1. Primer: CMS Star Ratings for Medicare Advantage Plans
Your group/presenter
Date

2. Stars Background P4P for Medicare Advantage Plans
CMS developed in 2007 for Part C and Part D
MA plans awarded 1-5 stars at the contract level
36 Part C and 17 Part D measures individually rated and rolled up to a plan star rating
Ratings posted on Medicare Plan Finder
Beneficiaries and CMS can assess plan performance
Plans can earn through performance what they are losing in prospective cap rates…CMS is eliminating the 14% advantage MA plans have had over FFS

3. Stars Significance – “The Carrot”
Congress mandated that CMS use star ratings beginning in 2010 to reward high performing plans with quality bonus
Starting in 2012, plans with 4 or more stars receive bonus and higher rebates
Four star plan bonus: 2012 = 1.5%, 2013 = 3%, 2014 = 5%
Group contracts are a % of MA premium so plan overall performance affects all groups

5. Stars Significance – “The Stick”
Plans with 3 or less stars for 3 years will be flagged as consistently low performers on the Plan Finder at medicare.gov

6. The Big MA Stars Picture

10. Focus In and Next Steps

11. Part C Measures Groups Can Impact
P4P HEDIS measures
Breast Cancer Screening
Colorectal Screening
CV Cholesterol Screening
Monitoring Patients on Long-Term Medications
Diabetes - Cholesterol Screening
Diabetes - Kidney Monitoring
Diabetes - Blood Sugar Control
Diabetes - Cholesterol control
Non-P4P HEDIS measures
Glaucoma Testing
Access to Primary Care Doctor Visits
Osteoporosis Management
Diabetes Eye Care
Controlling Blood Pressure
Rheumatoid Arthritis Management
Testing to Confirm COPD
Health Outcomes Survey® *
Improving Bladder Control
Reducing the Risk of Falling
Osteoporosis Testing
Monitoring Physical Activity
Improving or Maintaining Physical Health
Improving or Maintaining Mental Health
CAHPS® **
Annual Flu Vaccine
Pneumonia Vaccine
Ease of Getting Needed Care from Specialists
Doctors Who Communicate Well
*The Health Outcomes Survey® (HOS) is administered by CMS annually to obtain data for the first four measures in the table. The results are based on patient recall for each topic. Ratings for the last two measures are derived from responses to questions administered bi-annually to the same cohort of members. Functional status results from the baseline survey are compared to responses on the follow-up survey to assess decline in functional status. Functional status questions are based on patient perception of physical and mental health status.
**The Consumer Assessment of Healthcare Providers & Systems® (CAHPS) is administered annually by certified survey vendors hired by health plans. The first two questions in the table rely on patient recall of flu and pneumonia vaccines rather than administrative (claim/encounter) or medical record review data. 11

12. Where We Stand – Clinical Measures
Display your group’s performance dashboard(s) here

13. Prioritize – Meteor Program Path
2011: HEDIS measures - emphasis on non-P4P
All measures equally weighted
2011 performance drives 2013 bonus
Small denominator measures
Clinically significant measures
Health plan priority measures
2012: CAHPS and HOS
Patient recall measures
Patient experience

14. 2011 Measure priorities for 2011 outreach
Rheumatoid Arthritis Management
Spirometry for New COPD Diagnosis
Osteoporosis Management
Breast Cancer Screening
Focus on centralized outreach this year
Improve data exchange between group and health plans (standard format from plans)

15. Discussion – Action Plan