The
Centers for Medicare & Medicaid
Services (CMS) uses a five-star rating
system to measure Medicare beneficiaries’ experience with
their health plans and the health care system. This rating system
applies to all Medicare Advantage (MA)
lines of business: Health Maintenance
Organization (HMO), Preferred Provider
Organization (PPO), Private Fee-for-Service
(PFFS) and prescription drug plans (PDP).
The program is a key component in financing health care benefits for MA plan
enrollees. In addition, the ratings are posted on
the CMS consumer website, www.medicare.gov,
to give beneficiaries help in choosing among the
MA plans offered in their area.
CMS Goals for the Five-star Rating System
* Implement provisions of the Affordable Care Act
* Clarify program requirements
* Strengthen beneficiary protections
* Strengthen CMS’ ability to distinguish stronger health plans for
participation in Medicare Parts C
and D and to remove consistently poor performers
How Are Star Ratings Derived?
A health plan’s rating is based on measures in five categories:
* Members’ compliance with preventive care and screening recommendations
* Chronic condition management
* Plan responsiveness, access to care and overall quality
* Customer service complaints and appeals
* Clarity and accuracy of prescription drug information and pricing
Benefits to Providers
* Improved patient relations
* Improved health plan relations
* Increased awareness of patient safety issues
* Greater focus on preventive medicine and early disease detection
Benefits to Members
* Improved relations with their doctors
* Greater health plan focus on access to care
* Increased levels of customer service
* Greater focus on preventive services for peace of mind, early detection and
health care that matches their individual needs
CarePlus Health Plans, Inc.’s Commitment
CarePlus is strongly committed to providing high-quality Medicare health plans
that meet or exceed all CMS quality benchmarks. The structure and
operations of the CMS star rating system ensures that pay-for-performance
funding is used to protect or, in some cases, to increase benefits and to keep
member premiums low.
CarePlus encourages members to become
engaged in their reventive and
chronic care management through outreach, screening
opportunities and Medicare member rewards.
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