A Tale of Star Ratings & HEDIS®
Health directors are typically concerned with wellness, spend and profitability. The three are inextricably tied together.
In recent interviews with health plan directors, several commonalities on the subject of spend recurred. One common notion was, a “do-it-yourself” mentality for member communications fulfillment would reduce spend. What plans might not know is that “doing-it-yourself” actually increases spend and risk consequently reducing profitability. To make matters worse, they sent out 100K FIT kits and had 20K screened at an average cost to send of $15 (BRE postage, parcel postage, KIT, and literature) to the tune of $1.2M in waste not to mention the Billions in treatment for the members that went to stage IV cancer.
The tale of Star ratings and FIT kits. Plans are all too aware that there are multiple initiatives and weights that are conducive to improving a Plan’s Star ratings.
On average a star is worth $50 per person per star
If 5 stars are available that equals $250 per member in government subsidy. For 10K members that is $2.5M in revenue. Not bad unless your rating decreases a Star and revenue drops $500K. Workflows are introduced to garner those coveted Stars. Now think of fourth quarter and the mad dash to improve Star ratings. A mad house ensues. FIT kits and adherence programs are communicated and sent out yet receive about a 20% response .
Unanticipated hiccups occur and a trip to the CFO for more budget ensues
List are mismatched or who has the lists and why is George Smith getting three FIT kits? Bring in the temps to fold and stuff…wait did they go through HIPAA training? Mail runs, sky-rocketing postal costs…did we really just pay parcel? Where’s the inventory? Oh no, buy a small run at exorbitant costs. Was it noted in the member file so we don’t send again? To make matters worse, we sent out 100K FIT kits and had 20K screened at an average cost to send of $15 (BRE postage, parcel postage, KIT, and literature) to the tune of $1.2M in waste not to mention the Billions in treatment for the members that went to stage IV cancer.