Lilac Software

Is your #MedicareAdvantge plan ready for the added complexity of managing drug measures in the coming Star years? These measures saw a dip in scores in the latest Star performance data and CMS is adding two new drug measures that require oversight in Jan 2025 (reach out if you could use help ensuring you're on top of things!). In his latest article, Marc S. Ryan ???? breaks down recent drug measure trends, what's coming up and gives some tactical suggestions. This is a primer for a more in depth article on best practices in managing drug measures. https://lnkd.in/eDSAgyyJ #CMS #MAStars #healthcare #healthtech

Clinical Measures are some of the most important measures for an MA plan to "get right." They have a big impact on Stars score and, most importantly, they tie directly to the well being of members. Check out Lilac Software's guide defining some of the main challenges and best practices for delivering high performance in this crucial set of measures. We'll be putting together a series of such guides so stay tuned for more useful resources! https://lnkd.in/gPQ2yaF3 #MedicareAdvantage #MAStars #CMS #healthcare

The future of #MedicareAdvantage has a load of challenges and opportunities, as was clearly laid out by Bill Georges in his recent article in MedCity News. A core reason we built our #Stars platform is to empower plans to navigate the headwinds to seize opportunities and deliver better care for America's aging population. Check out how we do that in our latest post and reach out if you want to explore what we can do for your plan. https://lnkd.in/eZRRJbwt #MAStars #CMS #healthcare #healthtech #insuretech #payertech

Wondering what the recent elections mean for the healthcare system? Our Marc S. Ryan ???? joined Erik Sunset and the DocBuddy podcast to discuss what the new administration and unified government might mean for many parts of the healthcare system and in particular government run programs like #Medicaid and #Medicare. Check it out to start getting your ahead around the different scenarios that could unfold!

Lilac board member Bill Georges (former Chief Strategy Officer of Horizon BCBS of New Jersey and current AlleyCorp Partner) published a great piece in MedCity News about the future of Medicare Advantage. Bill makes an impassioned case that the importance of MA and the business opportunities it offers make it worth the challenges. Spoiler alert - one of the keys to success in MA is leveraging data and advanced analytics to drive better care management, member satisfaction and operational efficiency. Check out the article and reach out to Lilac Software if you're interested in learning how we can strengthen your plan's Stars analytics for improved performance. https://lnkd.in/gYH8PmKS

?? Calling all Medicare Advantage (MA) plans! New CMS info!?? ? Are you taking supplemental benefit encounter data submissions seriously? ? ? Below is the latest in a series of memos on the new CMS requirement to submit encounters for all supplemental benefit utilization. ? Check out this memo as well as a series of memos in HPMS on the subject. ? As well, note the links to the website that capture all documents on the subject and the slide deck from a recent webinar. The slide deck is a very valuable resource. ?? ? So, what is this ? ? CMS and Congress have questioned the amount of rebate dollars going toward supplemental benefits and whether utilization in bids are accurate. Submission of encounter data on the benefits will help determine the true value. ? This is one part of the reform. The other is mandatory education and a midyear utilization report to members. ? I think CMS has acted reasonably in terms of reforms. The agency has made great progress with plans to make clear how supplemental benefits should be submitted as encounters. Kudos to CMS! ?? ? But this will be a long journey, with technical and policy bumps. ? CMS is approaching this very collabroatively as both sides -- the agency and plans -- have a lot to do. Kudos to CMS again! ?? ? Note the concilliatory tone in the memo (I guess as concilliatory as a regulator can be!) and the lack of a formal deadline for submission of 2024 dates of service. CMS is being realistic about the long journey toward compliance. Kudos again to CMS! ?? ?? The takeaway: MA plans need to take this mandate seriously. CMS will be monitoring those MA plans that are not submitting supplemental benefit encounters. Don't get caught in CMS' net by not making progress. ?? Lilac Software is building a state-of-the-art data analytics platform to support health plans demystify data, meet government mandates, lower costs, and improve outcomes. Check us out at https://lilacsoftware.com/ . #cms #supplementalbenefits #encounterdata Lilac Software

Over the past several weeks I have published a series of LinkedIn posts on 2025 Medicare Advantage Star and past trends. You can search my feed for the entries. They began just after the Star announcement in early October. You can also visit Lilac Software's Knowledge page for our great Infographic on 2025 Star and our blogs and podcast here: https://lnkd.in/e4V-zfYV . I wanted to close out the series with a few final thoughts. ?? The challenges and the "long tail" of Star. ? Star Year 2025 continues the theme that Star achievement remains a huge challenge for plans big and small. ? What many plans fail to appreciate is the “long tail” of Star. The 40 plus measures for MA-PD plans are a curious concoction of clinical, survey, and plan performance measures. Data used to calculate a given Star year may be one year back for CAHPS and two years back for HOS surveys, clinical measures, and plan performance metrics. Once you get a Star score, it does not impact your revenue until the next payment year. ? What’s more, plans have to be working multiple Star years at once due to this lag. ? The point is that MA plans can never lose focus on the program, or they risk huge fallout well into the future. ?? Why are plans having a hard time? ? Many plans lack the technology, clean and timely data, and expertise to hone a consistent and high-performing program. ? They also lack the agility to respond to CMS changes in the Star program. ? The technology to analyze and keep tabs on all the years, measures, and formulas also is key. ?? Continued tough financial times. ? The Star Year 2025 results signal continued tough financial times moving forward. Given the results, Star revenue will drop again in the 2026 payment year. The risk model change will already mean low rates in 2026.?More benefit reductions could be on the horizon. ? Thus, investments in Star are critical for long-term financial success. ?? A fundamental reassessment coming? ? The 2025 Star results could lead to a fundamental reassessment in Congress and at CMS as to what is going wrong. ? Congress and CMS could consider a major rework of the program. ? MedPAC, the congressional policy arm for Medicare, is especially keen on changing the program in many ways. ?? Plans must realize Star is a continuous quality improvement program. ? Star is meant to challenge health plans to drive better and better quality each year. ? We can debate certain actions taken by CMS along the way. I support the lawsuits pushing accountability and transparency by CMS. ? A new study concludes that MA saves across Medicare and that should be celebrated. ? Plans need to consistently meet the quality improvement challenge. Lilac Software has built industry-leading technology with data analytics and best practices to improve Stars and more. Learn more at: https://lilacsoftware.com/ . Lilac Software

Hoping that the MA Stars landscape will get easier going forward? The reality is we are likely entering into a new normal where high performance is more challenging. Marc S. Ryan ???? lays out some upcoming changes that add layers of complexity to managing Stars programs. Lilac Software has the technology and expertise in Stars and data science that's needed to navigate the increasing complexity and deliver great scores and member satisfaction. Reach out if we can help your plan and/or follow our page for regular posts with useful insights! #medicareadvantage #CMS #MAstars #healthcare #healthtech #datascience

Want a quick snapshot of the MA Stars measures that plans were most commonly able to improve and which showed the most declines? Take a look at Marc S. Ryan ????'s most recent post analyzing Stars data if this kind of benchmarking would be useful for you.

Lilac Software's very own Marc S. Ryan ???? shares his next round of insights from our Star data analysis and infographic. This post focuses on some important nuances in how movements at the measure level impacted overall scores (hint: measure weightings mean just as much as measure movements).