Health Care Notes: Clover star rating raised after court-ordered recalculation

Franklin-based health insurer Clover Health Investments has received an upgraded star rating from the Centers for Medicare and Medicaid Services following a recent court ruling.

On May 29, the United States District Court for the Southern District of Georgia entered final judgment in Clover Insurance Co. v. U.S. Department of Health and Human Services, granting summary judgment in part for Clover Insurance Company, a subsidiary of Clover Health Investments Corp.

At issue in the lawsuit was Clover's 2026 star rating, which impacts payment year 2027.

The court set aside Clover's 2026 3.5-star rating for Contract H5141 and ordered the Centers for Medicare and Medicaid Services (CMS) to recalculate Clover's 2026 star rating "in a manner consistent with the order."

On June 9, the CMS informed Clover that, consistent with the court's order, it has recalculated the company's 2026 star rating as 4.5 stars.

The rating applies to, as noted, Contract H5141, Clover's PPO plan, which covers over 97 percent of the company's members.

The 2026 star rating for Clover's HMO plan (Contract H8010) was not subject to the litigation and its 2026 star rating remains at 4.0 stars, as previously reported.

Insider Monkey reports the downgrade could have resulted in a cut of up to $120 million of the statutorily mandated quality bonus and related government reimbursement payments Clover receives.

Centerstone lands grant for suicide reduction effort

Nashville-based nonprofit behavioral health organization Centerstone has received a philanthropic grant from Four Pines Fund to support an effort to understand and reduce suicide.

The dollar amount of the grant was not disclosed in a release.

The Center for the Helping Professions, also based in Nashville, is partnering with Centerstone's Institute for Clinical Excellence and Innovation on the national initiative.

The effort is one of a five grants made by Four Pines Fund in 2026 to accelerate the national implementation of effective suicide care practices in health organizations, according to a release.

With the grant, Centerstone's Institute for Clinical Excellence and Innovation — an in-house research and training center — will refine a tool and develop a technical assistance hub to help behavioral health organizations conduct reviews and analyses of suicide attempts and near-fatal overdoses.

The reviews will leverage an existing critical incident review tool that will be adapted for use in behavioral health settings.

Centerstone will work across its network of clinics and hospitals and partner with at least five other U.S. health organizations to implement the tool.

TriStar Southern Hills names Ben Rawcliffe CNO

TriStar Southern Hills Medical Center has named Ben Rawcliffe chief nursing officer.

Rawcliffe arrives from HCA Healthcare's Southern Hills Hospital and Medical Center in Las Vegas, where he most recently served as assistant chief nursing officer.

In his new role, Rawcliffe will oversee all nursing operations and work with clinical leaders to improve quality outcomes and patient experience.

His accomplishments include improving patient experience scores and reducing nursing turnover.

Prior to his nursing career, Rawcliffe served as a combat medic with the U.S. Army's 101st Airborne Division at Fort Campbell, Kentucky.

Rawcliffe earned a Bachelor of Science degree in nursing and a Master of Science degree, also in nursing, with a concentration in healthcare administration and leadership from Galen College of Nursing.

He is board certified as a nurse executive through the American Nurses Credentialing Center.

"Ben is a proven nursing leader with a deep commitment to patient-centered care and supporting clinical teams," Nick Howald, chief executive officer of TriStar Southern Hills Medical Center, said in a release.

"His experience leading complex service lines, developing high-performing teams and driving quality improvement initiatives will be invaluable as we continue to advance the exceptional care we provide to our community."