Assessing a Medicare Advantage plan’s Stars improvement operations to recommend best practices

Situation

A regional Medicare Advantage plan client (that also operated a Medicare Advantage plan under a subsidiary) wanted to ensure that its department focused on Medicare Advantage Stars Improvement was operating efficiently and effectively. The department worked cross-functionally across other departments as needed to influence Star Ratings.

Solution

Our project team reviewed documented policies, procedures, trainings, and materials related to Medicare Advantage Stars Improvement and past performance. We also interviewed key staff across departments involved directly or indirectly in Medicare Advantage Stars.

Success

Avalere Health evaluated quality indicators of the plan’s Medicare Advantage Stars operations and processes to identify gaps and recommend industry best practices to implement. We identified priority initiatives and an implementation timeline to drive organizational investment in Medicare Advantage Stars Improvement.