top of page

MLTC & Healthcare: Does plan size matter in Star Ratings for MLTC?

Updated: Jun 30, 2020

I have discussed before on the importance of the denominator in the star rating process for MLTC plans.

For those who are not familiar with the terminology, an easy definition is "Total of members who satisfy the criteria to be considered in a certain measure".

For example, in the domain Prevention for the MLTC Consumer Guide, the measure Flu Vaccination has a denominator per plan "Members who received an influenza vaccination in the last year".

All the measures have this denominator. Why is it important to know about it? Well, there are some measures in the star rating process (population-based measures) which considers in the calculation of the rating process this number. For the other type of data (survey-based measures) the process doesn't include this number in an evident way.

The impact of this "denominator" in the rating process, comes in the standardization formula of the measure:

Clearly, the Survey-based measure will describe a linear behavior in a plot of the rate vs. standardized measure. Meaning that the higher the rate of a plan, the higher the standardization result.

On the other hand, we identify a different behavior for population-based measures. This happens because of the inclusion of the denominator into the standardized process. In both plots, every point represents a plan in the MLTC program, and the size of the dot represents the size of the denominator, the bigger the dot, more members participate in the specific measure.

Here we identify that the linear behavior previously shown has gone. If we pay enough attention there are plans who obtained certain results, and because of its denominator, they did not perform as well as other plans with smaller results.

If you want to know more details about the importance of the denominator for the star rating process check the class

More information about Lagrange AI in our YouTube channel

Or even better, if you are ready to work with us and improve your ratings and quality incentives for the next measurement period, we are ready for you!

Find out how Byteflow's expertise can help you and your company. 

Byteflows AI is a boutique NYC based data consultancy with a global reach. Our small team of dedicated AI & data science consultants and experts strives to deliver business value with AI. [Healthcare, MLTC, Insurance, FinTech, NLP, Hedge Funds, Pharma, Political campaigns & more] 

Contact us:

40 views0 comments


bottom of page