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