Star Ratings: Measuring Quality
The Centers for Medicare & Medicaid Services (CMS) Star Rating System measures the overall quality of Medicare Advantage (MA) HMO, PPO, and Part D plans. Plans are rated on a scale of one to five stars, with five representing the highest quality.
The system encompasses:
- Quality of care
- Access to care
- Consumer satisfaction
- Customer service
- Responsiveness to member needs
Quality scores are based on more than 50 distinct measures that are derived from four sources:
- Healthcare Effectiveness Data and Information Set (HEDIS®)
- Centers for Medicare & Medicaid Services
- Consumer Assessment of Healthcare Providers and Systems (CAHPS®) program
- Health Outcomes Survey (HOS)
Measures you can affect:
Chronic Condition Management
Includes diabetes care (eye exam, monitoring kidney disease, controlling blood sugar), rheumatoid arthritis management, controlling blood pressure, and managing readmissions.
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.