In February, the CMS’s 2021 Medicare Advantage and Part D Advance Notice (Part II) outlined proposed changes to the Medicare program for the Calendar Year (CY) 2021. Included were changes to the Medicare Advantage Star Ratings program, and of particular note was the addition of two new measures. While “all cause readmissions” have long been a focus area, the average performance has dropped from 3.3 stars in Star Rating year 2018 to 2.8 stars in Star Rating year 2020. Outlined below, the new measures reflect an increased focus on better care coordination aimed at avoiding unnecessary readmissions.
Transitions of Care
This comprehensive measure incorporates time-sensitive elements known to mitigate readmission risk, including follow-up visits, awareness of admission and discharge, communication of discharge plan to patients and medication reconciliation. Experts have predicted that this measure may be triple-weighted by 2022.
Follow-Up After Emergency Department (ED) Visit for Patients with Multiple Chronic Conditions
This measure focuses on timely follow-up – for those members with multiple chronic conditions – following an ED visit. According to the National Committee for Quality Assurance (NCQA), one study shows that older adults discharged from the ED had an average ED readmission rate of 24% and an average post-discharge hospitalization rate of 24% within the first three months following the ED visit. As such, this proposed measure seeks to ensure follow-up within 7 days of discharge for these particularly vulnerable patients.
In light of these new measures, what will health plans need in order to be successful?
- Real-time data: To succeed in these new measures, plans will need to know when members have been admitted – and discharged – from an ED or hospital. Claims data are not fast enough to support the necessary timelines, and coordination with utilization management may be complicated and incomplete. Real-time data, such as hospital ADT feeds, will ensure that plans have enough time to deploy the necessary interventions to support their members.
- Care management infrastructure: Data is only as good as one’s ability to act on it. Plans will need to have strong care management infrastructure, in terms of both the clinical team and the technology they use to identify, prioritize and manage members as they transition from one care setting to another.
- Relationships with providers: The nature of these new measures requires not just health plan intervention, but also close collaboration with providers in the community. Value-based partnerships and contractual incentives will help spur collaboration, as will technology solutions that enable shared visibility and management of patients across care settings.
Although payers and providers have been focused on readmission prevention for years, success in these new measures will not come easily, and health plan leaders should begin planning and implementing solutions as soon as possible, in anticipation of the measures going live in 2021 – and CarePort’s suite of solutions is well-equipped to help. CarePort streamlines care transitions, ensuring transparency and communication between the patient, discharging provider and the post-discharge care site. CarePort’s real-time data exchange enables care management teams to contact, locate and track patients after discharge to ensure each patient continues to receive high quality care post-discharge, regardless of where they receive that care.
Is your organization prepared to succeed in these new measures under the revised Star Ratings program? Don’t wait until it’s too late – reach out and learn how CarePort can help.