- Staying healthy: screenings, tests, and vaccines.
- Managing chronic (long-term) conditions.
- Plan responsiveness and care.
- Member complaints, problems getting services, and choosing to leave the plan.
- Health plan customer service.
What measures are included in star ratings?
Part C) and Medicare Part D Star Ratings each year to measure the quality of health and drug services received by consumers enrolled in Medicare Advantage (MA) and Prescription Drug Plans (PDPs or Part D plans). The Star Rating system helps Medicare consumers compare the quality of Medicare health and drug plans being offered. As part of this effort, patients are …
What are the Medicare plan star ratings?
What Are Medicare Plan Star Ratings and How Are They Measured? 5-star rating: Excellent. 4-star rating: Above Average. 3-star rating: Average. …
What does a 5-star Medicare rating mean?
Feb 15, 2022 · What Measures Are Included Medicare Star Ratings? The quality measures used to evaluate a plan’s Star Rating are different for Medicare Advantage and Part D. As mentioned, the total number of measures included varies from year to year. In 2021, there were 46 measures used for the Star Rating evaluation — 32 for Medicare Advantage and 14 for Medicare Part D. …
What do Medicare Advantage plan's star ratings mean?
Highlights of Contract Performance in 2020 Star Ratings1 Medicare Advantage with prescription drug coverage (MA-PD) contracts are rated on up to 45 unique quality and performance measures; MA-only contracts (without prescription drug coverage) are rated on up to 33 measures; and stand-alone PDP contracts are rated on up to 14 measures.
What is the star rating for Medicare?
Medicare plans are rated on a scale of 1 to 5, with a 5-star rating being the highest score ...
What is chronic conditions management?
Chronic conditions management: Plans are rated for care coordination and how frequently members received services for long-term health conditions. Member experience: Plans are rated for overall satisfaction with the health plan.
HOS Measures in the Star Ratings
Prior to the 2022 Star Ratings, five HOS measures (two functional health measures and three HEDIS Effectiveness of Care measures) were included in the annual Medicare Part C Star Ratings and two HOS measures were used for display.
Medicare Star Ratings Timeline
CMS posted the 2021 Medicare Part C Star Ratings in October 2020.
Measures, domains for star ratings
CMS assesses a Medicare Advantage plan’s quality of care according to the plan’s performance on a list of quality measures. Each measure falls under one of nine domains. The domains include maintaining health, chronic disease management, member experience, member complaints, and customer service as well as four domains for scoring drug plans.
Categorical adjustment index
The fact that stars are assigned to contracts and not individual plans could pose a problem for contracts that cover a diverse set of Medicare Advantage health plans.
Adjustments for stable, high performance
Additionally, CMS has incorporated an improvement measure for plans that receive high scores multiple years in a row. Consistently high-scoring plans would receive a lower star score in successive years because they have less room for improvement.
Quality bonus payments
As a result of the data collection and calculations involved in this methodology, the Medicare Advantage Star Rating system helps consumers compare Medicare Advantage plans. It also informs CMS how much to reimburse payers with Medicare Advantage contracts.
