Primer: CMS Star Ratings for Medicare Advantage Plans

Your group/presenterDate

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 www.medicare.gov 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

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

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

The Big MA Stars Picture

Focus In and Next Steps

11

Part C Measures Groups Can ImpactP4P 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.

Where We Stand – Clinical Measures

• Display your group’s performance dashboard(s) here

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

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)

Discussion – Action Plan