The Journey to 4-Star Performance: How Data Analytics Make the Difference

The Journey to 4-Star Performance: How Data Analytics Make the Difference

Posted Sep 16, 2021 from

How the leaders at The Health Plan of West Virginia began a journey to move to higher performance, leveraging data analytics to identify the right strategies the right strategies for improvement and to provide support to close gaps in care

By Rachael Jones and Brenda Cappellini, R.N., CMCN This year, 77% of those enrolled in Medicare Advantage plans with drug coverage are in plans with 4 or more stars, up from 69% in 2017, a Centers for Medicare & Medicaid Services (CMS) analysis shows.

  • To surmount these hurdles, in 2019 The Health Plan became an early user of Cotiviti’s Star Navigator, a quality improvement tool that uses data to determine the most direct path to Star Ratings improvement.
  • A Data-Based Foundation for Success The Health Plan’s experience in using data analytics to achieve a higher rating amid the pandemic provides lessons learned that could help other plans bolster their results, even as Star Ratings criteria change.
  • Make sure they indicate the time of day at which they are most likely to be available as well.
  • As monthly reports point to gaps in care or services, appointing a single person to review the recommendations, prioritize opportunities and lead actions that could drive improvement strengthens efficiency.
  • Brenda Cappellini, RN, CMCN, is Assistant Vice President, Population Health for The Health Plan.

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