As CMS Star Ratings methodologies evolve, Medicare Advantage health plan leaders must address the immediate measures in front of them while developing the capabilities that support sustained performance.
Kimberly Switlick-Prose
Pareto Intelligence's Vice President of Quality Solutions, shares her perspective on building a Star Ratings strategy that can adapt to change.
Kimberly’s Answers
How do we build a Star Ratings strategy and execution plan that remains successful even if the rules keep changing?
Think in inches and miles.
The inches are the individual Star measures and gaps that need to close.
The miles are the foundational capabilities that are leading indicators of Star and drive long-term success – think value-based contracting, clinical data exchange, provider attribution, and confidence in plan understanding.
Too many Star strategies focus almost exclusively on the inches. That might improve today’s measures but can leave plans vulnerable when CMS changes the rules and measures shift.
The strongest organizations build accountability for both. They establish goals and targets for both measure performance and leading indicators of success that support foundational capabilities that make sustained performance possible.
Rules will continue to evolve. Foundational capabilities are what help you adapt without starting over.
How can health plans confidently forecast Star Rating performance when CMS methodologies and calculations continue to evolve?
It’s the question every Stars leader is asking: How do you forecast rules that don’t exist yet?
While you can’t predict every CMS change, you can reduce uncertainty.
- Scenario modeling to quickly understand the impact of different measure sets and methodologies.
- Probability modeling to quantify your risks. A single forecast gives you a fixed future view of the world. Probabilistic models calculate the likelihood of achieving certain outcomes (e.g., getting to 4.0 Stars).
In an uncertain environment, forecasting isn’t about predicting the future perfectly. It’s about understanding the range of outcomes and making better decisions with the information you have.
If volatility is the new normal, should we optimize for the Rating – or manage the volatility?
Both.
Your goal is still to maximize Star performance – but in a way that’s resilient to change.
Ask yourself:
- Are we investing in the measures and capabilities that create the greatest value?
- Can our analytics rapidly model new scenarios?
- Do we understand where our biggest risks and opportunities are?
- Are we building enterprise capabilities that matter regardless of how the measure set changes?
The plans that thrive won’t be the ones chasing every rule change. They’ll be the ones built to adapt.
That’s how you improve Ratings and manage volatility.
Related resources
For additional Pareto perspectives on the issues Kimberly raises, explore:
Kimberly examines the increasingly complex Star environment and the need for a system-wide strategy.
Explore what an adaptive Star Rating strategy could look like for your organization
Learn more about, Pareto Intelligence’s solution for Star Rating performance forecasting, scenario modeling, and actionable insights.