Raise Star Ratings With Dynamic Provider Billing Engagement

Raise Star Ratings With Dynamic Provider Billing EngagementNow that so many Medicare Advantage (MA) health plans have star ratings of 4 or greater, the new challenge for them is how to sustain those numbers as CMS continues to add or change metrics to drive better health outcomes and reduced costs. For instance, CMS has the authority to retire a quality measure that health plans have mastered and introduce a brand-new measure that forces health plans back to the drawing board.

A recent report on the performance of MA star ratings by McKinsey & Company1 indicated that while more people are enrolled in high-performing health plans, lower ratings in the patient experience category show a gap where health plans can make improvements to stay competitive. According to the report, improving provider engagement could go a long way toward boosting star ratings in the outcomes and patient experience categories.

“Investments in this area represent an opportunity for further improvements in underlying stars performance,” the report said. This statement suggests that provider engagement could be a key to improving and maintaining the majority, if not all, of the quality measures pertaining to care delivery, and could help MA plans better adapt when quality measures are suddenly changed or replaced.

The report also offered suggestions for how to improve physician relationships:

  • Invest in opportunities to change provider opinions and care behaviors to improve quality care
  • Provide competitive incentives to close care gaps
  • Provide materials that encourage performance on star ratings
  • Provide advanced analytics and provider web portals with information that help providers close care gaps


Learn more about QICS in this ebook

Solution Advances Quality Care While Improving Provider Engagement

As the McKinsey report suggests, finding ways to influence providers about quality care can change their actions and how they deliver care. Since traditional ways of communicating have not produced the desired result, health plans need to determine a better way to influence their providers.

After building the largest healthcare epayment network, Payspan recognized an opportunity to leverage the network as a tool for health plans to share simplified, actionable communications about care gaps and quality measures with their providers securely via attachments.

Payspan built the Quality Incentive Communications System (QICS) on the network to enable the secure exchange of sensitive medical information between health plans and providers to accelerate the application of quality measures to close care gaps.

Simple Communications Make Participation Easy

Payspan takes raw data from health plans and produces, easy-to-understand care gap alerts, guidance on quality measures and incentives reports that are shared with providers who, in turn, respond with proof of care gap closures to receive incentives. QICS addresses provider challenges by:

  • Eliminating the need to manually enroll and follow up on each health plan’s website
  • Clearly communicating about what care gaps providers should focus on closing, per member-patient
  • Providing clarification on cumbersome hard-to-understand value contracts
  • Reducing administrative labor and costs
  • Magnifying the value of financial incentives to the bottom line

Payspan recently partnered with Insightin Health to provide a member-provider engagement solution that will leverage advanced analytics to identify and proactively close member care gaps.

Helping providers improve outcomes and earn more dollars can help improve care delivery and outcomes broadly across numerous quality measures, enabling health plans to be better prepared for CMS’ surprises.

Learn how Payspan’s quality solution drives provider adoption of value-based care by leveraging electronic payment networks.


Learn more about QICS in this ebook


1McKinsey&Company: Healthcare Systems & Services, “Assessing the Medicare Advantage Star Ratings,” July 2018