Custom Solutions to Improve Your CMS Star Rating

By tapping into our nationwide network of over 5,000 licensed pharmacists, we empower health plans to improve their star rating and provide the highest level of care to their members.

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Overview

One of the key components to any high-performing health plan is a great CMS Star Rating. Star Ratings are an indicator that the health plan is effective in key areas such as managing disease, preventive care, and delivering the best service to their members.

High Star Ratings are vital to both the well-being of a health plan and the health plan’s members. Quality Bonus Payments (QBPs) are paid to high-performing health plans based on the Star Rating. Simply put – the higher a plan’s Star Rating, the higher the QBP. Larger bonus payments make room for health plans to reinvest funding in improving member care and overall member experience.

Aspen RxHealth and the Six Domains of Health Care Quality

Breaking down health care quality into six domains allows health plans to segment quality measure initiatives and target the areas that may lag behind:

  • Safe: Is the patient getting care that will avoid harm to them?
  • Effective: Is the patient getting the most appropriate care for their condition?
  • Patient-centered: Ensuring that care to the patient is responsive and respectful
  • Timely: Is the care delivered at the right time?
  • Efficient: Avoiding waste of all kinds (time, financial, supplies, etc.)
  • Equitable: Providing high-quality care regardless of the patient’s location, background, gender, race, or other personal characteristics

By using highly qualified clinical pharmacists, Aspen RxHealth ensures that the care we provide to health plan members is always the best it can possibly be. We intelligently match pharmacists and members using our proprietary algorithms based on clinical factors like specialty and claims data, along with social factors such as language, geographic location, and more.

Providing Excellence in All Areas of Quality

We know that it’s not easy for health plans to closely manage each quality measure to ensure the highest rating. While our pharmacists are in the process of completing a consultation, such as a CMR, they can simultaneously deliver additional care aimed at improving multiple quality measures.

For example: If our pharmacist is executing an annual CMR with a patient and identifies a medication adherence issue, they can proactively address it during the same call and prevent future adverse health effects, while boosting quality.

If you had a pharmacist on the phone with your member, what would you want them to address?

Improve CMS Star Ratings

Drive quality measure performance in Medicare (Star ratings), Medicaid, and commercial plans.

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CMS Star Ratings FAQ

How are CMS Star Ratings determined?

CMS Star Ratings are based on a variety of criteria that generally fall into three main categories:

Medical care (how well the health plan’s network manages members’ health care), Member experience (member satisfaction with care delivery), and Plan administration (how well the health plan is run, access to information, customer service, etc.).

How much is a Star Rating worth?
Why are CMS Star Ratings important?
How do quality measurement and quality improvement work together?

Cost

Bundling member consultations drives costs down 30% compared to in-source pharmacy teams and third-party vendors.

Clinical Experience

Pharmacist-only approach, matching against clinical and social factors most relevant to your members.

Quality

Our in-house Quality Assurance team audits consultations to ensure that we consistently deliver 100% CMS Requirements compliance.

Efficiency

Our on-demand model makes us 30% more efficient than competitive offerings, due to our elastic network and surge capabilities.

Member Experience

Our clinical pharmacists receive an avg 4.8-star rating (out of 5) and engagements can be customized to ensure better member experience.

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