiovascular Disease males 21-75, females 40-75.

Ratings and Thresholds:

1-star
⭐
<76%
2-stars
⭐⭐
<83%
3-stars
⭐⭐⭐
<90%
4-stars
⭐⭐⭐⭐
<94%
5-stars
⭐⭐⭐⭐⭐
>98%

Part-C Non-Star Display Measures

  • Care for older adult functional status assesment
  • FMC
  • KED
  • TRC: Patient Engagement
  • Wellness Visit

Part D Measures

Adherence for Diabetes

This measure's weight is 3 (very important)

Ratings and Thresholds:

1-star
⭐
80%
2-stars
⭐⭐
85%
3-stars
⭐⭐⭐
88%
4-stars
⭐⭐⭐⭐
92%
5-stars
⭐⭐⭐⭐⭐
>92%


Medications: Biguanides, sulfonylureas, thiazolidinediones, DPP-IV inhibitors, GLP-1 receptor agonist, meglitinides and SGLT2 inhibitors.

Adherence Hypertension (RAS)

This measure's weight is 3 (very important)

Ratings and Thresholds:

1-star
⭐
80%
2-stars
⭐⭐
86%
3-stars
⭐⭐⭐
89%
4-stars
⭐⭐⭐⭐
91%
5-stars
⭐⭐⭐⭐⭐
>91%


Medications: ACE inhibitors, ARBs, Direct Renin Inhibitors or combination

Adherence Cholesterol Statins

This measure's weight is 3 (very important)

Ratings and Thresholds:

1-star
⭐
81%
2-stars
⭐⭐
85%
3-stars
⭐⭐⭐
88%
4-stars
⭐⭐⭐⭐
92%
5-stars
⭐⭐⭐⭐⭐
>96%


Medications: TIER 1 and TIER 2

S.U.P.D. Statins Diabetics

This measure's weight is 1 (medium importance)

Ratings and Thresholds:

1-star
⭐
80%
2-stars
⭐⭐
84%
3-stars
⭐⭐⭐
86%
4-stars
⭐⭐⭐⭐
90%
5-stars
⭐⭐⭐⭐⭐
>90%


Medications: Statins TIER 1 and TIER 2.

SPC Statins Therapy

Eligible members are males between ages 21 to 75 and females from 40 to 75 with diagnosis of cardiovascular disease and or Diabetes.

The range should be Moderate to High intensity Statins.

This measure's weight is 1 (medium important)

Ratings and Thresholds:

1-star
⭐
81%
2-stars
⭐⭐
85%
3-stars
⭐⭐⭐
88%
4-stars
⭐⭐⭐⭐
92%
5-stars
⭐⭐⭐⭐⭐
>92%

Frequently Asked Questions

Quality improvement measures in healthcare refer to systematic efforts and initiatives undertaken to enhance the delivery of healthcare services. These measures aim to optimize patient outcomes, safety, and satisfaction through continuous assessment, analysis, and improvement of healthcare processes.

Quality improvement measures are crucial in healthcare to ensure that services provided meet the highest standards of safety and effectiveness. By identifying areas for enhancement and implementing evidence-based practices, healthcare organizations can consistently deliver better care, reduce errors, and enhance overall patient experiences.

Implementation of quality improvement measures involves a structured approach, including data collection, analysis, and the development of targeted interventions. Collaborative efforts among healthcare professionals, regular performance evaluations, and the integration of best practices contribute to the successful execution of improvement measures.

Patients play a significant role in quality improvement measures by providing valuable feedback on their healthcare experiences. Their perspectives help identify areas needing improvement, enhance communication, and contribute to the development of patient-centered care models. Engaging patients in the improvement process fosters transparency and accountability.

Success in quality improvement initiatives is measured through various indicators, including patient outcomes, safety records, and adherence to established protocols. Key performance indicators (KPIs), patient satisfaction surveys, and regular audits contribute to assessing the impact of improvement measures and guide further refinements for ongoing excellence.

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