MMM - Healthcare
Meet Our Customer
MMM Healthcare / PMC Medicare Choice (both known as MMM), a subsidiary of InnovaCare Health, is a leading health insurer in Puerto Rico currently managing over 200,000 Medicare Advantage (MA) beneficiaries, with over 50% being low-income, dual-eligible individuals. In 2001, it became the first Medicare Advantage (MA) plan established in Puerto Rico.
To provide healthcare coverage to eligible Medicare Advantage (MA) beneficiaries, MMM contracted with the Centers for Medicare and Medicaid Services (CMS), a federal government entity within the USA Department of Health and Human Services. CMS has instituted a Five-Star Quality Rating Program for Medicare Advantage (MA) health plans with the objective of increasing the quality of medical services that beneficiaries receive, while decreasing cost of care. Plans can receive a rating of one to five stars, with a five-star rating indicating that the plan offers the highest level of quality to its members.
This brought additional pressures to MMM as well as to other health plans in Puerto Rico and the United States:
With Medicare funding cuts included in the Affordable Care Act (ACA), MMM was struggling to drive costs down, control operations, improve outcomes, and achieve accountability.
Part of MMM’s compensation is based on achieving a quality rating of 4 stars or more.
Health plans have up to three years to show significant improvement in quality. Otherwise, plans can run the risk of getting their Medicare contract canceled by CMS.
MMM selected STARSTrack, a solution that provides visibility into performance metrics through reporting and analytics, enabling health plans to build actionable strategies across the quality spectrum.
STARSTrack has helped MMM build actionable strategies to strengthen their market position and provide better care management to members.
What was STARSTrack’s role in MMM?
By enabling better data integration STARSTrack has helped MMM’s Star Rating Intervention Team to be better prepared to address care gaps with members, providers, and medical groups.
STARSTrack Provider Quality Rating has allowed MMM to align their network providers with their quality goals, resulting in better care to beneficiaries. By sharing automatic monthly report statements, MMM is helping providers keep track of their patients care gaps within their established workflows.\
STARSTrack enabled results were
After just one year of implementing STARSTrack, MMM achieved an increase of .5 in their 2015 overall star rating, from 3 to 3.5 (average to above average).
An improvement of .5 stars in Part D (pharmacy and drug related) measures.
76% of the measures monitored by STARSTrack improved their performance (RY2015 vs. RY2014).
STARSTrack is valuable for the vast majority of plan-controlled Stars measures across different spectrums:
Key clinical improvements included:
An improvement of 21% in the Osteoporosis Management in Women who had a Fracture measure
10% improvement in the Colorectal Cancer Screening measure
An improvement of 11% in their Rheumatoid Arthritis Management measure
Medication Adherence for Cholesterol (Statins) improved by 11%
Key operational improvements included:
Timely review of appeals improved by 25%
Appeals Upheld (reviewed by the IRE) improved by 23%
Top 25 in US (Medicare Advantage/ Medicaid Health Plan)
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