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Star Ratings: Measuring Quality

The Centers for Medicare & Medicaid Services (CMS) Star rating system measures the overall quality of Medicare Advantage (MA only and MA-PD) and Prescription Drug Plans (PDPs). Plans are rated on a scale of one to five stars in half-step increments, with five stars representing the highest score and one the lowest.

The system encompasses: 

  • Quality of care
  • Access to care
  • Member satisfaction
  • Customer service
  • Responsiveness to member needs

Plans are assessed on a number of different health and drug plan quality and perfomance measures. The data for each measure comes from claims data, medical records, administrative data, survey data, pharmacy data and other sources. The main components are:

  • Healthcare Effectiveness Data and Information Set (HEDIS®)
  • Part D or Pharmacy
  • Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey
  • Health Outcomes Survey (HOS)
  • Centers for Medicare & Medicaid Services

Measures you can affect:

Preventive Medicine/Early Detection

Includes breast cancer screening, colorectal cancer screening, flu vaccine, BMI assessment, and osteoporosis management.

Chronic Condition Management

Includes diabetes care (eye exam, monitoring kidney disease, controlling blood sugar), rheumatoid arthritis management, controlling blood pressure, and managing readmissions.

Patient Safety

Includes diabetes, hypertension, and cholesterol medication adherence, and medication reconciliation post-discharge.

Health Outcome Survey (HOS)

Improving and maintaining physical and mental health including monitoring physical activity, improving bladder control, and falls prevention.

Consumer Assessment of Healthcare Providers and Systems Survey (CAHPS®)

Obtaining needed care and appointments promptly; care coordination, e.g. patient records/reports needed for patient care and prompt test results.