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Improving CAHPS With Existing Data & New Perspectives Oct 03, 2022

Show notes

“One area of opportunity that a lot of health plans overlook, is taking a step back and looking at data that’s right in front of them with a new perspective..”

The weight of the CAHPS survey has steadily increased over the years from 8% in 2014 to 32% of the overall Star Rating in 2021. Scoring is complex and there’s no one size fits all strategy. Two health plans the same size can do the same thing and get different results. The reason for this is attributed to the unique nature of every member experience in different member populations.

There are a number of variables that contribute to positive CAHPS performance. Although CAHPS performance can’t be pinned to one effort, the health plans that are most successful have a wholistic strategy that involves multiple departments and synergies between their member communications and outreach. Every single thing that’s printed on paper, published on websites, sent via email, or communicated verbally—matters. Carefully crafting and optimizing a targeted member journey is essential to successful CAHPS. It’s often forgotten that health plans are surveyed not just on their own interactions with members, but also their agents and provider networks. Education and onboarding partners to deliver a member experience is just as important as training customer service representatives. All member touch points are a reflection of the health plan.

In order to improve the member journey, plans must evaluate their available data from multiple perspectives. For example, it’s no longer sufficient to evaluate appeals and grievances through the narrow lens of whether it was an appropriate denial or not. Today, plans need to also analyze complaint data from a quality vantage point and determine it its more expensive to have an abrasive member experience.

About Our Guest
Amy Weiser is an accomplished healthcare executive with 20+ years of experience in health plans and facility and practice management. Weiser has experience with Medicare Advantage, Dual Special Needs Plans, MMP, and Medicaid lines of business. She has had responsibilities that have included Star and Hedis oversight, operations, member and provider materials and engagement, medical management leadership over care management and utilization departments, as well as experience starting a new quality and patient experience department for a large physician network.

Strategies For Reducing Gap and Chase Time Frames Sep 01, 2022

Show notes

“It’s essential to accelerate the speed and time for gaps to identify them faster and proactively.”

In the context of risk adjustment gaps, there are two overarching goals—to identify and accurately predict member conditions. To do this, health plans are reliant on the amount and quality of the data they have—primarily sourced from clinical and claims data. Plans need this data to produce intelligence and directives to providers on how best to proceed on a proactive care path.

Due to COVID, plans experienced a decrease in access to data and that resulted in unique challenges for risk adjustment and their ability to supply predictive analytic recommendations to providers. As we return to normalcy, plans can expect a huge influx of data in 2022 and 2023 as members return to their normal care and procedures. This is going to be great for generating greater intelligence and actionable insights, but it’s also going to present some unique challenges and strain on some plan’s operational systems, especially if they’re manual.

For plans who have the technology and capacity to process large amounts of data, these coming years may be very fruitful for risk adjustment. The large data sets will provide a lot of intelligence for predicting member gaps and creating strong member segmentation models.
About Our Guest: Abe Chaaya is the Managing Director of Product Management for Analytics Products. Abe has over twenty years of experience as a global IT leader in QA, DevOps, and product management spanning several industries including manufacturing, payment systems, and healthcare IT. He holds a bachelor's degree in mechanical engineering from Rensselaer and an MBA in operations and technology from Bentley.

Digital Tactics For Member Engagement Aug 01, 2022

Show notes

“There’s a whole new range of possibilities for interacting with members through digital medium.”

Marketing and communications in the Medicare Advantage space have evolved significantly in the past five years. Leaving behind a one-size-fits-all outreach approach, today’s best practice is messaging for a journey of one—targeting unique individuals or groups of individuals with similar needs. For example, health plans would want to communicate differently with members who have chronic conditions versus healthy members. Deploying specific-to-the-member messaging engages the member, grabs their attention, serves them up with relevant information, and guides them through a progression of messaging including calls to action.

Messages are deployed via a number of digital channels such as email campaigns, social media, and newsfeed ads. Make note, that the depth of modern-era outreach is expanding rapidly to include cutting-edge technologies such as artificial intelligence voice technology bots and care robots.

It’s important to remember that all of these digital tactics are not just forms of communication flowing back and forth. It’s a form of optimizing and understanding the communications. Most digital interactions leave a trail of data that can be analyzed with machine learning and artificial intelligence tools.

What that means ultimately, the member journey with the plan and with their own health no longer needs to be an isolated journey. The member’s health trajectory with the plan can be smooth, seamless, and guided by the hand of these digital tactics and insights.

About Our Guest: Andrea Wallace (Dre) has a background in product development and is an innovator in solutions for healthcare organizations. Wallace has served in a variety of roles across the technology industry as an innovator, investor, and strategist. She is the recipient of the 2019 Nolan Groce Business Leadership Award for her work in the startup and entrepreneurial ecosystems.
Resources:
Tech Adoption Climbs Among Older Adults. Monica Anderson, Andrew Perrin. May 17, 2017. https://www.pewresearch.org/internet/2017/05/17/technology-use-among-seniors/

Next Generation Care Management Technology Jul 01, 2022

Show notes

"The only way to proactively identify and manage members with rising risk is by connecting care teams with real time data, analytics, and predictive models."

In this episode, we explore the origins of care management, reactive versus proactive models of care, ways to coordinate care with real-time data, practical uses for data and analytics for diagnosis and treatment, as well as the ideal care management dashboards for frontline healthcare workers, managers, and directors of care management programs.
Guest : Dr. Chris Johnson is the Care Management Product Lead, designing and implementing health management solutions for government-sponsored health plans. Building upon academic training in medicine, public health, and medical informatics, Dr. Johnson pioneered new workflow methods at companies such as Dignity Health, Zynx Health, and Adventist Health. Dr. Johnson now leads a growing team to create effective solutions for health payers and provider networks.
Resources:
Baclic, O., Tunis, M., Young, K., Doan, C, Swerdfeger, H., Schonfeld, J. (2020). Challenges and opportunities for public health made possible by advances in natural language processing. Canada Communicable Disease Report, 46(6): 161-168. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC7343054/

Future of Stars Jun 06, 2022

Show notes

“Maintain the spirit of continual improvement across the organization. Even though there is uncertainty, CMS rewards heavily for improvement year over year.”
2021 was the first year that CMS shifted away from clinical metrics and skewed the weight towards member experience. Health plans will need to address matters such as how well members understand their benefits, the ease of the experience surrounding the use of benefits, and resolution of issues with paying for services—to name a few examples. Member experience is the summation of the entire scope of interactions for a member with their health plan and providers. We're talking with Erica Krieger about what plans can do in 2022 to boost Star Ratings.
Guest: Erica Krieger is the Vice President of Quality, a front runner in the Medicare Advantage plan operation space. Krieger has more than 20 years of experience—spanning strategic informatics, management of Star program reporting, HEDIS operations, forecasting models for HEDIS improvement initiatives and scoring methodologies.
Resources
Age of MA plans plays role in success: (2021). Fact Sheet - 2021 Part C and D Star Ratings. https://www.cms.gov/files/document/ 2021starratingsfactsheet-10-08-2020.pdf

By 2030, the entire baby boomer generation will be older than 65:(2018, March 13. Revised 2019, Oct 8). Older people projected to outnumber children for first time in U.S. history. https://www.census.gov/newsroom/press-releases/2018/cb18-41- population-projections.html

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