Reflecting on RISE Stars Master Class 2019

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This year, attendees of RISE Stars Master Class had the pleasure of listening to 4- and 5-Star Health Plans share their keys to success, including 5-star plan Cigna-Healthspring and Gateway Health, a plan with a 99% LIS population that achieved 4 Stars for the first time in the company’s history.

Below are our top takeaways from RISE Stars Master Class for medication adherence in 2020:


Star Ratings are Evolving
The sessions began with a keynote from Ashby Wolfe, Chief Medical Officer, Regions VIII, IX, & X for the Centers for Medicare & Medicaid Services. The key takeaway:  Star Ratings will continue to evolve to better serve members. Achieving a high Star Rating is going to become a more difficult feat for health plans. In an effort to more closely evaluate plans year over year, no new star measures are added for 2020. What does this mean? Cut points will increase on existing measures as more plans reach the 4-star threshold. The rumor of CMS re-evaluating HEDIS measures as their data source was confirmed by Wolfe as well. All in all, expect yearly Star Rating changes that will have a significant influence on how well plans are prepared to succeed.

Don’t Give Up on Your Members

Personalization and Social Determinants of Health (SDOH) were key topics shared throughout the conference. As representatives from health plans shared the unique challenges of their specific population sets, it was clear that empathetic and targeted member engagement programs are the strategies that worked. When it comes to Medication Adherence, behavior changes are often not achieved through a single engagement with a member. As Luis A. Cerda of Cigna-Healthspring explained in his session, “Now that you have identified your population and you know what their barriers are, then ask what tools do you have to work with those members”. The key takeaway: Listen to members to identify cultural and environmental needs, address their barriers of care, provide them with tools and resources, and ultimately don’t give up on them.

Work Smarter Not Harder

Small health plans may not have the funds and dedicated resources to build robust Star ratings programs like large national health plans, but that does not mean that they do not have ways to succeed on the same level. The right partnership and a focus on the measures that matter can make a significant impact on Stars ratings. When it comes to addressing Part C and D measures, Stars leaders should ask themselves how to create synergies across their member engagements. The key takeaway: Predictive analytics technology can be used to proactively identify the populations that will yield the most benefit from engagements and can help plans track their progress on a timely basis to pivot and adjust as needed.  This approach is exemplified by Learn Gateway Health, a Medicare Advantage plan that focused on Part D measures to achieve a 4-star rating for the first time in its company history in AdhereHealth’s latest webinar.

Overall, RISE Star Ratings Master Class provided an environment of collaboration and innovation that gave attendees some keys to success to consider as they build their STAR ratings strategies for 2020.