Health Dialog, a Boston-based provider of analytics and decision support, has launched a new program designed to help Medicare Advantage plans qualify for performance bonuses.
The company's Medicare Star Support Program is targeted at Health Plan Quality and Performance ("Star") ratings, which are assigned to MA plans by the Centers for Medicare and Medicaid Services on a scale of 1 to 5, with 5 being the highest quality. The so-called Star ratings are based on 33 different metrics analyzed by CMS officials.
Through health reform legislation passed this year, MA plans with Star ratings of 4 or 5 will qualify for quality bonuses. Conversely, those MA plans with Star ratings lower than 4 will most likely see significant reductions in reimbursements. According to a recent article in Kaiser Health News, only 15 percent of the nation's 11.1 million MA enrollees have access to MA plans with Star ratings of 4 or 5.
Health Dialog's program is designed to help both the MA plans and the seniors enrolled in them. Using data analytics, the program identifies members "falling through the gaps" and directs personalized outreach communications to them, coaching them on healthy lifestyles and accumulating outcomes for providers and health plans.
Company officials point out that actions taken by MA plans this year will help affect their Star ratings for 2013.
"We applaud CMS' efforts to shine a light on quality by leveraging star ratings to reward high performers," said Molly Doyle, vice president of senior programs at Health Dialog. "One of the most significant aspects of health reform is the impact it will have on Medicare Advantage plans and we want to help our clients improve the quality of care provided to members now, so they can be recognized for their superior performance and reimbursed accordingly in 2013."
"Health Dialog shares the vision that recognizing and rewarding high quality plans and providers will improve healthcare in America system-wide," she said. "Our program will raise Medicare Advantage plans' star ratings by providing seniors with improved health management skills, access to award-winning tools and decision aids, and education around key quality indicators."