Moving from 3.5 to 4.0 stars can add up to $62.5 million in annual Quality Bonus Payments

Abacus Insights, the leader in data usability for U.S. payers, is launching its breakthrough Stars Performance Data Solution to equip payers with the insights-ready data^TM to accelerate improvement in quality outcomes and member and provider experience, which will in turn boost Medicare Star Ratings. The data solution eliminates the current heavy burden of regularly wrangling data from multiple sources and manually integrating results across vendors and formats, empowering payers to focus more on executing interventions that result in improved quality, enhanced experience, and better Star Ratings.

The Stars Performance Data Solution integrates data from a payer’s internal and external data sources, including proprietary vendor formats, and delivers a single, integrated, harmonized foundation of usable data for Star Ratings. The solution automates performance on key Star Rating measures with source data refreshed as frequently as every 15 minutes and displayed alongside predicted cut-points and CMS measures to advance health equity, yielding contract-level Star Ratings estimates. The Stars Performance Data Solution delivers data usability and performance visibility that gives payers decision-making confidence and enables laser focus of limited resources on priority interventions that impact performance.

Moving from a 3.5 to 4.0 Star Rating means earning up to $62.5 million in quality bonus payments per Medicare Advantage contract for a MA plan with 150,000 members and an average quality bonus of $417 per enrollee, for 2023. The Centers for Medicare and Medicaid Services offers 5% quality bonus payments to MA plans with ratings of 4 stars or above, providing a significant source of revenue that can be used by payers to expand benefits or offer programs designed to attract and retain members.

“Payers can’t afford to spend the majority of their time manually corralling data for Star Ratings and HEDIS reporting, then scrambling at the end of the year to try to move the dial on performance,” said Minal Patel, MD, founder and CEO of Abacus Insights. “As the leader in usable data, our Stars Performance Data Solution takes average data that would otherwise generate average results and transforms it into insights-ready data™ for creating interventions that improve care and outcomes, smartly allocating resources, and informing contract-level budgeting and bids throughout the year.”

Consider Controlling Blood Pressure (CBP), a triple-weighted Stars HEDIS measure. Hypertension is generally diagnosed during a primary care visit, followed by a payer receiving a medical claim that identifies a member as having hypertension but does not include clinical details and information for a payer to act on. While current procedural terminology (CPT) 2 codes contain more accurate medical data, providers do not regularly include them in the medical claim because they are optional and do not impact reimbursement.

Abacus Insights’ Stars Performance Data Solution flags providers that don’t document CPT 2 codes, enabling payers to develop an intervention strategy such as offering an incentive personalized to those providers. This on-demand capability facilitates additional care management and care gap closure opportunities, more accurate documentation of members’ health status, greater collaboration between payers and providers, and a focus on quality initiatives and interventions that improve Star Ratings performance.

The Abacus Insights’ Stars Performance Data Solution gives payers the usable data they need for unmatched success in Medicare Advantage Star Ratings:

• Get Stars data integrated across all data sources, systems and formats.
• Measure cut point projections and CMS adjustments to predict performance.
• Monitor progress and trend performance on Star Ratings at the measure, member, provider and contract level.
• See plan-wide performance to catalyze resources to improve measures.
• Take action with resources allocated to close gaps and improve performance.

With the only HITRUST r2-certified and SOC2-certified data transformation platform and data solutions developed specifically for payers, Abacus Insights begins delivering value within 4 to 6 months with 60% lower TCO than internal builds. The company integrates with and leverages legacy tech stacks while providing tech currency and scalability. Abacus Insights manages data for more than 23+ million health plan members.

For more information on the Stars Performance Data Solution, click here.

About Abacus Insights

Abacus Insights is a healthcare technology leader with the only data transformation platform and data solutions built specifically for health plans. By setting the new standard of payer data to usability, Abacus Insights gives payers a new level of control and flexibility to support analytics and operational use cases. Managing data for 23+ million members, Abacus Insights partners with payers to deliver scalable solutions that drive strategic initiatives, control costs, and improve member lives and experiences.

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