HEDIS, Star Measures & Nutrition

Posted on Thursday, August 22, 2019

Most plans measure effectiveness and clinical quality, at least in part, through the Healthcare Effectiveness Data and Information Set, or HEDIS. HEDIS reports have become a major component of quality rating systems that measure the clinical quality performance of health plans by Centers for Medicare & Medicaid Services (CMS), states offering Medicaid, and other entities. This set of standardized performance measures is intended to provide purchasers and consumers with the information they need to make reliable comparisons of health plan performance. The measures also tie to significant public health issues, such as cancer, heart disease, smoking, asthma and diabetes.

Today, all Medicare Advantage (MA) plans are tied to HEDIS and Star measures.

Since 2007, CMS has used a 5-Star quality rating system to measure how well providers and Medicare Advantage (MA) plans provide service to members. The rating system is comprised of performance measures from HEDIS, member satisfaction scores, and the results of a health outcomes survey to its own data.

There is certainly a strong incentive for MA plans to perform at peak level—plans achieving a 5-Star rating may enroll new members all year long (versus only at enrollment periods), and Medicare beneficiaries are allowed to switch between 5-Star rated Advantage plans at any time during the year, provided they meet the plan requirements.

Where does nutrition come in?

MA plans are ranked on how successfully they perform in five categories:

  • Staying healthy: screenings, tests and vaccines
  • Managing chronic (long-term) conditions
  • Plan responsiveness and care
  • Member complaints, problems getting services and choosing to leave the plan
  • Health plan customer service

Nutrition is clinically proven to effectively treat and slow the progression of several of the leading chronic conditions, including heart disease, diabetes, renal disease and obesity. According to research, individuals with a chronic condition who receive home-delivered meals have lower average monthly healthcare costs (31% lower), fewer hospital admissions (50% reduction), and a shorter length of stay (37% shorter) when admitted. This can yield substantial savings for health plans and ultimately help boost a plan’s Star ratings—especially considering that one in every four Americans has multiple chronic conditions, and three in four Americans aged 65 and older have multiple chronic conditions.

Further, with the additional flexibility allowed for Special Supplemental Benefits for the Chronically Ill (SSBCI) in the Medicare Advantage and Part D Call Letter, released by the CMS on April 1, 2019  MA plans can now offer meal benefits to chronically ill enrollees if they have a “reasonable expectation of improving or maintaining the health or the overall function of an individual.”

In addition to helping members stay healthy and manage chronic conditions, health plans that offer meals also give a positive impression to their members. Data from Mom’s Meals shows that over 90% of MA plan members would be willing to recommend their health plan because it offered a meal program.

Without a doubt, MA plans face fierce competition when it comes to attracting and retaining members. As consumers shop for the health plan that best suits their needs and their pocketbook, they may just be looking to the stars for the right answer.

Which one best describes you?

Arranging meal delivery for myself I'm an Individual or Caregiver
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