Real-time Data Informatics for 2017 Medicare Bid Planning

Jan 25, 2016

The newest version of our Constellation modeling tool forecasts a Medicare plan’s current and future Star Ratings measures.

  • Medicare

Rochelle Article

Recognizing the importance of predictive analytics in helping Medicare plans project their Star Ratings performance, Express Scripts revamped its industry-leading Constellation® Ratings Advisor Tool. Now, plans are in the driver’s seat when it comes to mapping their Star Ratings performance potential.

Real-time Data Informatics for 2017 Medicare Bid Planning

The new, web-enabled version of Constellation builds upon the tool’s established foundation of providing Medicare plans with a customized model that keeps up with changing CMS regulations to identify areas where plans can boost their individual Star Ratings performance and maximize their CMS reimbursements with real, bottom-line impact. Using Constellation to analyze and project improvements across all 47 Part C and Part D measures, plans can see how even minor changes could have a major impact on CMS ratings and reimbursements.

With these enhancements, Constellation Ratings Advisor now offers Medicare plans the flexibility to model Stars using their own work flow and bid details. Using a plan’s data, Constellation can show anticipated Star Rating performance, and identify the precise measures requiring additional effort to help the plan move to the next higher Star Rating. Within Constellation, plans also have the ability to add new measures, modify cut points and weights for future years, and reinstate measures temporarily removed by CMS.

The intuitive nature of Constellation Star Ratings Advisor will allow any user to review and model out a clear, concise strategy for increasing their Star Ratings, and provides ease in sharing the strategy across their organization.

Benchmarking the Competition

Star Ratings calculations play a significant role in any Medicare plan’s 2017 bid planning process. With the removal of the four-star thresholds, a plan’s performance now is largely impacted by the competition’s performance.

In this new environment, the data informatics and predictive analytics provided by Constellation are critical in helping plans to compete. When a Medicare plan can more precisely estimate what its Star Rating performance may be, it can better benchmark against the competition -- a crucial element in determining investment decisions and related bid planning strategy.

Fueled by prescription claims data for more than a quarter of the Medicare market, Express Scripts and our team of dedicated Medicare experts are able to provide our plans with valuable, real-time benchmarking so plans can see their performance against others in the marketplace. With 188 new health plans in the marketplace that are not yet rated, knowing how those variables will affect the curve in 2017 is critical for building a successful bid.

When data are timely and relevant, they become actionable. With Constellation Ratings Advisor, and access to Express Scripts’ real-time industry insights, Medicare plans have access to custom, comprehensive modeling that will inform a successful strategy and bid for the coming year.

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