Acronyms
FHIR
What is Fast Healthcare Interoperability Resources
These are set using a clustering methodology which separates plans into groups that are most similar within a grouping, but most dissimilar to the next grouping
What are thresholds
CVS stands for this, reflecting the company's founding principle of providing high-quality products and services at affordable prices
What is Consumer Value Stores
The team so nice they named it twice
What is HQS or Stars
This document is where the final regulations are published by CMS
What is the Federal Register
FOBT
Fecal Occult Blood Test
This grouping of measures has moved from 1.5 weight, to 2.0 weight, to 4.0 weight and will now move back to 2.0 weight
What are the PEAC measures (Patient Experience Access and Complaints
This insurance competitor ranks number 5 on Fortune's list of the 500 largest companies
What is UnitedHealth Group
This team is your go to for analytics and technology solutions
What is HQRI Technology and Analytics (HTA)
This period lasts for 60 days typically following CMS regulation proposals or releases
What is the Comment Period
PEX
What is a Provider Engagement Executive
This allows a contract to use the better of the current year or prior year measure star
What is a disaster adjustment (or extreme and uncontrollable circumstances)
This startup features a number of former Athenahealth executives and impressed in its initial star ratings driven by outstanding medication adherence performance
What is Devoted Health
This team now manages corporate Stars interactions with the markets
What is the Strategy Advancement team
After CMS forwards the rule for publication, it also forwards to regulation to these 3 bodies of government
The Government Accountability Office (GAO), the Senate and the House
STARS
What is Stars is not an acronym and therefore is never used in all caps
This factor tries to account for the average within-contract disparity in performance for Low Income Subsidy/Dual Eligible beneficiaries and disabled beneficiaries
What is the Categorical Adjustment Index (CAI)
This competitor is a federation, or superorganization, of 34 independent and locally operated companies providing health insurance
What is Blue Cross Blue Shield
This team is responsible for projecting the $ impact of expected and current membership
What is the Financial Analytics team
The annual regulatory document that describes the agency's proposed payment and coverage policies for MA and Part D plans for the upcoming year and soliciting input on future measures and concepts
What is the Advanced Notice
PMPM
Per Member Per Month
This "scenario" allows you to not leverage the Improvement measures if it benefits your plan at certain star levels
What is hold harmless
This health insurance startup opened to much fanfare around its full stack technology platform in the New York, Florida and Houston markets, but has failed to deliver on its quality promises
What is Oscar
This team leads the documentation of member conditions that help balance the costs and risks of health plans that cover different types of patients
What is the Risk Adjustment team
Regulation announcing CMS' intent to issue a new regulation or modify an existing regulation
What is the proposed rule