1. CMS 5 Stars and Health Survey 1

2. What are the CMS Stars? CMS created the Five-Star Quality Rating System for Medicare Advantage plans to compare Medicare Advantage plans more easily, and to help identify areas about which they may want to ask questions. The Stars are a quality rating system that gives each plan a rating of between 1 and 5 stars. Plans with 5 stars are considered to be highly above average in quality, and plans with 1 star are considered to be very below average in quality. 2

3. What are the CMS Stars? What are Star Ratings? Star Ratings are CMS ratings for Part C and D Medicare Plans What are they used for? The original purpose of Star Ratings was to enable Medicare beneficiaries to compare quality among Medicare Advantage Plans on the Medicare Prescription Drug Plan Finder (MPDPF). As part of Health Care Reform CMS will begin a quality bonus payment in 2012 for MA Plans based on the Five Star Ratings. When did they start? In the fall of 2006, CMS posted Plan ratings based on a 3 star scale For 2008 Annual Enrollment Period (AEP), CMS introduced a 5 star scale. [5= highly above average; 1 = very below average] Star Ratings are updated annually (during AEP) 3

4. What are the CMS Stars? Plans receive an overall Star rating and ratings by domain Part C Domain I: Staying Healthy: Screenings, Tests and Vaccines Domain II: Managing Chronic (Long Lasting) Conditions Domain III: Rating of Health Plan Responsiveness and Care Domain IV: Member Complaints, Appeals and Choosing to Leave the Health Plan Domain V: Customer Service Part D Domain I: Drug Plan Customer Service Domain III: Member Experience with the Health Plan Domain IV: Drug Pricing and Patient Safety 4

5. What are the CMS Stars? The Star ratings are drawn from various data sources, and each measure is given a “weight” from 1 to 3. This means that some measures affect plan ratings more than others. 5

6. CMS Star Ratings – Data Sources 6 HEDIS Healthcare Effectiveness Data and Information Set A widely used set of performance measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA). CAHPS Consumer Assessment of Healthcare Providers and Systems CAHPS refers to a comprehensive and evolving family of surveys that ask consumers and patients to evaluate the interpersonal aspects of health care. CAHPS surveys probe those aspects of care for which consumers and patients are the best and/or only source of information, as well as those that consumers and patients have identified as being important. CAHPS initially stood for the Consumer Assessment of Health Plans Study, but as the products have evolved beyond health plans, the acronym now stands for Consumer Assessment of Healthcare Providers and Systems. HOS Health Outcomes Survey The first patient reported outcomes measure used in Medicare managed care. The goal of the Medicare HOS program is to gather valid, reliable, and clinically meaningful health status data in the Medicare Advantage (MA) program for use in quality improvement activities, pay for performance, program oversight, public reporting, and improving health. All managed care organizations with MA contracts must participate. CTM Complaints Tracking Module Data were obtained from the CTM based on the contract entry date (the date that complaints are assigned or re-assigned to contracts; also known as the contract assignment/reassignment date) for the reporting period specified. Complaint rates per 1,000 enrollees are adjusted to a 30-day basis. CMS Audit CMS Administrative Data Findings of CMS audits, ad hoc and compliance actions that occurred during the 14 month past performance review period between January 1, 2010 and February 28, 2011. MBDS Medicare Beneficiary Database Suite of Systems A collection of individual applications and services that access a single, enterprise-wide authoritative source for Medicare beneficiary demographic data. IRE Independent Review Entity An independent entity contracted by CMS to review Medicare health plans’ adverse reconsiderations of organization determinations. Phone Monitori ng Call CenterCall center data collected by CMS PDE data Prescription Drug Event DataData were obtained from PDE data files submitted by drug plans to Medicare for the reporting period. MARx Medicare Advantage Prescription Drug System This data used for this measure is from the Medicare Advantage Prescription Drug System (MARx). It presents the percentage of new enrollment requests from beneficiaries that the plan submitted to Medicare within 7 days of the application date.

7. Data Sources by Weight 7 Data SourceDomains Weighted Value % Total Stars Ratings HEDISPart C: Domains I&II24.530.82% PDE DataPart D: Domain IV1620.13% CAHPS Part C: Domain I&III; Part D: Domain III1417.61% HOSPart C: Domains I&II911.32% IREPart C: Domain V; Part D: Domain I67.55% Phone MonitoringPart C: Domain V; Part D: Domain I4.55.66% CTMPart C: Domain IV1.51.89% CMS AuditPart C: Domain IV1.51.89% MBDSPart C: Domain IV1.51.89% MARxPart D: Domain I11.26% Total: 79.5100.00%

8. 2010-2012 Ratings CA Plans 8

9. 2010-2012 CA Ratings 77 th percentile nationally 74 th percentile in CA SCAN H9104 & H5425 9

10. HOS Survey  Member-reported survey April - July  Measures patient reported functional status and quality of patient/doctor interaction  Knowing what to ask patients can improve scores 10

11. 5 Star HOS Questions 5 key measures  Improving or maintaining physical health 3  Improving or maintaining mental health 3  Monitoring physical activity  Reducing risk of falling  Improving bladder control 11

12. 5 Star HOS Questions Improving or Maintaining Physical & Mental Health  “Compared to one year ago, how would you rate …?”  Gauge patients’ physical and mental status at each visit  Consider how the following measures can impact these 12

13. 5 Star HOS Questions Monitoring Physical Activity  Find out how much they’re getting  Advise them how to start, increase or maintain  One of best all-around “prescriptions” for improving physical and mental health 13

14. 5 Star HOS Questions Reducing Risk of Falling  Leading cause of fatal injury, non-fatal injury and hospital admissions  Discuss balance problems, trouble walking and other risk factors 14

15. 5 Star HOS Questions Improving Bladder Control  Can be treated or improved in 8 of 10 cases  Urinary Incontinence linked to:  increased fall risk  decline in mental health  Physicians need to initiate discussion 15

16. SCAN Contacts for 5 Stars For additional information, please contact us by e-mail:  5stars@scanhealthplan.com 5stars@scanhealthplan.com  Qualityinitiatives@scanhealthplan.com Qualityinitiatives@scanhealthplan.com “Geriatric toolkit” currently in development 16

17. Break for Pfizer 17

18. What Can You Do?  Ask your patients about their physical and mental health  Ask your patients about their physical activity and how it can be improved  Your medical staff are key for setting the stage for improved patient/doctor interaction  Use the Annual Wellness Visit as a vehicle to set the stage 18

19. What Can You Do? Distribute this presentation and consider posting an excerpt on your web site. Please refer to the following web sites for additional resources:  www.scancme.com: learn more about SCAN’s Continuing Medical Education (CME PIE) Program featuring guidelines and CMS Star relevant courses www.scancme.com  www.scanhealthplan.com/qip: learn more about the CMS 5 Star Ratings, CAHPS, HOS, and Initial Health Assessment (“HQ”)www.scanhealthplan.com/qip 19

20. What Can We Do?  SCAN/Pfizer will present to your staff the “Big Picture” on how they can impact your groups star rating  Present to your staff the questions that will be asked on the HOS and how they can positively impact the results  Educate your staff on the AWV and how it can impact the overall star ratings  Develop a comprehensive “geriatric tool kit” with forms/checklist and guidelines on improving patient satisfaction and overall quality of care 20

21. SCAN Initiatives  Member GuideBook – Multiple mailings and incentives throughout the year  Annual Wellness Visit – April, 2012  Medication Adherence – June, 2012  Diabetes – June, 2012  Annual Flu Vaccinations – September, 2012 21

22. SCAN Initiatives  Medication Adherence – Reminder letters for those members who have a history of not refilling their prescriptions as prescribed – April, 2012  Automated Calls – For those members who have a gap in care for one of the following conditions – Quarterly starting April, 2012  Osteoporosis  Rheumatoid Arthritis  COPD 22

23. REFERENCE 23 Following are HOS questions used for Star Ratings

24. HOS – Physical Health Improving or Maintaining Physical Health 1. In general, would you say your health is: a. Excellentb. Very Goodc. Goodd. Faire. Poor 2. The following are items about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? a. Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf a. Yes, limited a lotb. Yes, limited a littlec. No, not limited at all b. Climbing several flights of stairs a. Yes, limited a lotb. Yes, limited a littlec. No, not limited at all 3. During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of your physical health? a. Accomplished less than you would like a. No, none of the timeb. Yes, a little of the timec. Yes, some of the time d. Yes, most of the timee. Yes, all of the time b. Were limited in the kind of work or other activities a. No, none of the timeb. Yes, a little of the timec. Yes, some of the time d. Yes, most of the timee. Yes, all of the time 5. During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)? a. Not at allb. A little bitc. Moderatelyd. Quite a bit e. Extremely 8. Compared to one year ago, how would you rate your physical health in general now? a. Much betterb. Slightly betterc. About the samed. Slightly worsed. Much worse 24

25. HOS – Mental Health Improving or Maintaining Mental Health 4. During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)? a. Accomplished less than you would like a. No, none of the timeb. Yes, a little of the timec. Yes, some of the time d. Yes, most of the timee. Yes, all of the time b. Didn’t do work or other activities as carefully as usual a. No, none of the timeb. Yes, a little of the timec. Yes, some of the time d. Yes, most of the timee. Yes, all of the time 6. How much of the time during the past 4 weeks: a. Have you felt calm and peaceful? a. All of the timeb. Most of the timec. A good bit of the time d. Some of the timee. A little of the timef. None of the time b. Did you have a lot of energy? a. All of the timeb. Most of the timec. A good bit of the time d. Some of the timee. A little of the timef. None of the timec. Have you felt downhearted and blue? a. All of the timeb. Most of the timec. A good bit of the time d. Some of the timee. A little of the timef. None of the time 7. During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)? a. All of the timeb. Most of the timec. A good bit of the time d. Some of the timee. A little of the timef. None of the time 9. Compared to one year ago, how would you rate your emotional problems (such as feeling anxious, depressed or irritable) in general now? a. Much betterb. Slightly betterc. About the samed. Slightly worse e. Much worse 25

26. HOS – Physical Activity and UI Monitoring Physical Activity 46. In the past 12 months, did you talk with a doctor or health provider about your level of exercise or physical activity? For example, a doctor or other health provider may ask if you exercise regularly or take part in physical exercise. a. Yesb. No 47. In the past 12 months, did a doctor or other health care provider advise you to start, increase or maintain your level of exercise or physical activity ? For example, in order to improve your health, your doctor or other health care provider may advise you to start taking the stairs, increase walking from 10 to 20 minutes every day or maintain your current exercise program. a. Yesb. No Improving Bladder Control 42. Many people experience problems with urinary incontinence, the leakage of urine. In the past 6 months, have you accidentally leaked urine? a. Yes (go to question 43)b. No (go to question 46) 43. How much of a problem, if any, was the urine leakage for you? a. A big problem (go to question 44)b. A small problem (go to question 44) c. Not a problem (go to question 46) 44. Have you talked with your current doctor or other health provider about your urine leakage problem? a. Yesb. No 45. There are many ways to treat urinary incontinence including bladder training exercises, medication and surgery. Have you received these or any other treatments for your current urine leakage problem? a. Yesb. No 26

27. HOS – Reducing Risk of Falling Reducing the Risk of Falling 48. A fall is when your body goes to the ground without being pushed. In the past 12 months, did your doctor or other health provider talk with you about falling or problems with balance or walking? a. Yesb. Noc. I had no visits in the past 12 months 49. Did you fall in the past 12 months? a. Yesb. No 50. In the past 12 months, have you had a problem with balance or walking? a. Yes b. No 51. Has your doctor or other health provider done anything to help prevent falls or treat problems with balance or walking? Some things they might do include: -Suggest that you use a cane or walker -Check your blood pressure lying or standing -Suggest that you do an exercise or physical therapy program -Suggest a vision or hearing testing a. Yesb. Noc. I had no visits in the past 12 months 27