Star Management

HCSS provides health plan guidance and tools for meeting the 5 star quality metrics. For example, support in the development of robust tracking of the measures (e.g.HEDIS tracking) and the development of performance incentives for the ongoing management to hit the targeted results.

Star Ratings - Revenue Opportunity 

1) CMS Data on quality & member satisfaction - (8 measures)

2) Consumer Assessment of Healthcare Providers & Systems - (8 operational measures)

3) Medicare HEDIS - (11 measures)

 
4) Health Outcomes Survey (HOS) - (6 measures)

Plans must achieve a minimum of 4 Stars to receive quality bonus beginning 2012:

   2012 - 1.5%
   2013 - 3%  
   2014 - 5% 

Due to FFS revenue scaling, health reform will reduce by 2017 revenue on average by 12% - payment increases will be realized through Star quality performance.

In addition, 4.5 Star plans receive 70% rebate vs. 50% for plan with 3 stars.