New Web-Based Application has Medicare Plans Seeing Stars
ESSENTIALSTARSTM helps plans meet quality targets and qualify for Medicare incentives
METAIRIE, La.—Peoples Health, a Louisiana-based Medicare Advantage (MA) plan administrator, is rolling out a breakthrough business intelligence application. As the first pilot for a MA plan, this will better position Peoples Health to take advantage of the 5 billion dollars in federal funding available now. This is due to the changes in healthcare based on the Affordable Care Act. These funds will help risk-adjusted health plans meet quality-of-care targets and qualify for Medicare incentives.
ESSENTIALSTARSTM provides a web-based platform that integrates quality management, medical management and risk adjustment data. According to Carol Solomon, CEO of Peoples Health, “health plans already store this information in any number of independent data systems.”
“What we needed was a highly sophisticated data integration tool; something that could provide consistent data across the organization,” said Solomon. “We are continually looking for ways to improve our member population health, enhance patient experience and reduce out-of-pocket costs for plan members. What we’ve been looking for is the right tool to help us achieve all these various objectives in a coordinated, consistent way.”
ESSENTIALSTARS met Solomon’s requisites. Not only does it tell her the percentage of members receiving needed screenings and preventive care, but the dashboard’s drilldown menu pulls up “report cards” for the Independent Practice Association (IPAs), provider groups, primary care physicians, and individual practices.
“It enables us to identify care gaps, set up alerts and other measures that help improve care and assess performance in terms of CMS benchmarks,” continued Solomon.
ESSENTIALSTARS is HIPAA-compliant and provides a complete audit trail of all user activity and views of protected health information. While other software designers are racing to develop platforms by combining existing systems, ESSENTIALSTARS was created for its present function.
“We built it on the Statistical Analytics Software (SAS) Business Enterprise platform that allows fast, easy searches and drill downs,” says Richard Lieberman, CEO of Health Data Essentials. “Because of SAS, ESSENTIALSTARS works on any computer with an Internet browser, including any smartphone or iPad. A single sign-on link can even be embedded within a provider’s electronic medical record system.”
The ESSENTIALSTARS suite is comprised of three modules that work together to provide comprehensive and actionable information to users:
- Star-QM focuses on measures that drive the CMS star ratings, a response to Congress’ five star quality rating system. Plans that achieve three or more stars are eligible for the five percent Medicare Advantage quality bonus payment.
- STAR-E identifies inefficient utilization such as avoidable hospital admissions/readmissions, avoidable ER use and medication noncompliance.
- STAR-RM focuses on risk adjusted morbidity scores and payments; improving documentation that drives revenue and mitigates audit risk.
As part of the Affordable Care Act (ACA) of 2010, payment to Medicare Advantage plans is linked to a beneficiary’s experience and quality of care. For the first time, high performing plans will be paid more than lower performing plans. By improving quality, plans can realize substantial payment increases that, in many cases, are close to offsetting reductions they will face as a result of payment changes due to the new ACA laws.
For CEOs like Carol Solomon, the challenge of taking the 3.5 star Peoples Health up to four and five stars seems less daunting, thanks to ESSENTIALSTARS.
About Health Data Essentials
HDE is a consulting firm serving Medicare-Advantage and risk-adjusted Medicaid managed care plans. HDE provides high-quality analytical services that include quality measurement, financial modeling, revenue management, value-based purchasing, policy analysis, education services, and medical record review.
About Peoples Health
Established in 1994, Peoples Health is a Medicare Advantage organization serving Medicare beneficiaries in southeast Louisiana. The physician-owned company has over 600 employees that help administer and provide a unique approach to wellness, care coordination and support services for plan members. The company is a proud supporter of many social, cultural, athletic and health organizations and holds an accreditation by URAC. More information about Peoples Health can be obtained by visiting www.peopleshealth.com.
Suzanne Whitaker, APR
Director of Communications
(504) 949-3999 ext. 210