Think like a 5 Star Plan. Act like a 5 Star Plan. Be a 5 Star Plan.

Transcription

1 The Road to 5 Stars Think like a 5 Star Plan. Act like a 5 Star Plan. Be a 5 Star Plan. A whitepaper 5550 W. Idlewild Avenue, Suite 150. Tampa, FL (813) Innovation@MedHOK.com

2 The quest for a 5 Star health plan rating comes with ongoing twists and turns. Changing measures, high performing plan influence, even the possible threat of legislative changes mean ever evolving quality measures. While CMS s ongoing evaluation of quality measures reflects its commitment to ensuring quality care for plan enrollees, these ever tightening controls pose steep challenges for health plans to achieve. The good news is that CMS is providing substantial incentives that make grabbing that brass ring its own reward. For health plans, delivering 5 Star rated care to beneficiaries will drive both enrollment and substantial revenue opportunities and generally ensure compliant plan contract performance and successful audits. This is not a once a year activity. 5 Star practices must be applied year round to ensure ratings hold steady come time for measurement. From Humble Beginnings Implemented by the Centers for Medicare and Medicaid Services (CMS) in 2007, the Star program started as a way for beneficiaries to compare Medicare Advantage plans in order to enroll in the best plan, based on quality, to suit their needs. The addition of deeper and broader quality measures over time gives beneficiaries even more relevant information to help in their enrollment decision making. The evolution of administrative, clinical quality, and regulatory compliance measures has brought both opportunities and challenges to health plans. All totaled, the Star system offers Medicare Advantage and stand-alone Part D plans significant opportunity to be recognized financially for the quality improvements they put in place on behalf of their members, delivering a better health care experience, and improving measurable outcomes. But achieving this recognition is no small task as evidenced by the fact that only 15 of 384 rated Medicare Advantage plan contracts achieved a 5 Star status in Of these, only 9 plan contracts maintained their 5 Star rating from Competition is stiffer yet for PDP plans. Only 7 of 54 PDPs achieved 5 Star rating in Of those, 5 held their 5 Star status from The Affordable Care Act s impact on the Star ratings shifted the onus of care from transaction-driven to today s evolving value-based healthcare model. Key provisions in the ACA are driving this shift by providing financial rewards for improving and sustaining health plans overall quality performance. Today, Medicare Advantage (MA) only contracts (without prescription drug coverage) are rated on up to 34 measures while MA contracts with prescription drug coverage (MA-PD) are rated on up to 48 unique quality and performance measures; and stand-alone PDP contracts are rated on up to 14 measures. i Data for analysis comes from a wide array of sources and the Star Ratings measures span five broad categories: Outcomes Intermediate Outcomes Patient Experience Access Process 2017 MedHOK, Inc. Page 2

3 What Gets You to 5 Stars Won t Keep You There If your plan has achieved the holy grail of 5 Stars congratulations! Just don t get too comfortable there. Sustaining that rating will not be easy. And if you re still striving to reach the pinnacle, know that there is work to be done, both now and in the future. CMS Star Ratings are a moving target that health plans are expected to reach each year. CMS reviews Star measures annually, adding new measures, sunsetting others, and adjusting thresholds on still others based on the performance of high rated plans. These annual reviews take into consideration data issues, feedback from health plans, clinical recommendations, and reliability of each measure. Additionally, measures can move in and out from display measures. Display measures are a proving ground where they are tested and evaluated to move to full-on inclusion in Star Ratings or to be removed altogether. ii Some measures are simply displayed for informational purposes. CMS notifies plans if a display measure is under consideration to make the big move to the show. Throughout the consideration process, data for display measures is collected and monitored, and poor scores are subject to compliance actions by CMS. It s no wonder, then, that plans experience ongoing slips and gains in their ratings. While a plan may be a 5 Star plan in year X and attain a significant financial bonus to use toward future plan initiatives, the next year, a plan could slide to a lower rating simply by not meeting a revised threshold or new measure published by CMS was no different. In fact, some of the biggest and most prominent plans, with previously high Star scores, lost major ground in This year s shake up was most evident in plans slipping within the 4s and even down into the 3s. At the same time, other big plans Average MA Star Rating Over Time saw great improvement in their results for results reflect this slip-and-slide phenomenon when compared year over year to At that, MA, MA-PD and PDP plans have come a long way since the benchmark year of 2010 (the year Medicare Advantage quality was largely overhauled by the Affordable Care Act). In 2010, just MedHOK, Inc. Page 3

4 percent of Medicare Advantage Part D (MA-PD) plans had 4 Star or greater ratings and just 24 percent of all enrollees were in such plans. The average Star rating was a paltry Compared to 2017, the number of highly rated Star MA-PD plans in 2018 has remained flat. With an average overall Star rating of 4.06, 2018 has not demonstrated a statistically significant improvement compared to 2016 and 2017 which were 4.03 and 4.02, respectively. The story is brighter for PDP plans. While their low overall ratings remain a major concern of CMS, PDP Star ratings continue to improve, if at a snail s pace, rising from 3.55 in 2017 to 3.62 in Overall, the number of MA-PD contracts achieving 4 Stars or better slipped compared to 2017, from 49 percent to 44 percent. However, enrollment in these plans increased from 69 percent in 2017 to 73 percent in On a high note, 6 MA-PD contracts have been newly minted with 5 Stars for 2018.Two of these rising stars are Special Needs Plans (joining 4 existing 5 Star MA-PD plans with SNPs), where achieving top scores is extremely difficult given the socioeconomic challenges of these populations. Given the higher risk involved in these populations, CMS has introduced the Categorical Adjustment Index (CAI) to adjust for the higher socioeconomic and chronic health conditions of the individuals they serve. Time will tell if the CAI will alleviate the bonus potential concerns of SNPs and other plans that serve disadvantaged populations. PDP plans were added to the Star program in The number of PDP plans continues to shrink from more than 70 in 2014 to just 54 for Stand-alone PDP plans made the biggest strides in 2018 raising their overall Star rating to 3.62 from 3.55 in 2017, but continue to struggle with low overall ratings. Fifty-two percent of PDP plans earned 4 or more Stars compared with 49 percent in More than 47 percent of enrollees are in PDPs with 4 or more stars, a small increase from the 41 percent in PDPs in This positive trend has occurred despite ongoing contraction in the market that began in iii CMS remains concerned that Part D achievement remains well below 4 Stars overall. Still, all is not lost. Two PDP plans achieved 5 Star gold for 2018, increasing the number of 5 Star PDP plans from 6 to 7 over 2017, and only 1 PDP plan rolled out of high Star range Looking closely at individual measures shows that while health plans can positively move scores from year-to-year, often, they seem unable to lock in and build on positive performance once achieved. One possible reason plans are struggling may be that they do not make Star activity a year-round focus. Another reason is that plans do not have the rigorous infrastructure and configurable technology needed in quality, analytics, care management, and provider relations to maintain higher and higher performance standards, especially as the highest performing MA plans will continue to push performance thresholds ever higher in the future. The loss of quality bonus for 38 plans from 2017 to 2018 is a case in point MedHOK, Inc. Page 4

5 There s money in these Stars 4 and 5 Star plans get a significant revenue boost for their efforts. In fact, 5 Star plans can earn up to an 11% advantage or $100 per member per month (PMPM) on an actuarial basis for their quality efforts. 1. Star Rating equals more premium money for plans per member. This money has to be allocated to additional member benefits above and beyond traditional Medicare. 2. Since additional premium is allocated to benefits, higher Star plans have better benefits in the marketplace and attract more members, further driving premium Star plans can market yearround to all members, giving them the advantage of attracting even more members. dental, hearing and vision. Follow the Money Bonuses and Beyond To understand the full revenue potential (and advantage) top Star rated plans have, it helps to understand the intricacies of how Medicare Advantage rates, rebates, benchmarks, and quality bonuses are set. In practice, the actual calculations of these items are significantly more complex. For ease of understanding, we have pared down our discussion to a high level summary of the process. First, CMS sets a county benchmark that is a percentage of the monthly cost of the average beneficiary in the traditional fee for service program (depending on where you are in the country, this can be slightly below the average cost or higher than the average cost). CMS evaluates plan bids against the benchmark. Second, health plans, in part, determine the Medicare payments they receive. Each plan submits its bid to CMS specific to the Part C (and D, in the case of an MA-PD plan) coverage it intends to offer beneficiaries in each county it serves. The plan bids on what it believes its costs are for basic Medicare benefits. Then, the plan also proposes enhanced benefits for its members that it believes it can fund within the benchmark. These added services include defrayed cost sharing as well as additional services to the member such as Third, as long as the plan s bid is below the benchmark, it is allowed to keep a portion of the difference between the county benchmark and the cost of providing benefits. This is known as the rebate. The higher a plan s Star rating, the greater the portion of the difference the plan gets to keep. For example, a 4.5 or 5 Star plan gets to keep 70% of the difference between its bid for basic Medicare and the county benchmark. That 70% must be returned to beneficiaries in the form of enhanced benefits. The federal government keeps the remaining 30% as cost savings to bolster the Medicare trust funds. A plan at or below 3.5 Stars gets to keep only 50% of the difference. Percentage Add On for Quality Bonus Payments 5 Stars 5% 4.5 Stars 5% 4 Stars 5% 3.5 Stars 0% In and of itself, a 20% difference in rebates between a 4.5 and 5 Star Plans and 3 Star and below plans is huge when considering the average monthly premium in some areas of the country is at or above $1,000 per member. 3 Stars 0% Less than 3 Stars 0% 2017 MedHOK, Inc. Page 5

6 Finally, plans rated 4 Stars or greater receive an additional 5% quality bonus to pass through to beneficiaries as well. All totaled, the combination of the rebate and the quality bonus gives plans rated 4 Stars and higher a significant advantage in the marketplace. By our calculation, if a high performing plan assumes in its bid a 70% MLR for basic benefits against a county benchmark, that plans get up to an 11% premium advantage in the marketplace that it then passes on to its members. This can amount to as much as $100 PMPM or more on an actuarial basis that a plan can give back to its members. In short, CMS devised a rather brilliant system to align toward and reward quality: members get added benefits passed through and plans benefit through increased membership. Highly rated plans have the additional advantage of getting benefits above and beyond bonuses and rebates. For instance, 5 Star plans can market to new members year-round and accept new members throughout the year, too, while all other plans are limited to welcoming new beneficiaries during the two-month open enrollment period ending in early December. What s more, top rated health plans benefit from CMS s indirect marketing support when they promote 5 star plans on their website. As well, the consistent message from CMS to enrollees is to join a highly rated plan for the best service and healthcare outcomes. Looking closely at membership levels shows a direct correlation between Star rating and plan growth; doing the right things by beneficiaries leads to more and better business, as well as Stars. iv In fact, 73% of beneficiaries are in plans rated 4 Star and higher. With their bonuses and rebates, higher rated plans are able to offer increased benefit levels that are appealing to beneficiaries. Because health plans must reinvest their rebate and bonus for the benefit of beneficiaries, 4, 4.5 and 5 Star plans are also able to offer lower premiums as well as design benefit plans with significantly lower cost sharing options. As a result, higher rated plans grow faster and experience significantly less churn than health plans with fewer than 4 Stars. Medicare Advantage Member Benefit Rebate Percentages Star Rating Stars 70% 3.5 to <4.5 Stars 65% <3.5 Stars 50% Revenue Advantage (Based on assumed 70% MLR for base Medicare benefit) 3 Star and below Zero advantage 3.5 Star Up to 4.5 percent advantage 4 Star Up to 9.5 percent advantage 4.5 Star Up to 11 percent advantage 5 Star Up to 11 percent advantage Everything Under the Stars Because Star ratings are constantly evolving, it s not surprising to see the significant, ongoing volatility in measure results plans are experiencing. CMS is pushing the boundaries of quality making it harder and harder to maintain Star ratings MedHOK, Inc. Page 6

7 The real dream of CMS is not to be grading plans on ad hoc clinical measures as in the early days of the Star program, but to move toward a clinical measurement system that is holistic in nature, including care transitions and complex suites of measures. Ultimately, CMS wants to motivate plans to offer higher quality care while giving beneficiaries greater choices in quality health plans. All of this means that in the not too distant future, achieving exemplary Star performance will move from remediating discrete measures (although it will still be in play) to accomplishing plan-wide daily collaboration between health plan departments and together with providers to manage chronic conditions of each and every member. As measures and the Star program change, health plans may have to significantly increase performance levels year over year simply to maintain existing ratings. Consider the Star measures that plans will need to perform well on in the future to achieve or maintain 4 Star or greater status and survive in the marketplace: Perform well on the current readmissions measure by monitoring and care coordinating people with certain conditions and stopping them from being readmitted in 30 days. Closely managing the entire population with certain chronic conditions from entering a hospital for exacerbation of those conditions. Ensuring seamless care transitions post hospitalization. Ensuring appropriate follow-up after ER visits or inpatient stays. Adequately assessing members post-acute stay and communicating to providers. Notifying providers timely of IP admission, discharge and follow-up care. Engaging in medication reconciliation and medication therapy management. Managing ever-more-complex suites of measures covering physical and mental health conditions. For 2018, Star ratings included a maximum of 9 domains comprised of a maximum of 48 measures MedHOK, Inc. Page 7

8 MA only plans are measured on 5 domains with a maximum of 34 measures. PDPs were measured on 4 domains with a maximum of 14 measures. MA-PD contracts were measured on all 9 domains with a maximum of 48 measures, 45 of which are unique measures. Three of the measures are shown in both Part C and Part D so that the results for a MA-PD contract can be compared to an MA-Only contract or a PDP contract. Only one instance of those three measures was used in calculating the overall rating. The three duplicated measures were Complaints about the Health/Drug Plan (CTM), Members Choosing to Leave the Plan (MCLP), and Beneficiary Access and Performance Problems (BAPP). With all of these different measures and the complex calculation, how is a plan supposed to know which measures to focus on for success? Understanding how CMS scores measures is helpful to identifying key measures that influence ratings. Star measures are essentially ranked on a bell curve. Very high performing plans can move the percentage thresholds in each measure even as others stay roughly the same or even improve slightly. Plans falling behind on given measures need to be concerned. This was the whole purpose of the Star rating program to force plans to practice continuous quality improvement. Summary and overall Star ratings are calculated as weighted averages of the measure stars. For 2017, CMS assigned the highest weight to the improvement measures, followed by the outcomes and intermediate outcomes measures, then by patient experience/complaints and access measures, and finally, the process measures. Improvements in 2018 measures were mostly small and incremental increases of a point or two. However, several measures slid back significantly MA-PD plans achieved major measure gains in: Diabetes Care, Blood Sugar Controlled (hit 4.2) 2017 MedHOK, Inc. Page 8

9 Call Center Foreign Language Interpreter and TTY available (hit 4.5) Appeals Auto Forward (hit 4.8) Appeals Upheld (up a full point over 2017) Appeals Upheld jumped a full point to 3.9 MTM Comprehensive Medication Review increased dramatically from 2.5 to 3.5 Major measure losers for MA-PDs included: Breast Cancer Screening (slid a full point to 3.1) Controlling Blood Pressure (slid nearly a full point) All three of the medication adherence measures dropped some, in part, due to inflation of the cut points Members Choosing to Leave the Plan (slid below 4) Rheumatoid Arthritis Management dropped significantly, again due to cut point inflation The Medication Therapy Management Program s Comprehensive Medication Review (MTM and CMR) measures (hot buttons for quality performance measurement) improved significantly in 2018 compared to 2017, jumping a full point to 3.5. That said, CMS remains very concerned about the performance of both the CMR measure and the overall MTM program. Looking for major gains in PDPs measures show that no measure increased more than a point or two. The biggest gains came from: Appeals Auto-Forwarded Appeals Upheld However, two measures decreased substantially: Members Choosing to Leave the Plan (decreased almost a full point) All three of the medication adherence measures dropped to some degree McKinsey evaluated the data to search for those domains with the most impact on ratings, they found the top three to be (ranked in order of correlation with positive Star performance): v HD4: Member Complaints and Changes in the Health Plan s Performance HD2: Managing Chronic (Long Term) Conditions HD1: Staying Healthy: Screenings, Tests and Vaccines Plans should continue to focus on measures across the board, however, special attention should be paid to quality improvement and outcome measures, particularly those that may have slipped for a plan or are at risk of slipping, keeping in mind that measures, across the board, are a moving target and a quality vice with significantly more complicated activity and measurement. Plans should focus on their ability to handle member complaints, manage chronic conditions, and deliver preventive care, as these areas also correlate directly to high performance ratings. Lastly, plans need to focus on medication adherence, medication therapy management and the member s experience with the drug plan. These critical measures are a major area of concern for CMS, particularly given the opioid and other drug misuse issues in the United States MedHOK, Inc. Page 9

10 Managing the Complexity That Abounds in Audits and Star Ratings Plans not only have to obsess over Star performance but also must constantly monitor compliance because CMS is increasing the number of audits it conducts each year. Poor audit performance can lead to significant Civil Monetary Penalties or worse suspension of enrollment and/or marketing. In truth, there is a bit of a chasm between compliance and audit performance and overall Star ratings. It is entirely possible to perform well on Star measures and yet have a poor audit track record. The disparity between audit scores and Star ratings became even more fractured in 2016 when CMS suspended indefinitely the automatic reduction in Star ratings based on sanctions to evaluate further the overall impact sanctions should have on a plan s final Star measure. Right now, on some measures, a plan can effectively be penalized doubly, paying a fine for a bad audit and also seeing measures on various Star measures rated low and dragging down its overall Star measure for a given year thereby reducing Star revenue potential. Consider that there are at least five measures now that reflect audit findings or enforcement activities. Additionally, CMS is also refining one measure in the Star program that directly takes audit scores and factors them into Star results. We believe that quality should align across all Star measures and audits for the benefit of MA beneficiaries. To achieve the highest ratings, plans should focus on maintaining quality, compliance, and delivering an unwavering level of customer service to members across all of its business units as well as in all member interactions. At the end of the day, not only will this core focus achieve high Star ratings and drive compliance, it will also meet the goals of the Triple Aim to improve the healthcare experience, drive population health outcomes, and control per capita costs. Another level of complexity comes into the equation for plans looking to outsource their pharmacy function to a PBM. Plans must choose wisely identifying a PBM partner as PBMs are clearly in CMS s crosshairs for both compliance and quality. Health plans delegating their pharmacy management to a PBM must insist on a partner that can deliver accurate and compliant service with transparent data for simplified oversight, in addition to the basics of claims adjudication, for the most mutually beneficial and successful relationship. Remember, while MA-PD plans perform well above 4.0 on Part C measures, many fail to achieve overall 4 Star status because their Part D scores are too low. This is due, in part, to poor PBM performance and a lack of appropriate delegated oversight. Best Practices of the Best of the Best Top-rated plans see all of the challenges noted in this whitepaper as opportunities to provide the right care and service to their members. In fact, these plans have in common one steadfast philosophy: the member is at the center of all care. Star ratings are heavily focused on the member experience, so creating a customer-centric health plan is tantamount to success in value-based healthcare. We know that customer centricity is an oft used buzz word, but if plans truly want to achieve 5 Star status and the commensurate bonuses and rebates that come with them, they must take this approach to heart. Creating an unwaveringly positive customer experience is an ongoing process that requires a commitment to innovation in organizational design and service delivery as well as the willingness to 2017 MedHOK, Inc. Page 10

11 explore and implement innovative technology solutions that drive member engagement, optimal health outcomes, and customer satisfaction. At the end of the day, consumers have a choice across MA, MA-PD and PDP plans. As they become more and more savvy healthcare purchasers and rely more heavily on Star ratings to identify a top quality health plan to join (and not just finding the plan with the right price point), successful plans will ensure that their message and overall customer experience leave no room for doubt in a beneficiary s selection. Furthermore, successful health plans ensure that their compliance with state and regulatory requirements is flawless and sustainable. They repeatedly evaluate their data, develop member engagement campaigns to ensure all timeliness goals are met, and conduct mock audits in order to identify and mitigate any potential risk of surprise compliance issues well in advance of the actual CMS audit. They also see both compliance and quality as mutually inclusive as well as non-negotiable, and focus on both simultaneously to ensure that quality service delivery is fully in sync with compliant tactical execution. Top rated MA, MA-PD and PDP plans are the standard bearers for these best practices (customer centricity, stellar customer experience, and flawless compliance execution). They consistently evaluate and monitor both their strategy and tactical execution in connection with changes in the marketplace (such as the 5 Best Practices to Achieve 5 Stardom 1. Ensure compliance and quality are fully integrated and embedded throughout the plan. Plans that live and breathe customer-centricity lead the way with Star ratings. 2. Make customer love a central tenet of your organization. Regardless of the touchpoint, every interaction with a beneficiary is an opportunity to provide 5 Star customer service. Empowering front line employees with the ability to resolve member inquiries without a myriad number of handoffs is the surest way to improve member satisfaction. 3. Launch targeted member outreach campaigns. Ensure that members are receiving appropriate and needed care by reaching out to them with care reminders and follow ups. This is particularly important for members with chronic care needs like diabetes and hypertension. 4. Regularly review progress to Star measures and goals regularly. Monthly or quarterly, internal measure owners need to plan for improvements and track progress to goals, engaging service teams along the way to maximize improvement. Additionally, top rated plans conduct mock audits during the year as a means of continual quality improvement and to ensure there are no surprises when final reports are prepared. 5. Engage all members of the care team: providers, pharmacists, case managers and others. Value based care is squarely focused on quality of care. Ensuring that all caregivers are actively engaged will drive improved outcomes and better Star scores. Primary and specialty care providers drive much needed care coordination and collaboration while pharmacists can help drive medication therapy management and adherence. 6. Track complaints, appeals and grievances. No one likes complaints, but some of the best insights can be gleaned from issues. Look for patterns, including complaints about benefit coverage, drug plans, formularies, and communication MedHOK, Inc. Page 11

12 needs of the ageing Baby Boomer population) as well as the evolving compliance and Star rating standards. Charting Your Course: MedHOK Solutions Lead the Way in Compliance and Quality Coordinating compliance and quality across health plans, PBMs, specialty pharmacy and other clinical and service providers takes extraordinary effort to break down silos, ensure seamless care across the continuum of care, and deliver an exemplary customer experience for beneficiaries. CMS is clearly committed to the Star rating structure. Not only is it highly unlikely to go away, CMS is, in fact, working toward a National Model of Care that looks to bring together vigorous quality, compliance and Star programs across all lines of business to raise the standard of healthcare to a new and equitable level across populations. Making this happen will require innovative technology that enables a holistic, 360-degree view of the member across all service providers in the continuum of care as well as the data transparency to accurately monitor, measure, and report on outcomes and compliance activities. Finding a solutions partner to achieve these goals should be a top priority for health plans to meet immediate needs and long term goals equally. MedHOK s Unified Payer Platform is the Gold Standard of Enabling Healthcare Technology Early on, MedHOK recognized that healthcare organizations would require a unified system to align member care to quality measures for value-based healthcare. MedHOK s founders conceived the Unified Payer Platform to accomplish precisely that goal and succeed in the new world of value-based healthcare. At the heart of our vision, we believe: All stakeholders responsible for managing the member should have a singular view of the member both real-time and historical 2017 MedHOK, Inc. Page 12

13 True population healthcare management includes both medical and pharmaceutical care Compliance is achievable and sustainable across all lines of business MedHOK s Unified Payer Platform (UPP) brings all applications needed to enable success into a single platform. Built from the ground up on a single data repository with a single code set, the UPP delivers the structured workflows that ensure compliance adherence, data integrity, uncompromising quality, and stellar productivity gains. Specifically, MedHOK offers both a comprehensive, turnkey compliance and quality platform across the care continuum, as well as the ability to address specific components of quality care management such as HEDIS, Care Gaps and Star Analytics. Each module is based on compliance rules and best practices for Medicare, Medicaid and commercial lines of business 30+ compliance and product team proactively monitors all regulatory dictates and audit findings MedHOK maps its modules to all findings and guidance To date, no MedHOK client has been penalized financially by a regulator for a finding related to the MedHOK system CMS CDAG, ODAG, and MOC universes are out-of-the-box reports and can be used for proactive mock audits Significant regulatory and operational monitoring reports out-of-the-box We believe that we have set the new standard for the health plan software market as ours is the ONLY platform today that truly unifies disparate systems and data siloes under one roof. Our industry-leading, unique approach aligns health plan organizational imperatives to the realities of the clinical setting where care is administered. In one platform, MedHOK delivers everything needed to succeed in valuebased healthcare and help health plans achieve 5 Star status: A Holistic View of Each Member Including a holistic approach that ensures higher member and provider satisfaction, thereby improving CAHPS and HOS scores on Star measures 2017 MedHOK, Inc. Page 13

14 Integrated Medical and Pharmacy Care Member Engagement capabilities Stakeholder Collaboration functionality Automated Workflows to Improve Efficiencies Built-in Compliance Adherence Pay for Quality Revenue Models Builds out approaches to drive performance on complex clinical measures to ensure high performance Includes medication, readmissions and potentially preventable readmission measures ROI from MedHOK system use is generally categorized into four areas: Cost savings derived from efficiency gains Elimination of civil monetary penalties at each audit Lower medical loss ratio spending Higher revenue due to Star quality performance rating and bonus attainment and sustainability Learn more about how MedHOK can help your plan achieve and maintain 5 Star status, remove siloes and deliver on the promise of quality, compliance, and member centricity. Call or us to schedule a demonstration of our Unified Payer Platform Innovation@medhok.com i 2018 Star Ratings Fact Sheet, Press-releases-items/ html ii iii AIS Health, PDPs Made Big Gains in 2017 Star Ratings, but Results Were Mixed for Large MA Firms iv McKinsey Center for U.S. Health System Reform Intelligence Brief, Assessing the 2017 Medicare Advantage Star Ratings v McKinsey Center for U.S. Health System Reform Intelligence Brief, Assessing the 2017 Medicare Advantage Star Ratings 2017 MedHOK, Inc. Page 14