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CMS Star Rating

The Centers for Medicare & Medicaid Services (CMS) have raised the stakes in measuring whether Medicare Advantage plans are delivering quality care with the Medicare 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
A Long-Term Approach to Quality

 

Program Considerations

Checkmark Administrative Claims Data and Chart Reviews Healthcare Effectiveness Data and Information Set (HEDIS) and medication adherence
Checkmark Member Satisfaction and Member Experience Surveys Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Health Outcomes Surveys (HOS)
Checkmark CMS Monitoring and Oversight Appeals timeliness, call center performance, enrollment processing, etc.

CMS Publishes Ratings

Starting with the 2014 Star Ratings, CMS will assign the Low Performance icon to any MA-PD contract receiving 2.5 Stars or lower for any combination of their Part C or Part D summary rating for three consecutive years.

 

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Understanding the CMS S.T.A.R.S. Rating System

Over the past three years, DTS Group has completed Medicare Advantage Stars Improvement projects for dozens of plans. Our HEDIS clients include 6 of the 11 MAPD 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) have raised 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.

 

Ready to meet the highest standards
Our approach returns results

 
 

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