Rex Wallace Consulting, LLC (RWC) was created to help health plans improve Quality. RWC helps plans increase engagement with members, providers, and employees, fostering the collaboration necessary to overcome the many obstacles standing in the way of high Quality. When health plans perform at higher levels and achieve higher Quality, the ultimate winners are the members who make up every quality measure. Their improved outcomes and experiences are what matter most. Improving the quality of life for those members is what drives RWC.
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Don't miss today's webinar at 1:00 PM CST in partnership with Rex Wallace Consulting, LLC as we break down everything you need to know about 2025 Medicare Star Ratings! Register now to join us live or get early access to the event recording: https://lnkd.in/gG-bd324
We are excited to welcome Jennifer Nguyen, MPH, CHES and Paige Caprara to our team! Jennifer’s deep expertise in Medicare Stars and health equity, combined with Paige’s extensive background in Medicare strategy and value-based contracting, will strengthen our capabilities to provide unparalleled strategic insights and execution support for our clients. Their proven track records in enhancing healthcare outcomes and operational efficiencies will drive impactful improvements and exceptional results. Join us in celebrating their arrival and the value they bring to our firm, and learn a little more about each of them below: Jennifer Nguyen has over ten years of diverse experience in the payer field, healthcare industry, and non-profit sector. With a Master’s degree in Public Health and certification as a Health Education Specialist, Jennifer has a strong foundation in health equity and health outcomes. She previously led the Medicare Stars Program at a local carrier, where she developed and executed multi-year Stars strategies across multiple contracts, and implemented strong program governance as the owner of executive committees and workgroups. Her extensive knowledge of Medicare operations and oversight, along with her passion for quality improvement, will be instrumental in driving our initiatives forward through comprehensive execution guidance. Paige Caprara brings a rich background in healthcare management, with more than a decade of expertise in Medicare strategy, population health, and value-based contracting. Holding a Bachelor’s degree in Human Development, Family Sciences, and Middle Childhood Education. Paige has a unique blend of skills that enhance her strategic approach. She has extensive experience on both the provider and payer sides of the healthcare quality ecosystem. Paige has supported quality improvement, patient outcomes, revenue capture, and operational efficiencies for Accountable Care Organizations, Clinically Integrated Networks, and IPAs through leadership roles at WellCare/Centene Health Plans. She led a national team of Stars Improvement strategists focused on enhancing healthcare outcomes and Stars performance across the organization’s 100+ H-contracts. Paige’s multifaceted experience will be a tremendous asset to our team.
Rex Wallace Consulting, LLC is thrilled to join RISE this week in Orlando. If you're in attendance, there are several chances to hear RWC speak: First up, Rex Wallace, CEO, will speak on using Product Design to boost Star Ratings (Product Design Master Class, Monday, 1:20pm) with CareFirst BlueCross BlueShield and Amplifon Hearing Health Care. Next, Luis Cerda will join Blue Cross Blue Shield of Massachusetts to talk about the role of Part D in Stars (Part D Master Class, Monday, 3:20pm). Over at the Member Engagement & Experience Summit: Rex and Luis will talk about the importance of Trust in your Stars and Member Engagement Strategy (Monday, 11:10am). Luis will moderate a roundtable on Improving Access to Care, and Rex will moderate a roundtable on the importance of vendor oversight (Monday, 4:20pm). Return to the MX Summit on Tuesday to catch Nate Lucena, Chief Strategy Officer, speaking with Circle and Baylor Scott & White Health Plan on addressing health equity in LGBTQ+ Seniors (Tuesday, 9:45am). Finally, Heidi Salerno, MX guru, will join Clover Health to talk about all the best practices you need to improve CAHPS and HOS. It's going to be a busy couple of days, but find us in your downtime to connect! We can't wait to see you all.
Small, medium, and large shifts in CAHPS benchmarks this year! If you haven't seen your Westat memos, get in touch with your product compliance contacts today. At Rex Wallace Consulting, LLC we have a comprehensive approach to improving the member experience, including best-practice strategies, tools, and analytics that have generated big results for our clients. Reach out to Nate (nate.lucena@rexwallaceconsulting.com) and our industry-leading MX expert Heidi (heidi.salerno@rexwallaceconsulting) to get your CAHPS improvement strategy to the next level!
The Stars 2025 party continues! #CMS has begun releasing Westat memos with critical information about CAHPS performance adjustments for contracts and industry benchmarks for Star Ratings. A few observations: Despite early indications of widespread reliability issues in Care Coordination and Rating of Healthcare Quality, many (but not all) in our book of business have received ratings, and benchmarks remained stable or ticked up slightly. We knew there would be a shift in Getting Appointments and Care Quickly due to removal of the 15-minute wait time question, but peep that 6-point jump with remarkable consistency across the entire performance distribution. Flu vaccine benchmarks continue a march downward, with an even more precipitous drop between the CY2023/SY2024 and CY2024/SY2025 surveys than in prior years. Expect PP1 at any time folks. As the uncertainties in your SY 2025 math path dwindle, take the opportunity to cheer (or cry 😓 ), then roll up your sleeves and use the new information to calibrate your priorities for SY 2026! As always, Rex Wallace Consulting, LLC is here to help you turn this data into action. ✌ 🌟
The ins and outs of the annual Call Center Monitoring study, which feeds two heavily-weighted Star measures, have stepped into the spotlight with recent payer lawsuits against CMS. The limited sample sizes and murky program execution (calls never connecting? anyone?) mean that every single call has a huge impact on Stars. Check out the infographic and call to action from Nate before you slam that laptop shut for the weekend!
CMS is sending us into the weekend with newly-released Call Center Monitoring results for Stars 2025! The Part C and D Foreign Language/TTY measures were the two most-impacted after CMS' re-calculation of Star Year 2024 cut point and Stars. The attached graphic shows the magnitude of change across all measures and cut points...take a look at those top two rows to see FL/TTY leading the pack. With the lack of full guidance on how CMS will approach cut points for the fast-approaching Star Year 2025 calculations, all plans should become very fluent in their results from the study and be ready for anything. This year's tumultuous study execution and some infamous FL/TTY shout outs in consequential lawsuits should put every data point under scrutiny for your contracts! Head to HPMS to get to your data. And if you need help making sense of your results, you know where to find us! ✌
This one goes out to all our fellow Stars nerds out there. Enjoy some Friday afternoon maps! #MedicareStars #Tukeygate
Did you know I'm an unabashed data nerd? If you didn't, you will if you make it through this post... We've all been patiently (but not really) awaiting the release of an industry dataset for the newly recalculated 2024 Stars, and CMS threw us a bone on Tuesday. As a visual person, I love a map. So I started digging into the data with a couple of primary questions: - Where in the country did #MedicareStars gains appear impactful? - Did the "where" change depending on what Star level we're looking at? Check out this video showing very high-level answers to those questions. In this series of maps, each dot represents a county. The color of the dot represents a recalculated Star Rating (for example, red indicates moving from 2.5 to 3 Stars). The size of each dot represents the total volume of MA membership in the county that moved to that Star Rating (the bigger the dot, the larger the member volume). These are really simple initial steps to look at some nationwide trends coming out of the recalculation, but some impactful images nonetheless. What do you think? Share what other views you'd like to see!
We are immensely proud to announce that Nate Lucena, our Chief Strategy and Analytics Officer, has been recognized by the St. Louis Business Journal as a 2024 Business of Pride Honoree! Nate sets a new standard in championing workplace authenticity and equity. His standout leadership on the Health Equity Technical Expert Panel for the Pharmacy Quality Alliance and his pioneering work in incorporating sexual orientation and gender identity data into health equity initiatives distinguish him in the field. Beyond his professional achievements, Nate's profound community impact through co-founding WILDFRUIT Projects and his leadership on purpose-driven boards make him an invaluable contributor to our firm, industry, and the broader discourse on LGBTQ+ equality. Nate's recognition underscores the limitless impact of promoting diversity and inclusion, demonstrating that anyone can drive meaningful change. As Nate powerfully stated in the SLBJ article, "The ways in which we show up to build inclusive cultures can be as unique as our fingerprints, and when we create space for that, we end up with a whole that is greater than the sum of its parts." Congratulations, Nate! A link to full article written by the St. Louis Business Journal can be found here: https://lnkd.in/g5yizcx5 #Pride2024 #LGBTQIA
RWC is growing, and we're excited to announce that we're seeking two full-time additions to our team! If you'd like to learn more, please reach out to Nate at nate.lucena@rexwallaceconsulting.com.
LinkedIn Fam: Rex Wallace Consulting, LLC is continuing our phenomenal growth trajectory! I'm looking to hire two full-time unicorns 🦄 who can deliver deep, data-driven insights, innovative improvement strategies, and push organizations to execution. Desirable skills for these positions: - Experience across government programs (Medicare including Stars, Medicaid Quality Withholds, Exchange) - Expertise in Quality Improvement and/or Risk Adjustment - Clinical, Operational, Member Experience, or Provider Engagement SMEs - Ability to use data to self-source insights and recommendations - High EQ - Exceptional professional integrity - Strong project/program management skills - Stellar written + oral communication of complex concepts The pace is fast, the environment Is challenging, and the colleagues are FUN! Reach out to nate.lucena@rexwallaceconsulting.com if you think you're a good fit, and please share with your networks!
Check out this fun and informative weekend update of all things #SCAN, #Elevance, #CMS, and #MedicsreStars with RWC CSO Nate Lucena and our very smart friends Jenn Kerfoot of DUOS and Jessica Assefa of Ameropia Advisors! Link in post.
What better way to enjoy my Saturday morning coffee than #CMS dad jokes and #TukeyGate insights with Jenn + Jessica? This is big Stars nerd energy, and we had a lot to say about the last week of lawsuits, recalculations, and overall industry drama in #MedicareAdvantage. If you want a recap of the fast facts and our predictions for where this is pushing our industry, then join these two thought leaders and me (complete with side eye) for this half-hour rundown of all that's happened and all that's still to come! Many thanks to Jenn for pulling us together to talk about work without it feeling like work! Link to the full episode: https://lnkd.in/gZrFU4Qf
Are you ready? Recalculations for Stars 2024 are out, and plans can re-tool and re-submit bids and formularies if they've been impacted. Get details and a copy of the memo at the post below, and you can contact anyone at Rex Wallace Consulting, LLC if you're unsure what your next steps should be! #MedicareStars #MedicareAdvantage
Health plan friends: Get thee to HPMS! CMS has released recalculated #StarRatings for Star Year 2024 using guardrails applied to published (non-Tukey) Star Year 2023 cut points. New Overall and Summary Stars are being assigned in a "hold harmless" manner, such that ratings resulting in a higher rebate and QBP than what was previously calculated will be updated, whereas contracts whose QBP is eliminated by the recalculation will not be updated. #CMS is allowing any contract with increases to rebate/QBP to re-submit their 2025 bid packages and formularies by June 28th! Your new Star Ratings and your TBC are both available now in HPMS. Start revisions ASAP, because the resubmission will open on June 26th. Importantly, you must notify CMS of your intent to make formulary changes by June 18th. Don't hesitate to reach out with questions or guidance on how to proceed! #MedicareAdvantage #TukeyGate