New MA star ratings released by CMS

November 11, 2010

For information on this topic please read our new post, “Health plans “score” with Medicare’s 5-star rating system.”

The Centers for Medicare and Medicaid have released updated star ratings for Medicare Advantage plans, just in time for the Annual Enrollment Period. You can see the new ratings on the Medicare Plan Finder on Medicare.gov.

The ratings are significant for at least two reasons: most importantly, they’re an indicator of the quality of  the service provided by each plan and can serve as a guide for individuals as they evaluate their coverage options.

The Star ratings are also important to the plan’s insurance carrier – because these ratings will be used by CMS to determine if the plan qualifies for a quality bonus payment in  2012. These bonus payments,  part of the health care reform bill, provide an incentive for plans to improve their performance.  MA plans that earn the highest rating of 5 stars are eligible to receive the largest bonus, equal to 5 percent, but all MA plans that have a score of three stars and higher will qualify for a bonus payment in 2012. (Plans with a rating lower than 3 stars for the past three years not only won’t qualify for bonuses, they also have a “low performer” icon placed next to their name.)

Wondering how CMS determines the star ratings? Read on…Medicare surveys plan members and clinicians, uses statistics and information from the plans themselves, and conducts regular monitoring activities to determine the star ratings for health services. For drug services, information sources also include reviews of billing information for the plans. In total, the star rating system considers 53 quality measures.

From the Overall Plan Rating definition on Medicare.gov:

“The Overall Plan Rating combines scores for the types of services each plan offers:

For plans offering health services, the overall score for quality of those services covers 36 different topics in 5 categories:

  • Staying healthy: screenings, tests, and vaccines: Includes how often members got various screening tests, vaccines, and other check-ups that help them stay healthy.
  • Managing chronic (long-term) conditions: Includes how often members with different conditions got certain tests and treatments that help them manage their condition.
  • Ratings of health plan responsiveness and care: Includes ratings of member satisfaction with the plan.
  • Health plan member complaints and appeals: Includes how often members filed a complaint against the plan.
  • Health plan telephone customer service: Includes how well the plan handles calls from members.
  • For plans covering drug services, the overall score for quality of those services covers 17 different topics in 4 categories:
    • Drug plan customer service: Includes how well the drug plan handles calls and makes decisions about member appeals.
    • Drug plan member complaints and Medicare audit findings: Includes how often members filed a complaint about the drug and findings from Medicare’s audit of the plan.
    • Member experience with drug plan: Includes member satisfaction information.
    • Drug pricing and patient safety: Includes how well the drug plan prices prescriptions and provides updated information on the Medicare website. Includes information on how often members with certain medical conditions get prescription drugs that are considered safer and clinically recommended for their condition.
  • For plans covering both health & drug services, the overall score for quality of those services covers all of the 53 topics listed above. “

7 Responses to “New MA star ratings released by CMS”

  1. […] The ratings are based on 36 measures in five categories, covering things like screenings, tests, complaints, service, and other relevant measures. There’s a helpful CMS document called, “Choose Higher Quality for Better Health Care,” that provides a very good overview of the program. We also recommend reading our previous blog post, “New MA star ratings released by CMS.” […]

  2. […] The ratings are based on 36 measures in five categories, covering things like screenings, tests, complaints, service, and other relevant measures. There’s a helpful CMS document called, “Choose Higher Quality for Better Health Care,” that provides a very good overview of the program. We also recommend reading our previous blog post, “New MA star ratings released by CMS.” […]

  3. Linda Brinkmann-Woode said

    5/4/2012 – Three doctors in the Kelsey Advantage Care plan have said “they do not do pap screens on women over 65” even tho their Evidence of Coverage book states they do. I want a) their rating changed from 5 stars and b) their booklet of EoC to be written truthfully. How can a plan be judged before enrolling if their EoC’s are not accurate and truthful.

  4. L. Woode said

    I have contacted CMS on May 3, 2012 awaiting comment. I have also contacted Inspector General’s Office of Texas, TDI only checks for financial health not for complaints on care. Neither is QIO as listed by Medicare booklet, they will take complaint but have no authority to pursue. I am aware Extend health does not award ratings. I am trying to find others that have had problems with this so called 5 Star Advantage Plan.

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