The Affordable Care Act was introduced in 2012. Since then, Medicare advantage
bonuses and rebate levels were tied back to...
For more information, visit Syntel online at www.syntelinc.com
or call us at US/+1 (248) 619-3503, UK/+44 (0) 207-636-3587...
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Syntel’s Star Rating Improvement and Tracking Solution for Healthcare Payers

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Syntel has developed a comprehensive solution for Payers to analyze and improve their CMS star ratings. The solution reduces effort and time-to-market for star rating improvement program implementation. It facilitates rule-based segmentation and prioritization, with detailed analysis of current measures. It also includes a real-time reporting and tracking dashboard to predict and generate alerts, enabling users to identify and act on improvement areas.

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Syntel’s Star Rating Improvement and Tracking Solution for Healthcare Payers

  1. 1. The Affordable Care Act was introduced in 2012. Since then, Medicare advantage bonuses and rebate levels were tied back to the Center for Medicare and Medicaid services (CMS) five star quality rating system. CMS issued higher bonus payments to the best-performing carriers, while three stars and lower ratings were tagged as “low performing”. According to the 2015 CMS mandate, health plans with three stars and low rating for three consecutive years will be terminated. This will result in Payers facing high member attrition. Further cuts in Medicare advantage payments might lead Payers to face increased provider attrition, which directly impact care delivery. To balance ratings and provider attrition, Payers must maintain high star scores with enhanced provider engagement. However, Payers are challenged by the lack of technology to calculate and monitor their star ratings for Part C and D performance measures. Currently, there is no accurate way to calculate the star ratings of Payers, or identify quality or performance shortfalls. Payers can fall victim to incorrect forecasts, because of the inability to pinpoint improvement areas or adequate intervention strategies. Payers also struggle hard to monitor and deliver rewards to providers for their exemplary care services. Syntel’s Star Rating Improvement and Tracking Solution for Healthcare Payers Business Benefits • Maximized bonus payments: Up to 5% maximized bonus payments with improved star ratings • Reduced payment cuts: Ensures additional bonus and protection from extra 3.5% payment cuts • Increased enrolment: Increased five-star contracts enrolment through Special Enrolment Period (SEP) • Increased member satisfaction: Lower voluntary disenrollment rates resulting in enhanced member satisfaction • Larger rebates: For bids under benchmark contract rate • Comprehensive dashboard: Complete and accurate view of the Payer’s performance on star measures that recognizes the quality and efficiency of improvement opportunities • Lower customer attrition: Protects against customer base reduction due to improvement in the relative performance of competing plans Syntel’s Solution Syntel has developed a comprehensive solution for Payers to analyze and improve their CMS star ratings. The solution reduces effort and time-to-market for star rating improvement program implementation. It facilitates rule-based segmentation and prioritization, with detailed analysis of current measures. It also includes a real-time reporting and tracking dashboard to predict and generate alerts, enabling users to identify and act on improvement areas. Our four-staged approach includes: Data Analysis Extract Data • HEDIS, member, claims, lab and medical data, provider data Prioritize Member Data • Impact analytics • Risk assessment Integrate Data with Outreach Arms • Retail clinics • Outreach partners • Care management Reporting Dashboard Track Performance • Performance trends • Intervention tracker Generate Reports • Region, contract, physician performance Plan Intervention • Root cause analysis • What-if analysis • Granular analysis Outreach Campaign Member Targeting • What-if modeling • Member prioritization • Geographic distribution Coordinating Alerts • Alerting and scheduling (IVR, portal, mobile applications) Remediate Non-compliance • Outreach partners • Retail clinics Provider Engagement and Incentivization Provider Engagement • Clinical data extraction • Gap analysis • Automatic alerts Provider Incentivization • Real time reward processing Star Rating - Tracking and Improvement Process
  2. 2. For more information, visit Syntel online at www.syntelinc.com or call us at US/+1 (248) 619-3503, UK/+44 (0) 207-636-3587 Syntel’s Star Rating Improvement and Tracking Solution for Healthcare Payers © 2014, SYNTEL INC. 052014 Syntel Differentiators Why Syntel? Solution Highlights • What-if analysis and outreach for member engagement in star rating improvement • Star rating reporting and tracking dashboard to monitor plan ratings, by viewing the plan performance in real time and meeting the benchmarks specified by CMS • Target member segmentation and prioritization: Priority indicators to predict and target non- compliant members • Provider portal enhancement: Analyze members’ data to identify gaps in care and send alert mails/reminders to providers to notify them of the gaps • Provider incentivization and engagement: Incentivizing providers for their remarkable service performance assessment • Star rating improvement: Early identification of measures with low star ratings, and engaging providers and members to improve the same Extract medical claims, lab results, and membership and HEDIS data from the core Payer systems Powerful database cleansing through a variety of techniques, including standardization, transformation and rationalization while maintaining an accurate audit trail Transformation routines and analytics for member segmentation Member prioritization approach based on member risk and impact Load target member data into Payer care systems/clinical improvement program via outward interfaces Alert mails/reminders to providers for gaps in care reduction through Provider Portal Data Extraction Data Cleansing & Staging Member Segmentation Member Prioritization Load Target Member Data Maintenance Approach to Gap Identification Targeted Gap Identification

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