CASE STUDY SEEING ST ARS A struggling Medicare program has a stunning turnaround. THE CHALLENGE When a Medicare plan performs poorly in CMS audits, problems follow. Sanctions, fines, low Star Ratings, increased CMS plan oversight, and a weak competitive position in the market are usually just the beginning. Add to that skyrocketing specialty drug costs and a high dual- eligible population with chronic conditions and special needs, and you have a prescription for near disaster. For the plan to continue serving this population, it needed to achieve Star Ratings that would unlock bonus performance payments. Without funding to pay for rising costs and investments in services to attract new members, the future would be uncertain. Yet, this was precisely the situation a regional Medicare p

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