Healthmine Clients Achieve Outstanding Performance in Star Ratings

Healthmine Clients Achieve Remarkable Star Ratings Success

Healthmine, a prominent player in technology-enabled engagement solutions, has announced impressive scores in the Star Ratings for its clients. Achieving success in a challenging environment, 70% of Healthmine’s on-platform clients either maintained or improved their overall ratings for the Stars Year (SY) 2025, compared to SY2024. Notably, 40% of these clients achieved ratings of 4 Stars or higher.

Significant Improvements Across Key Health Metrics

The clients of Healthmine experienced notable advancements in several critical areas. There was a remarkable 20% increase in flu shot completion rates. Additionally, breast cancer screenings increased by 16%, along with a 15% rise in diabetic retinal eye exams and fall risk assessments. These improvements highlight Healthmine's effective strategies as they now partner with two 5-Star plans.

The Impact of Recent Investments

In recent years, Healthmine has strategically focused on developing its platform and enhancing its subject matter expertise. These efforts aim to provide Medicare plans with impactful solutions in a landscape where many have seen their Stars scores drop. The transition from pandemic flexibility to standard scoring has necessitated that health plans reassess their strategies to maintain quality.

Challenges Ahead in the Medicare Landscape

As health plans gear up to meet the new Stars criteria, they face the need for innovative strategies. Paul Mango, former Deputy Chief of Staff for Policy at the U.S. Department of Health and Human Services and now Chairman of Healthmine's Board of Directors, emphasizes that it's a critical period for Medicare. Payers must reconsider their approaches to quality, risk management, and health equity in a world where previous strategies may fall short.

Understanding New Star Ratings Criteria

The landscape of Star Ratings is evolving, with nearly 70% of cut points seeing increases compared to the 2024 ratings. CMS is implementing new Tukey guardrails for establishing cut points, signaling that health plans may experience further adjustments for SY2025. The transition from the Reward Factor to the Health Equity Index calls for plans to demonstrate success in eliminating health disparities at the measure level, complicating the path to achieving quality bonus payments.

Quality Relationship Management Framework

Healthmine has rolled out its innovative Quality Relationship Management™ (QRM™) system, a transformational tool designed to provide plans with a comprehensive view of each member and overall performance metrics. The QRM platform integrates member data from various sources and facilitates personalized, omnichannel engagement strategies, allowing health plans to effectively communicate with members when it matters most.

Empowering Health Plans for Future Success

According to Bryce Williams, President and CEO of Healthmine, the QRM initiative is specifically tailored for health plans engaged in government programs. It empowers organizations to scale operations according to their needs, ensuring they maintain effectiveness across all metrics. As health plans strive to focus on social determinants of health with equal intensity as they do on member feedback, the QRM framework stands poised to accelerate progress.

About Healthmine

Healthmine is recognized as a leading member engagement solution provider, streamlining how health plans optimize every interaction with members. The company's SaaS-based, always-on Quality Relationship Management™ (QRM™) platform simplifies the complexities of data management. By offering comprehensive insights into each member, Healthmine collaborates with health plans to devise customized outreach strategies that inspire members to actively participate in their health journeys. With triggers based on diverse metrics and intelligent incentives, plans can achieve improved health equity and outcomes. Rapid data dashboards provide actionable insights, allowing plans to respond quickly to identified opportunities, maximizing both revenue and quality objectives.

Frequently Asked Questions

What recent achievements have Healthmine clients accomplished?

Healthmine clients achieved a remarkable 70% success rate in maintaining or improving their Star Ratings for SY2025, with a significant portion reaching 4 Stars or higher.

How has Healthmine improved health outcomes for its clients?

Clients have reported notable increases in key health metrics, including flu shot completions, breast cancer screenings, and diabetic retinal eye exams.

What is the significance of the Quality Relationship Management (QRM) platform?

The QRM platform integrates member data to offer personalized engagement, helping health plans reach members effectively and improve health outcomes.

What challenges are Medicare plans currently facing?

Medicare plans must adapt to new Stars criteria and face increased competition as previous scoring leniency from COVID-19 is no longer applicable.

How does Healthmine support improved health equity?

Healthmine emphasizes health equity by helping plans analyze and address health disparities at the measure level, aiming for better outcomes for all members.

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