Software tracks facility progress in CMS’ 5-star ratings

Using data analytics and 1.5 billion health-specific interactions from consumers, the company claims that its Eliza for Medicare software can be used to improve key measures such as preventive care, chronic condition management, medication adherence and post-hospital discharges, as well as identifying gaps in star measures.

The software’s “unique predictive and prescriptive capabilities contribute to more accurate and holistic views of both clinical and retention risk at the member level,” according to a press release. “Actionable intelligence, not mere data stores, is the insight that Eliza mines…to yield targeting and messaging strategies that drive year-over-year improvements in star performance.”

The star ratings programs are crucial for Medicare Advantage plans, notes McKinsey & Co. in a report on the 2015 Medicare Advantage star programs: "Star performance is important not only because others have shown that it correlates with market share, but also because it results in higher payments, contributing to healthy plan economics, richer benefit packages, and the ability to invest in new plan capabilities. Through 2017, CMS will continue to reset the Medicare Advantage premium level closer to the fee-for-service expense equivalent. As well, the eligibility for STAR bonuses is now bi-modal—only plans achieving 4 or more stars will be awarded bonus payments.