Health Plans:There is a Better Way to Attain a Five-Star Medicare Rating

February 02, 2017
Dawn Milstead, BSN, MBA / Vice President, Clinical Innovation, Geneia


First, let me share our results.

Our health plan client used the Theon® analytics and insights platform  as the foundation for its comprehensive, clinically-focused and repeatable process to increase its Medicare star rating to four stars – and to support its goal of achieving a five-star rating.

In the words of the health plan’s senior vice president of government programs,

“Through our use of the Theon® platform, our health plan was able to effectively and efficiently conduct population health analysis, measure performance against benchmarks, develop an improvement strategy, and execute a comprehensive and coordinated outreach and intervention plan that resulted in our achievement of a four-star rating for our HMO and PPO products. The platform is also supporting our efforts to achieve a five-star rating.”Geneia healthplan client

Eliminating Frustration

If you’re a health plan leader who works on star ratings, HEDIS® and quality measure optimization, you know this is “big league.” Creating a cost-efficient, repeatable process – one that no longer relies on expensive, one-off ‘chart chasing’ tactics and doesn’t increase frustration for physicians and their staff – is far from easy.

Perhaps you enjoy fishing like me. Truth be told, I’ve been a frustrated fisherman even longer than I’ve been working to improve clinical outcomes for health plans. If an organization with proven results could offer me a cost-efficient, repeatable way to catch more fish, I’d be all ears.

Likewise, I hope Geneia’s success helping health plans improve Medicare star rating has piqued your interest.

Second, let me share how Geneia collaborated with a health plan to attain a four-star Medicare rating.

A Clinically-Focused and Meaningful Dashboard

The health plan chose the Theon® platform because it features a clinically-focused and meaningful dashboard that efficiently presents care gaps aggregated by provider and by patient. It also provides the plan with a comprehensive, centralized analytics and reporting system, one that collects and integrates timely information from more than 25 diverse sources. Learning the platform

At the outset, the health plan used the Theon® platform to determine true gaps in care, not just the ones identified through lagging medical claims. The plan learned that more than 25 percent of the gaps determined by its old system had, in fact, already been closed. For example, because of the timely addition of vision benefit and claims information, the Theon® platform easily displayed the true number of diabetics who had not had an annual eye exam. This eliminated a significant pain point for the plan and its network physicians, and allowed them to focus limited resources on closing outstanding care gaps. 

Download our case study  to learn how the health plan used the Theon® platform to achieve and maintain a Medicare rating of four-stars or more. Act now so you can spend the late summer and fall fishing rather than chart chasing.