Managed Care

 

Medical Directors' Fate Rests in the MA Stars

MANAGED CARE June 2014. © MediMedia USA
Managing Editor's Memo

Medical Directors' Fate Rests in the MA Stars

Frank Diamond

Spoiler alert, but only blue (guarded) because the movie Captain Phillips is based on something that really happened. One of the more affecting scenes comes at the end when a Navy medic examines the hero. The director uses a real medic, and Corpsman Danielle Albert plays herself beautifully.

She examines the traumatized hero while asking questions in a manner that mixes clinical detachment with just the slightest pinch of empathy. She’s doing her job. They told her to treat the scene as a drill and anyone familiar with life on a Navy destroyer knows that drills take up a good part of each day.

You don’t have to be in the Navy to identify with that character. Medical directors keep their cool as well. They are trained to do so in medical school and it carries over when they become businesspeople.

Well, the pressure’s on. Our cover story examines the challenges – and the stakes – presented by the Five Star Quality Rating System for Medicare Advantage Plans. One star can add up to millions of dollars in bonuses. Not only that, but high-achieving plans can enroll beneficiaries all year round.

It all comes down to quality. The Centers for Medicare & Medicaid Services notes, “Outcome and intermediate outcome measures continue to be weighted three times as much as process measures, and patient experience and access measures are weighted 1.5 times as much as process measures.”

Executives in MA plans are scrambling, but medical directors who specialize in quality assurance will be particularly challenged, notes Jaan Sidorov, MD, a member of Managed Care’s Editorial Advisory Board. “It’s hard to overestimate the luster of the money from increased payments and the threat of being put on the MA naughty list, let alone having your competition outpace you.” Good luck.

Meetings

Private Health Insurance Exchanges Conference Washington, D.C. October 7–8, 2014
National Healthcare Facility Management Summit Palm Beach, FL October 16–17, 2014
National Healthcare CFO Summit Las Vegas, NV October 19–21, 2014
National Healthcare CXO Summit Las Vegas, NV October 19–21, 2014
Innovative Member Engagement Operations For Health Plans Las Vegas, NV October 20–21, 2014
4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014