Medicare Stars Podcast

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. --- Send in a voice message: https://podcasters.spotify.com/pod/show/dr-peter-saah/message

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. --- Send in a voice message: https://podcasters.spotify.com/pod/show/dr-peter-saah/message

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. --- Send in a voice message: https://podcasters.spotify.com/pod/show/dr-peter-saah/message

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. --- Send in a voice message: https://podcasters.spotify.com/pod/show/dr-peter-saah/message

Welcome to another information-packed episode of "Healthcare Insights Uncovered," where we unravel the complexities of the healthcare industry. In this episode, we take a deep dive into the world of HEDIS audits and provide expert guidance on how to successfully navigate and pass these rigorous evaluations. HEDIS (Healthcare Effectiveness Data and Information Set) audits serve as critical benchmarks for healthcare organizations. As these audits play a vital role in ensuring accurate, reliable data that can be used by employers, consumers and government to compare health plans, it is essential for healthcare professionals to develop a thorough understanding of the process and equip themselves with the knowledge and strategies needed to excel. Together with my esteemed and seasoned quality and compliance expert -Katharine Iskrant, as we explore the intricacies of HEDIS audits. Together, we'll unravel the key components of a successful audit strategy, offering practical tips and best practices to optimize your organization's performance. Katharine shares her insights on how to ensure accurate and complete data reporting, which forms the backbone of a successful audit. We discuss the importance of data integrity, documentation, and effective communication within the organization to streamline the audit process and minimize potential pitfalls. Moreover, we address common challenges faced by healthcare organizations during HEDIS compliance audits and provide strategies to overcome them. From establishing robust data collection and reporting systems to fostering a culture of quality improvement and continuous learning, we explore practical approaches that can enhance your organization's audit readiness. 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 navigate the complex landscape of HEDIS compliance audits successfully. Our goal is to empower you with the knowledge, tools, and insights needed to not only pass the audits but also drive meaningful improvements in patient outcomes and the overall quality of care provided. Click to access presentation slide deck, at your cadence: https://docs.google.com/presentation/d/17kyfQ-_XG3z8eTH0v_jcy-BPIcW0G-Q5/edit?usp=drivesdk&ouid=111997070797299909985&rtpof=true&sd=true --- Send in a voice message: https://podcasters.spotify.com/pod/show/dr-peter-saah/message

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. --- Send in a voice message: https://podcasters.spotify.com/pod/show/dr-peter-saah/message

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. --- Send in a voice message: https://podcasters.spotify.com/pod/show/dr-peter-saah/message

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. --- Send in a voice message: https://podcasters.spotify.com/pod/show/dr-peter-saah/message

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. --- Send in a voice message: https://podcasters.spotify.com/pod/show/dr-peter-saah/message

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. Guest: Katharine Iskrant 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. --- Send in a voice message: https://podcasters.spotify.com/pod/show/dr-peter-saah/message

In this session, we discussed the importance of CAHPS to Medicare Stars, and Valerie provided ways to improve CAHPS results through a partnership between healthplans and providers/healthcare organizations. She explained why setting the right expectations with members is key to member experience and provided examples of how to manage expectations. Listen to hear more. Guest: Valerie Choniuk, MPA-HCA, CPXP 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. --- Send in a voice message: https://podcasters.spotify.com/pod/show/dr-peter-saah/message

Phil shares some tips that can help in the management of an effective HEDIS season. In addition, he also provides information on 2023 CMS HEDIS changes and perspective for the future of HEDIS. Listen to hear details. Guest: Philip (Phil) Collins.  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. --- Send in a voice message: https://podcasters.spotify.com/pod/show/dr-peter-saah/message