Star Ratings and Distance Running

I'm a relatively new runner. I ran track in high school, but I was a sprinter and long-jumper; not a distance runner. The past two years, I've picked up distance running. I began it with the goal of keeping my gut and heart in check, but it's become a way more meaningful activity than just that.

Two years ago, I couldn't jog 5 minutes. I slowly built up endurance and started running 5K's. And then I eventually ran 10K's, which forced me to run more than an hour continuously for the first time ever. Yesterday, I ran my first 10-Miler, which was just over two hours for me. It kind of sucked and was kind of glorious, all at the same time. Like much of life. And I had a few #Stars epiphanies while running.

First epiphany: The longer the race, the more separation there is between runners.

A 5K is more tightly clustered, but a 10-Miler has a much longer duration which causes the differences in pace to be magnified. Slower runners are in the back "cluster". There are obviously some seasoned runners in the back who just happen to have a slow pace, for many different reasons, but a good percentage of those runners in the back are likely newer runners. Distance running takes stamina, and that typically has to be developed over time.

Similarly with #MedicareAdvantage plans, age matters when it comes to #StarRatings. In most cases, the longer your plan has been in existence, the better it will perform. This is not always true, of course. Devoted Health , as just one example, came out of the gate with a 5-Star plan this year. A rare achievement. But generally, it takes time to develop the foundation and culture needed to be excellent in Stars. For example...

• BlueCross BlueShield of Tennessee achieved 5 Stars this time for the first time, after spending years building an incredibly strong and thoughtful foundation. An incredible achievement this year, absent of disaster relief.
• Select Health achieved 5 Stars for the second year in a row, after being a perennial high-performer for years at the 4 and 4.5-Star level. Again, absent of disaster relief, proving that not all plans were "gifted" their rating last year, as Mick Twomey has said many times and proven with his analysis across several of our common clients.
• And in a year when some of its competitors at the national level struggled, Cigna Healthcare achieved 5 Stars in its largest contract, which was perennially high-performing at 4.5 Stars but had not achieved 5 Stars even last year with disaster relief. Herculean.

To climb the learning curve, it takes a mix of patience, urgency, humility to admit that there is a lot to learn, and collaboration with other Stars people who have walked in your shoes.

This year, there is more separation in the Star Ratings distribution than in years. (Thanks Jeff Schoenborn, MPH for quickly observing this.) There are almost as many <3-Star plans this year as there are 5-Star plans. This is driven by many, many things, but I believe the #1 factor is simply how effectively an organization prioritizes its focus on Star Ratings. There are lots of factors out of our control, but none of them are out of our influence.

Second epiphany: Running is difficult, but it brings enormous benefits to the body and mind. It tests the limits of our physical and mental abilities.

Likewise, Stars is difficult, but it presents the opportunity to build enormous synergy within our health plans, to become excellent at the things we can control, and to learn how to more strongly influence the things we can't.

Effective organizational engagement is one of the key traits of high-performing plans, and Stars is the perfect program to build that cross-functional engagement muscle. To develop relationships that didn't exist before. To transfer accountability to the point in the organization where influence is the strongest on that specific measure or activity. To collaborate across silos, thereby breaking them down. To teach your senior leadership team how to help steer this program across the enterprise by sending the right message to their teams, breaking down barriers, and prioritizing the most-needed initiatives.

Stars, like distance running, takes time, focus, discipline, and recovery. Don't forget to recover. Take time. Sometimes, that's only in July when HEDIS, CAHPS, and the Call Center measures are behind us and PP1 is ahead of us. But December is also an important time to recover, and it's just ahead of us. Taking time at the end of one measurement year and before the next one begins can be the best time to recharge. You might think you can't afford to take a break. I would argue that you can't afford not to. As bad as I want to go to the gym today, I know my body needs to recover from yesterday. And I have my first Half-Marathon in 3 weeks.

May we all accept our limitations... then go beyond them.