Our Chief Medical Officer, Dr. Maurice Herbelin, has highlighted crucial updates from CMS regarding Star ratings calculations. Check out his post and the attached CMS memo to understand the necessary actions required by June 28th. This recalibration follows successful advocacy by SCAN Health Plan and Elevance, allowing for bid resubmissions. Make sure your organization is informed and ready to act! #HealthPlanIndustry #CMSUpdates #StarRatings
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For all of those in the health plan industry impacted by the recent CMS changes in Star ratings calculation -- keep reading and see the attached CMS memo from yesterday which outlines the necessary actions you need to take by June 28th to lookup your newly calculated rating and resubmit your bids. Context: The news has been hitting over the past week about how one of our clients, SCAN Health Plan, was successful in pushing back on CMS on the Tukey Stars rating methodology which negatively impacted their ratings. As a result of their success and that of Elevance, CMS is recalculating the ratings and allowing bids to be resubmitted. The following memo from CMS is tough to find and outlines three key things which you should be aware of: 1) CMS is recalculating the 2024 Star Ratings using the published 2023 Star Ratings cut points to determine the guardrails for the 2024 Star Ratings (and not the Tukey outliers being removed); 2) All MA contracts can view their updated 2025 QBP Ratings and Total Beneficiary Cost (TBC) data in the Health Plan Management System (HPMS); and 3) CMS will open the gates in HPMS on June 26, 2024 for affected contracts to resubmit bids to reflect the change in their QBP Rating. The memo states that these bids must be submitted by June 28, 2024. Make sure to bring this to the attention of your organization and take the necessary actions. #MHK #healthcareinnovation #AHIP2024 #HealthcareonLinkedIn
