Star Ratings Booster helps low-scoring Medicare plans
Posted on September 28, 2012 at 14:00 PM EDT
BUFFALO, N.Y., Sept. 28, 2012 /PRNewswire/ -- In preparation for fall enrollment, Medicare plan sponsors have had the opportunity to preview their 2013 Star Ratings – which go live on Medicare Planfinder on Oct. 11. Those whose scores aren't as high as they would like may be able to improve them with the Star Ratings BoosterTM technology platform from Clinical Support Services, Inc. (CSS).
The Star Ratings Booster module enables CSS clinicians, with the support of clients' pharmacy and medical claims data, to determine a patient's compliance on select Part C/D measures and proactively generate comprehensive care-enhancing recommendations, which then may be shared with the patient's physician and/or pharmacy. CSS's web-based module enables pharmacy claims – and other available clinical data – to be uploaded to the client's patient profiles. Using claims data and clinical source information, the MTMPathTM module allows CSS clinicians to identify patients who are non-compliant on certain Part C/D measures that would have a negative impact on a plan sponsor's CMS Star Rating, explained CSS President James Notaro, RPh, Ph. D. When a measure is tagged as non-compliant, CSS reaches out to the respective patient and his/her physician to bring the measure into compliance. This proactive feature gives CSS the potential to improve Star Ratings measures over time.
"We understand CMS's rules and regulations, and can make it easier for Medicare plans to meet them while still aligning with CMS's focus on value-driven healthcare," Notaro said.
In addition, CSS has developed a "CY 2013 MTM Program Assessment Guide" to help Medicare Plans take a hard look at their current MTM programs and assess whether they are fully compliant and successful. The guide outlines a dozen regulatory and outcome questions that Medicare plans should be asking their current MTM program administrators, including CMR rates, Star Ratings measurements and beneficiary engagement.
"We think of this guide as a roadmap for MTM program sponsors," Notaro said. "It will help them do a quick yet comprehensive inventory of their current MTM offering to determine whether the program meets all CMS requirements, and whether the Medicare Plan is getting the most return on investment."
About CSS: Founded in 1999 by pharmacists and technologists, CSS is staffed by experienced clinicians, software developers and operations personnel who develop innovative and proprietary technology tools that improve patient care while providing financial value.
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Contact: Cheryl Krajna, +1-716-541-0273
SOURCE Clinical Support Services, Inc.
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