CMS Star Rating Improvement Reach A Higher Standard of Care
The Centers for Medicare & Medicaid Services (CMS) are raising the stakes in measuring whether Medicare Advantage plans are delivering quality care with the implementation of a new star rating system. The new system rewards only plans that achieve certain benchmarks for multiple quality measures.
These ratings help participants compare plans based on quality and performance. A plan can achieve a rating from one to five stars. A 5-star rating is considered excellent. The overall plan rating provides a single summary score that makes it easy to compare plans based on quality and performance. Visit the Medicare Plan Finder Tool on www.medicare.gov to learn more about plans and see their ratings.
Five Star Quality Rating System Raising The Quality of Care
Program Considerations
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Administrative Claims Data and Chart Reviews | Healthcare Effectiveness Data and Information Set (HEDIS) and medication adherence |
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Member Satisfaction and Member Experience Surveys | Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Health Outcomes Surveys (HOS) |
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CMS Monitoring and Oversight | Appeals timeliness, call center performance, enrollment processing, etc. |
Quality Bonus Payments
Plans that earn more than three stars and fewer than four stars will receive partial Quality Bonus Payments (QBPs) from 2012 through 2014.
Having Trouble Navigating the Ratings? Use This Chart Below to Calculate
Over the past two years, DTS Group has completed Medicare Advantage Stars Improvement projects for dozens of plans. Our HEDIS clients include 6 of the 9 five star plans in the nation. Our experience has led to improvement approaches that include analysis tools, improvement initiatives, and interventions that drive improvement.
Stars Outreach and Action Plans – Prioritize your short-term efforts as part of an integrated long-term strategy for Stars excellence. The Centers for Medicare & Medicaid Services (CMS) are raising the stakes in measuring whether Medicare Advantage plans are delivering quality care with the implementation of a new star rating system. The new system rewards only plans that achieve certain benchmarks for multiple quality measures.
01/12/12 -