In this episode, we shine a spotlight on two essential components of healthcare quality measurement and improvement: the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and the Centers for Medicare and Medicaid Services (CMS) Star Ratings. Join us as we uncover the intricacies of these programs and their role in driving excellence in health plans.

The CAHPS survey serves as a vital tool for capturing patient experiences and perceptions of care across multiple dimensions. CMS Star Ratings, on the other hand, provide a comprehensive assessment of health plan performance, guiding consumers in making informed decisions. Together, these initiatives play a significant role in quality improvement, accountability, and enhancing member satisfaction.

In this episode, Jessica Asefa, a healthcare leader, provides effective strategies for maximizing performance in CAHPS and CMS Star Ratings. Throughout the episode, we discuss practical strategies for health plans to optimize their performance in CAHPS and CMS Star Ratings. From enhancing patient engagement and communication to implementing evidence-based interventions and care coordination initiatives, our guest shares valuable insights on how to drive continuous improvement and achieve high ratings.

Whether you are a healthcare executive, a quality professional, or a provider directly involved in patient care, this episode is a must-listen for anyone seeking to elevate their health plan's performance and deliver exceptional care experiences.

In this episode, we delve into the profound significance of data in addressing health equity, and how it can be a catalyst for transformative change. Health equity remains a critical challenge in our society, with disparities in access to healthcare and health outcomes persisting across diverse populations. The key to tackling these disparities lies in understanding the root causes and implementing targeted interventions. Join us as we explore the role of data in this process and uncover its power to drive meaningful progress in achieving health equity.

Our esteemed Carissa Stajnrah, share her perspectives on the importance of data in addressing health disparities. We dive into the nuances of collecting, analyzing, and interpreting data to identify and address inequities at individual, community, and systemic levels.

Throughout the episode, we explore the ways in which data can reveal patterns and insights, uncovering disparities related to race, ethnicity, socioeconomic status, geography, and other determinants of health. Carissa also highlight the significance of community engagement and partnership in leveraging data for health equity.

RADV has become increasingly important in today's landscape, as it directly impacts the financial stability of healthcare organizations. It involves a comprehensive review and validation of the clinical data used for risk adjustment, which determines reimbursement levels for health plans and providers. Join us as we uncover the intricacies of RADV and explore strategies for maximizing accuracy and compliance in this crucial process.

Our expert guest- Melissa James, a seasoned risk adjustment professional and a senior consultant provides valuable insights on how the Final rule on RADV audit will impact RA as whole. We also discussed what extrapolation looks like and what plans can do to comply with the rule.

Moreover, we discuss the significance of compliance in RADV and the potential consequences of non-compliance. Our expert shed light on the regulatory landscape, sharing tips on how organizations can stay abreast of changing guidelines and maintain adherence to risk adjustment regulations.

Whether you are a healthcare executive, a risk adjustment professional, or a provider involved in documentation and coding, this episode offers valuable insights into optimizing RADV processes. By implementing effective strategies and focusing on accuracy and compliance, organizations can improve financial stability, drive appropriate reimbursement, and enhance the overall quality of care provided.

In this episode, we dive into the dynamic world of health plans and uncover effective strategies for driving meaningful quality improvements in these complex organizations.

Health plans play a crucial role in the delivery of healthcare, acting as the bridge between providers, payers, and patients. As the industry continues to evolve, it is imperative for health plans to adopt robust quality improvement strategies that not only meet regulatory requirements but also elevate the overall quality of care provided to members.

Ryan Bernstein shares effective strategies that health plans can employ to enhance the delivery of care and maximize member satisfaction.

Throughout this episode, we delve into key areas of focus for quality improvement in health plans. From the development of comprehensive quality metrics and performance measurement frameworks to the implementation of evidence-based clinical guidelines and best practices, we provide insights into the building blocks of a successful quality improvement program.

My guest share his experiences and lessons learned, highlighting real-life examples of successful quality improvement initiatives within health plans. We discuss the importance of data analytics, leveraging technology, and fostering collaboration among stakeholders to drive meaningful change and improve health outcomes for members.

Furthermore, we explore the critical role of member engagement and communication in quality improvement efforts. Ryan delves into effective strategies for educating and empowering members to actively participate in their own care, fostering a sense of partnership and shared responsibility.

Whether you are a quality professional working within a health plan, a healthcare executive responsible for organizational performance, or a provider seeking to optimize care coordination, this episode offers valuable insights and practical guidance.

In the episode, we delve into a topic that has gained significant attention in recent times—burnout and wellbeing among quality professionals.

Join us as we explore the challenges faced by these dedicated individuals and discuss effective strategies to maintain a healthy work-life balance while pursuing excellence in their roles. Burnout has become an all-too-familiar experience for many quality professionals. The relentless pursuit of high standards, coupled with the pressure to deliver flawless outcomes, can often lead to exhaustion and a sense of overwhelm.

We explore the telltale signs of burnout and delve into its potential consequences, both for individuals and the organizations they serve. My expert guest - Nidhi Tewari, LCSW, share her insights, offering practical advice on how quality professionals can prioritize self-care and maintain their wellbeing amidst demanding work environments.

We discuss the importance of setting boundaries, managing workload effectively, and fostering a supportive workplace culture that values mental health and work-life balance. Additionally, we shed light on various strategies that quality professionals can adopt to prevent burnout and promote their overall wellbeing.

Remember, investing in the wellbeing of quality professionals not only enhances their personal lives but also positively impacts the quality and effectiveness of the work they deliver. Join us as we prioritize the people behind the processes and redefine what it means to excel in the world of quality improvement.

Globally, healthcare leaders are progressively looking to embed the principles of continuous improvement in their organizations. Enabling staff to deliver safe, equitable, high-quality, reliable care can provide a step-change in results. In this episode, Tracey provides tips on building a continuous improvement culture.

Guest: Tracey Papas

Listen in to The Medicare Stars Best Practice Podcast for discussion, insights and perspectives from subject-matter expects knowledgeable names in the managed care industry. Tune in and subscribe for future episodes.

Any views, thoughts, and opinions expressed in this podcast are solely that of the individual's and do not reflect the views, opinions, or position of the panelist's employer, organization, committee or other groups.

What will be the impact if every provider understands the importance of submitting CPTII and also complies? The world of quality will be much easier as submitted encounter codes will close gaps and plans will have no need for chart retrieval activities that requires resources on both sides✅ 👍👌

In this episode we discussed the importance of CPTII codes in addressing care gaps, provider barriers to utilizing CPTII codes and providing them with the resources, education, reinforcement, tools, building trustful relationship and staying persistent has proven to be helpful. It’s about impacting one provider at time.

Guest: Eden Anne Encarnacion

Listen in to The Medicare Stars Best Practice Podcast for discussion, insights and perspectives from subject-matter expects knowledgeable names in the managed care industry. Tune in and subscribe for future episodes.

In this episode, we talked about the financial implications of CMS proposed changes and what plans can do to mitigate these headwind changes. Rex is the guest on this episode. Rex is a quality consultant with over 30 years of experience, the CEO of Rex Wallace Consulting. RWC was created to help health plans improve Quality.

Guest: Rex Wallace

Listen in to The Medicare Stars Best Practice Podcast for discussion, insights and perspectives from subject-matter expects knowledgeable names in the managed care industry. Tune in and subscribe for future episodes.

Katharine is a HEDIS auditor, the president of Healthy People; with 25 years of experience. She is also a member of NCQA's Data Collection Advisory panel. Health People is a HEDIS audit firm.

This episode is a deep dive into 2024 CMS AN, Proposed Rules, and HEDIS Public Comments released on February 13, 2023. Katharine also provides strategies on how plans can succeed with respect to these proposed changes.

Listen in to The Medicare Stars Best Practice Podcast for discussion, insights and perspectives from subject-matter expects knowledgeable names in the managed care industry. Tune in and subscribe for future episodes.