Monday, December 10, 2012

Star Ratings and their impact on Medicare

Star ratings have grown in importance for Medicare plans.  Where they were previously used by beneficiaries to judge which plan they would choose, they have grown in importance with the Affordable Care Act.  Now, only those plans with four and five stars are eligible for their MA quality bonus payments.

According to the article at Mintz Levin, MAs star ratings come from these five categories:
  • - Staying Healthy: Screenings, Tests and Vaccines (10 measures);
  • - Managing Chronic Long Term Conditions (13 measures);
  • - Member Experience With Health Plan (6 measures);
  • - Member Complaints, Problems Getting Services, and Improvements in the Health Plan's Performance (4 measures); and
  • - Health Plan Customer Service (4 measures).

Star Ratings come from a collection of information from these sources:
  • - The Healthcare Effectiveness Data and Information Set ("HEDIS").
  • - The Consumer Assessment of Healthcare Providers and Systems ("CAHPS") Survey.
  • - The Health Outcomes Survey ("HOS").
  • - CMS administrative data, including but not limited to member satisfaction, appeals processes, audit results, and customer service.
  • - Prescription drug event ("PDE") data submitted to the CMS by the drug plans (for Part D).
This February at The Medicare Congress, we'll host the first annual Stars Summit,which will bring professionals from around the industry together to help professionals in the field raise their star rating. For more information on the Summit and the rest of the agenda, download the brochure. If you'd like to join us, register and mention code XP1706BLOG and save 15% off the standard rate.

Do you agree with the new Star Rating System? What is the one thing you think needs improvement?

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