With the recent release of CMS Star Ratings for 2019, we had a conversation with Dan Weaver, VP of Stars, Quality and Risk at Gateway Health to reflect on Gateway’s achievement of a 4 star rating and how he plans for success in 2020
1. What is an innovative approach/technology you have seen in the market that would help health plans improve star ratings performance for next year?
As a guy who loves new tech, I’m glad to say that there are so many innovative approaches and technologies emerging every day that I would have to spend all day every day listening to pitch sessions, answering solicitation calls, or researching press releases to stay ahead of the curve. There are countless tools popping up to address specific measure needs, address barriers to care, simplify complicated processes, and mobilize previously cumbersome processes. And almost as quickly as these new companies and capabilities arise, someone is there to absorb them for resale value or exclusivity. After all, the Star Rating system forces competition and every plan is looking for an edge. I’m most excited about companies that are combining analytics and predictive modeling as well as ones that bring a boutique service approach that enables holistic member management. Programs that treat complete persons and instead of individual conditions are changing the paradigm.
2. What is one area that Gateway really focused on in 2018 that allowed you to be successful?
Quality improvement. I was given the opportunity to assist the Gateway Health team early in 2018 in a consultative capacity before making the move permanently in August. Our path of least resistance required a strong showing across the board in all measures, but especially our Part D and operational performance. With new statin measures included in Stars scoring, we had an opportunity to capitalize with a robust Part D strategy. Having worked with AdhereHealth for many years at my previous organization, I knew what we could expect from a partnership with AdhereHealth.
3. What do you think are the greatest barriers to superior Part D performance?
The greatest barrier I’ve encountered is assuming there is some kind of magic bullet to fix adherence. Medication management is a personal problem that affects every member differently. Every health plan managed different populations in different geographies with their own unique sets of challenges. Every person reacts differently to education, engagement, and intervention efforts plans and pharmacies undertake to help them manage their medications. Gateway Health manages a large Dual Eligible Special Needs Plan (DSNP) population, of which almost 100% are Low Income Subsidy eligible. Understanding how to help any individual member requires that we understand and appreciate the specific barriers that person faces to self-managing their condition.
4. As a plan with an almost 100% Low Income Subsidy population, what unique factors does your team have to consider when building a Star Ratings strategy?
Personalization. Members with greater financial constraints are faced with choices that other populations don’t have to consider. Ask a member with limited available income to choose between picking up a medication, feeding his or her dog, or buying toilet paper. Or what about a member that lives in a crime-riddled neighborhood and doesn’t feel safe walking down to the corner pharmacy to pick up her diabetes medication. Gateway Health has been focused on addressing the needs of the less fortunate and helping them achieve the quality of care they need for over twenty years by navigating Maslow’s Hierarchy of Needs, commonly repurposed today as the Social Determinants of Health. In December, Kent Holdcroft, EVP of Strategic Partnerships at AdhereHealth will join me in Carlsbad, CA at the Rise Stars Master Class conference to talk about how important addressing the Social Determinants of Health are to achieving Stars performance success.
5. Overall, what value do you see technology and partnerships bringing to plans looking to engage this unique population in an effort to boost their Star Ratings?
I believe that evolutions in both technology and partnerships are critical to achieving strong performance. A few years ago, my previous employer and AdhereHealth partnered together to evolve an AdhereHealth technology to meet a specific performance need in our market. That request led AdhereHealth to expand and innovate on the company’s strategic vision and required a lot of collaboration. That partnership proved to be successful in helping my previous organization achieve its performance objectives and paved the way for the initiatives we are now implementing at Gateway Health. It also allowed AdhereHealth to evolve in new and exciting ways that added more tangible value to its partnerships. To see how much AdhereHealth has continued to grow in the years following those intense planning meetings is incredibly exciting. AdhereHealth continues to search for new partnerships and has metamorphosed into a forward-thinking company that proactively seeks and implements new solutions to address their partner’s needs even before the partner has expressed the need. Through strong analytics and strategic planning, AdhereHealth is taking the steps necessary to be a leader in Stars performance management rather than just another option.
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About Dan Weaver
Daniel Weaver spent the first fifteen years of his career advancing through various departments at an international BPO organization. With experience managing multiple disciplines including analytics, business development, operations, financial modeling, and performance management, Daniel advanced to the Director of Analytics and Vice President of Corporate Planning prior to accepting a role in the Healthcare industry with Highmark Inc. in 2013.
Dan helped establish and grow a Stars Quality organization within Highmark, serving as the Director of Programs and successfully achieving 4.0+ Stars ratings for over 5 years. Dan recently joined the Gateway Health team as the Vice President of Stars, Quality, and Risk Adjustment. In his first year at Gateway, Dan was able to lead the company to its first 4.0 Star Rating. Dan is focused on establishing a Stars Quality program that consistently delivers 4.0+ Stars while improving performance across multiple state-based government programs and delivering the highest quality Risk Adjustment results possible.
Throughout his career, Dan has overseen the development and implementation of analytic-driven and customer-focused programs. Dan leveraged deep analytics expertise and a strong focus on team development to create a methodology and infrastructure that have driven consistent results for one of the 10 largest Medicare Advantage health plans in the U.S. The impact of these efforts during Daniel’s time at Highmark led to increasing and maintaining performance levels at 4.5 Stars out of 5 across Highmark’s largest contracts, representing nearly 300,000 annual lives and roughly $1B in quality bonuses.
Dan is an industry thought leader that believes in challenging the status quo and embracing innovation.