EvokeInsights:

A Quick Reference Guide on Quality, Risk Adjustment, and Supplemental Benefits from the 2020 CMS final notice

The Centers for Medicare and Medicaid Services (CMS) released the 2019 Final Notice on April 1, 2019. The notice detailed important information for Medicare Advantage (MA) and Part D plan sponsors. The notice contained both challenges and opportunities for plans. The CMS final notice significantly impacts benchmarks, risk adjustment, Star Ratings and quality, cost-sharing and benefit design requirements. This intense focus combined with the uncertainty of the 2020 payment variables means each MA health plan and their provider networks have a great deal of analyses and collaboration to conduct.

Each health plan will have their own unique concerns, but the final notice means all health plans and value-based contracted providers must have the following areas of operational excellence:

  • Quality & Star Rating data management and strategy implementation
  • Risk adjustment data management, submissions, compliant coding, and strategy¬†implementation
  • Benefit design, network alignment, and care pathways
  • Member engagement, satisfaction, and retention
  • Provider engagement and enablement

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