Rex Wallace Consulting, LLC

We are excited to welcome Jennifer Nguyen, MPH, CHES and Paige Caprara to our team! Jennifer’s deep expertise in Medicare Stars and health equity, combined with Paige’s extensive background in Medicare strategy and value-based contracting, will strengthen our capabilities to provide unparalleled strategic insights and execution support for our clients. Their proven track records in enhancing healthcare outcomes and operational efficiencies will drive impactful improvements and exceptional results. Join us in celebrating their arrival and the value they bring to our firm, and learn a little more about each of them below: ? Jennifer Nguyen?has over ten years of diverse experience in the payer field, healthcare industry, and non-profit sector. With a Master’s degree in Public Health and certification as a Health Education Specialist, Jennifer has a strong foundation in health equity and health outcomes. She previously led the Medicare Stars Program at a local carrier, where she developed and executed multi-year Stars strategies across multiple contracts, and implemented strong program governance as the owner of executive committees and workgroups. Her extensive knowledge of Medicare operations and oversight, along with her passion for quality improvement, will be instrumental in driving our initiatives forward through comprehensive execution guidance. ? Paige Caprara?brings a rich background in healthcare management, with more than a decade of expertise in Medicare strategy, population health, and value-based contracting. Holding a Bachelor’s degree in Human Development, Family Sciences, and Middle Childhood Education. Paige has a unique blend of skills that enhance her strategic approach. She has extensive experience on both the provider and payer sides of the healthcare quality ecosystem. Paige has supported quality improvement, patient outcomes, revenue capture, and operational efficiencies for Accountable Care Organizations, Clinically Integrated Networks, and IPAs through leadership roles at WellCare/Centene Health Plans. She led a national team of Stars Improvement strategists focused on enhancing healthcare outcomes and Stars performance across the organization’s 100+ H-contracts. Paige’s multifaceted experience will be a tremendous asset to our team.

Rex Wallace Consulting, LLC is thrilled to join RISE this week in Orlando. If you're in attendance, there are several chances to hear RWC speak: First up, Rex Wallace, CEO, will speak on using Product Design to boost Star Ratings (Product Design Master Class, Monday, 1:20pm) with CareFirst BlueCross BlueShield and Amplifon Hearing Health Care. Next, Luis Cerda will join Blue Cross Blue Shield of Massachusetts to talk about the role of Part D in Stars (Part D Master Class, Monday, 3:20pm). Over at the Member Engagement & Experience Summit: Rex and Luis will talk about the importance of Trust in your Stars and Member Engagement Strategy (Monday, 11:10am). Luis will moderate a roundtable on Improving Access to Care, and Rex will moderate a roundtable on the importance of vendor oversight (Monday, 4:20pm). Return to the MX Summit on Tuesday to catch Nate Lucena, Chief Strategy Officer, speaking with Circle and Baylor Scott & White Health Plan on addressing health equity in LGBTQ+ Seniors (Tuesday, 9:45am). Finally, Heidi Salerno, MX guru, will join Clover Health to talk about all the best practices you need to improve CAHPS and HOS. It's going to be a busy couple of days, but find us in your downtime to connect! We can't wait to see you all.

Small, medium, and large shifts in CAHPS benchmarks this year! If you haven't seen your Westat memos, get in touch with your product compliance contacts today. At Rex Wallace Consulting, LLC we have a comprehensive approach to improving the member experience, including best-practice strategies, tools, and analytics that have generated big results for our clients. Reach out to Nate ([email protected]) and our industry-leading MX expert Heidi (heidi.salerno@rexwallaceconsulting) to get your CAHPS improvement strategy to the next level!

The ins and outs of the annual Call Center Monitoring study, which feeds two heavily-weighted Star measures, have stepped into the spotlight with recent payer lawsuits against CMS. The limited sample sizes and murky program execution (calls never connecting? anyone?) mean that every single call has a huge impact on Stars. Check out the infographic and call to action from Nate before you slam that laptop shut for the weekend!

This one goes out to all our fellow Stars nerds out there. Enjoy some Friday afternoon maps! #MedicareStars #Tukeygate

We are immensely proud to announce that Nate Lucena, our Chief Strategy and Analytics Officer, has been recognized by the St. Louis Business Journal as a 2024 Business of Pride Honoree! Nate sets a new standard in championing workplace authenticity and equity. His standout leadership on the Health Equity Technical Expert Panel for the Pharmacy Quality Alliance and his pioneering work in incorporating sexual orientation and gender identity data into health equity initiatives distinguish him in the field. Beyond his professional achievements, Nate's profound community impact through co-founding WILDFRUIT Projects and his leadership on purpose-driven boards make him an invaluable contributor to our firm, industry, and the broader discourse on LGBTQ+ equality. Nate's recognition underscores the limitless impact of promoting diversity and inclusion, demonstrating that anyone can drive meaningful change. As Nate powerfully stated in the SLBJ article, "The ways in which we show up to build inclusive cultures can be as unique as our fingerprints, and when we create space for that, we end up with a whole that is greater than the sum of its parts." Congratulations, Nate! A link to full article written by the St. Louis Business Journal can be found here: https://lnkd.in/g5yizcx5 #Pride2024 #LGBTQIA

RWC is growing, and we're excited to announce that we're seeking two full-time additions to our team! If you'd like to learn more, please reach out to Nate at [email protected].

Check out this fun and informative weekend update of all things #SCAN, #Elevance, #CMS, and #MedicsreStars with RWC CSO Nate Lucena and our very smart friends Jenn Kerfoot of DUOS and Jessica Assefa of Ameropia Advisors! Link in post.

Are you ready? Recalculations for Stars 2024 are out, and plans can re-tool and re-submit bids and formularies if they've been impacted. Get details and a copy of the memo at the post below, and you can contact anyone at Rex Wallace Consulting, LLC if you're unsure what your next steps should be! #MedicareStars #MedicareAdvantage

Last Friday (June 7, 2024) Judge Randolph Moss from the District Court of Columbia issued a memorandum opinion and order that granted relief to Elevance’s contract H5422 (BCBS of Georgia), while not conceding it for the remaining contracts included in the lawsuit. ? Here's what you need to know from our Strategy Officer Nate Lucena and Policy & Data Analyst Angelo L. Rexach Guzmán :? ? 1. Court’s Decision: - CMS contended that only contract H5422 (BCBS of Georgia) had shown sufficient evidence of injury due to alleged regulatory violations. - The court agreed with CMS, ruling that only BCBS of Georgia was entitled to the relief sought by the Plaintiffs. ? 2. Elevance's Evidence: - To demonstrate standing, Elevance brought in an expert to analyze the cutpoints, showing the impact of CMS’s use of simulated instead of actual 2023 Star Ratings cutpoints. - The analysis showed that contract H5422 would have received a higher star rating for C25, D01, D02, increasing from 3 stars to 3.5 stars overall. ? 3. Plaintiffs' Shortcomings: - Plaintiffs did not provide additional evidence for other contracts, nor could they prove that other contracts would be similarly affected by CMS's actions. - The Court found insufficient argument or evidence to establish standing for the?other?contracts?involved. ? 4. Consistency across Scan and Elevance decisions: - Judge Moss's decision aligns with the recent ruling published by Judge Nichols in the Scan lawsuit, emphasizing that CMS must adhere to regulatory requirements rather than preamble statements. - Furthermore, Judge Moss referred to Judge’s Nichols decision on Scan Health Plan lawsuit on a couple of occasions as part of the evaluation of the use of Simulated 2023 Cut Points in 2024 Star Ratings. ? What’s Next?? - The 2024 Star Ratings for BCBS of Georgia will be set aside, and CMS must redetermine these ratings according to the court’s opinion. - CMS may extend similar relief to other Medicare Advantage Organizations (MAOs) through the administrative process. However, CMS has not stated how they will handle issues with other contracts. - Yesterday (June 10) Zing’s Attorney filed a notice of supplementary authority including both SCAN Health Plan and Elevance’s memorandum opinions as exhibits for the ongoing case with CMS. If you are a health plan considering similar litigation, please make sure that your expert(s) have the proper and sufficient data to clearly?show you had a difference in your Star Ratings performance. If you're not sure where to start, reach out to [email protected] or [email protected] to assist your team on the most effective path forward. #StarRatings #CMS #MedicareAdvantage https://lnkd.in/egemSH5s