Avior Announces Star Rating Module

AVIOR COMPUTING ANNOUNCES STAR RATING PROVIDER ENGAGEMENT MODULE

 

New offering helps Medicare Advantage plans improve their CMS Star rating and increase reimbursements  

 

NASHUA, NH, March 17, 2014 – Avior Computing Corporation announced today a new module for its flagship Avior BenchmarkTM platform aimed at helping Medicare Advantage health plans engage their provider networks to help improve their CMS Star rating and increase their Quality Bonus Payments. 

 

“A number of our health plan customers have successfully used Avior BenchMark in their engagement of their provider networks to manage the transition to ICD-10.  When our customers asked about extending this to help with quality initiatives for their Medicare Advantage business, we immediately saw the value” said Steve McCalmont, CEO.  “CMS is raising the threshold for a Quality Bonus payment to a 4 star rating.  This represents millions of dollars in reimbursements so there is a significant ROI to our customers.”

 

In 2012, CMS paid out more than $3 billion Quality Bonus Payments (QBP) based on the star rating of each contract. CMS rates a plan on a 5 star scale, where 1 star is poor performance and 5 stars represent excellent performance.  The higher scores mean higher bonus payments. In 2013 and 2014, plans that do not score at least 3 stars will not receive a QBP. In 2015 and beyond, the threshold rises to a 4 star minimum and the percentage rises to a 5% bonus. In addition, the Star rating also affects a contract’s rebate percentage. The rebate percentage increases for plans with higher ratings.

 

65% of the total Part C rating is based on HEDIS metrics which reflect the work of primary care providers to address preventative care and chronic conditions.  Since this work is done by the PCP, plans must have a way to engage these providers to ensure that there are no gaps in care that would reduce the Star rating.

 

Avior BenchMark provides a means to consolidate data from a plan’s HEDIS reporting system and present it to the provider using a secure web interface.  The web interface can be customized to work as part of a plans’ portal.  The provider can provide updates and corrections through the interface.  The plan can use the analytic tools to add value to other Star programs such as member engagement.  The process fully conforms to the NCQA requirements for supplemental HEDIS data.

 

“By automating a closed loop process with their provider network, the health plan can expand their provider outreach to ensure they get the highest rating and reimbursement possible.  It is critical to our customers that they have the full audit capabilities that we offer.” commented McCalmont.

 

About Avior Computing

 Founded by industry veterans, Avior Computing is a leader in automated risk and compliance management. Avior’s solutions automate the entire lifecycle of governance, risk, and compliance. Avior BenchMark eases the burden of managing compliance by mapping regulations and controls to web based assessments with complete process management for remediation. Our BenchMark Solution Packs provide rapid implementation and fast time-to-value to manage a wide range of compliance programs for globally regulated industries.

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