Learn how one health system solved challenges by providing timely and effective specialty care to their elderly and vulnerable dual-eligible patient population through leveraging the AristaMD eConsult platform.
“When embraced, eConsults helped providers become a Super PCP.”
Partnering to improve CMS star ratings and chronic care management
Access to chronic care management, care coordination and avoidable hospitalizations are benefits of eConsults. These factors directly tie into CMS patient satisfaction star ratings and improving patient satisfaction, which are imperative for providers and healthcare organizations as patients select membership plans.
Star ratings
The Centers for Medicare & Medicaid Services (CMS) created a five-star quality rating system to help the healthcare consumer population, their families, and caregivers measure Medicare beneficiaries’ experience with their health plans and the healthcare system. The rating identifies areas where the healthcare consumer needs to be reviewed in detail and queried.
Medicare plans are rated on a 1 to 5 scale. A 5-star rating represents the highest score. Higher star ratings signify better performance and quality—a more desirable plan.
- 5-star rating: Excellent
- 4-star rating: Above Average
- 3-star rating: Average
- 2-star rating: Below Average
- 1-star rating: Poor
We will focus on Medicare plans and Medicaid plans for dual-eligable patients providing health coverage that are evaluated within the following categories according to CMS:
- Staying healthy: This rating is based on patient access to preventive services to promote continued health, including physical examinations, vaccinations like flu shots, and preventive screenings.
- Chronic care management: Plans are rated for care coordination and how frequently members receive services for long-term health conditions.
- Member experience: Overall satisfaction with the health plan.
- Member complaints: A rating on how frequently members submitted complaints or left the plan, whether members had issues getting needed services, and whether plan performance improved from one year to the next.
- Customer service: Plans are rated for quality call center services (including TTY and interpreter services) and promptly processing appeals and new enrollments.
Immediate access to necessary care leads to improved patient outcomes and plan satisfaction. Curious as to how eConsults are improving patient satisfaction to increase Star ratings?