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It's that time again for a new Star Year (SY). We are currently four full months into measurement year 2023 (SY2025), and in the final months of closing out the performance for SY2024. During this time, health plans must have a keen eye on two Star Years at once to maximize interventions and try to increase performance. With the pending changes coming into effect that will have a negative impact on plans, such as Tukey Outlier Deletion (SY2024), it is imperative that as we begin SY2025 we have the right plan in place from the beginning.
ProspHire’s Stars experts provided critical strategies to success as we are within SY2025 planning /execution:
SY2024 Expectation Setting: Tukey Outlier Deletion Impacts
As your health plan continues to map out initiatives for SY2025, Tukey expectation setting and education are important to communicate early with leadership and shared services to understand possible impacts to your organizations Star rating in SY2024 and SY2025. With the implementation of Tukey Outlier Deletion and the reality of a potential drop in overall Star rating, plans must understand the implications of Tukey for their plan. It is important to communicate with leadership early and often to allow for future planning efforts to take place. Plans must continue to educate shared services on these impacts to drive new innovative solutions to continue to boost performance with this barrier.
*These results were calculated in partnership with Hyperlift and use methodology that excludes CAI and Reward Factor. QI Measures were applied
Goal Setting Sessions
Within the plan it's critical to analyze your goals early and often within the performance year and select targets that consider the potential Quality Improvement measures and promote significant improvement. Doing measure-by-measure goal setting allows for prioritization of targeted measures that the plan can design specific interventions to promote improvement. It is also important to consider potential Tukey Outlier Deletion impacts for SY2025 projected cut points to allow for more aggressive planning and execution throughout the year.
Stars Strategic Plan
Once targets are established for the performance year, it's imperative to develop a plan by domain that includes targeted interventions and strategies for member outreach and provider partnerships. It is critical that Stars is made a priority throughout the entire organization and measure-level owners are clearly defined to strongly execute defined strategies throughout the year.
Intervention Key Performance Indicator (KPI) Tracking
After you establish a strategic plan for Stars, it is critical to establish ongoing assessments of intervention effectiveness. Ensuring that the plan has regular access to these KPIs will allow for the proactive monitoring of performance and help inform where strategies may be falling short and additional interventions are needed. These should be set for internal interventions and vendor partners driving measure improvement strategies. Access to data is critical to inform planning and performance success.
Additional key themes to consider throughout SY2025:
- Ongoing Training and Education of Stars
- Transparency By All Parties Within Shared Services
- Understand Organizational and Industry Changes
- Ongoing Measure Analysis
At ProspHire, we continue to partner with health plans to offer insights, analysis and execution strategies that improve Star ratings.
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