A tough question
“So why does the Stars team need to exist?”
It was a provocative question from a C-Suite leader at a health plan I worked for. We had just provided him with an overview of how our company’s Star operating model. The Star team didn’t “do” anything. We weren’t closing gaps or chasing charts. We weren’t running the call center or processing appeals. We didn’t own plan design or our MA growth strategy.
"The Star team didn't 'do' anything... or at least it seemed that way."
It was a fair question.
We set targets; reported on results; forecast EOY results; held Steering Committee meetings. These weren’t member-impacting, revenue generating, or cost avoiding capabilities. There was reason to question if this was a value-add team.
Because in a perfect world, all matrixed partners in a health plan know what to do and then do it. But we don’t live in a perfect world; we live in the real world.
A day in the life of an MA Plan
For a moment, allow me to digress into the “real world” of running an MA plan.
A handful of appeals come in late. A systems error resulted in wide-spread member miscommunications. A high-performing employer group signs with another payer. CMS changes the scoring system mid-year.
Suddenly, Star forecasts are not looking as “green.” Executives start asking questions, and demanding action. “Measure Owners” and the “Stars Team” are being asked to do everything they can to get back us back on track.
Enter the “solutions.” Vendors. Pilots. Campaigns… oh, and the requests for funding. The business cases enter the chat. They show “massive” impact. “20% lift!” “2 Star improvement!”
Now, there is more to do than there is money to spend. Decisions have to be made as to where bets should be placed. The Stars team is asked where the best return on investment is. Analytics is tapped to model the impact.
A lot of insights
The questions start coming.
Is it enough?
Does it get us to the next Star for the measure?
Does it change our QI forecast?
What happens to Reward Factor?
How much do we need to pad against cut point uncertainty?
What if our CAHPS forecast is overly rosy?
Each question can be answered in and of itself. Answering them together is hard. Explaining it to an executive is even harder.
Insights are plentiful, but recommendations are scarce. More analysis is called for. Paralysis sets in. Decisions are informed by gut over data, politics over performance. Action occurs, but maybe it’s too late, or maybe it’s “wrong.”
"Insights are plentiful, but recommendations are scarce."
The answer to the question
So back to that tough question I was asked—what does the Stars team do?
At its core, they develop a plan for their company to succeed, they track their progress against the plan, and they activate based upon what they are seeing. This is easier said than done, given the complexity of Stars.
Set the plan. Star Ratings are based on a rigidly defined mathematical equation, and so planning for performance must fundamentally be based on that math. A non-negotiable in the Star leader’s toolkit is an analytical solution that enables forward-looking models of what scoring will look like in the future. That tool must enable thoughtful decision making by allowing leaders to understand the impact of myriad factors (e.g., weight changes impact on contract rating, raw improvement needed to increase QI measure Stars). A great tool enables leaders to set meaningful measure-level targets, informed by prior performance and peer benchmarks. An analytical foundation is core to setting a proper strategic plan.
Forecast the future. On January 1 of every year, the work to impact Star scores issued 21 months later is already in motion. From early in the performance year, Star leaders need to understand how they are doing relative to the plan they set out. As is the case in any business forecast, there is a range of possible outcomes in Stars, and the earlier in the cycle, the bigger that range is. The tricky part with Star Ratings is that they are not a “sliding scale”, but a “stair step”, with steep cliffs of revenue drops that occur with sometimes small changes in forecasts. A small change in a measure’s performance could be amplified if it triggers a QI-drop, which triggers a reward factor drop, which ultimately leads to a drop in QBP or rebates. A Star leader needs to understand not only where they think an H-Contract will land, but how likely that outcome is. And more importantly, they need to know where their biggest areas of risk and opportunity are, so that they can take action.
This is why Star leaders need an analytical tool which projects the future at a deep level of granularity– and manages that reality that we live in an uncertain world–and so develops projections that are probability-based. An analytical tool must provide leaders with insights into the nitty-gritty of Star Ratings—Reward Factor, QI, CAI, member- and segment-level performance.
Take intelligent action. A set of dashboards is useless if it doesn’t enable action (even if that action is to stay the course!). A Star leader knows that not all measures are created equal. Measures are weighted differently, cut point gaps vary by measure, certain measures involve longer periods to influence member behavior, etc. Where Star leaders can become “stuck” is how to simultaneously consider all those factors and nevertheless drive action.
"A set of dashboards is useless if it doesn't enable action."
Star leaders need an analytical tool that helps cut through the noise and inform action. They need a tool that condenses all the “what if’s” into “what now’s”. At a contract level, leaders need a tool that allows them to easily identify the measures that are most likely to make the difference and prioritize those from greatest to least. At a measure level, leaders need to know who is highly likely to be (non)compliant, and who would benefit from a nudge. They need to know what providers are performing strongly, so that they can focus their energy on improving those lagging.
In summary, Star leaders don’t need more data. In a common analogy, if data is the “modern day oil”, then Star leaders don’t need oil… they need more refined fuel (insights). But fuel is not their goal either; they need it to power their performance (action).
Contact Pareto Intelligence to learn how a more action-oriented approach can help your Star team focus on the interventions most likely to improve performance.