The Medicare STAR Ratings System
Medicare Star Ratings Program
The Centers for Medicare & Medicaid Services (CMS) Medicare Star Ratings program measures how well plans perform based on a cross section of quality metrics including meeting clinical and pharmacy goals, member and provider satisfaction, health outcomes and plan operations. The 50+ metrics are divided into the following categories:
- Staying healthy — evaluates how often members receive screening tests, vaccines, checkups and other preventive services to help them stay healthy
- Managing chronic conditions — evaluates how effectively health plans help members manage long-term conditions, with a focus on diabetes and medication management
- Member satisfaction — evaluates how members feel about the health plan and quality of care they receive
- Customer service — evaluates the responsiveness, helpfulness and accuracy of customer service
A plan’s star ratings are ranked 1-5 in each category, then used to determine the plan’s overall score, with five being the highest rating of excellent.
What is Health Partners Plans doing to maintain or improve star ratings?
Our goal is to help our members maintain and improve their health outcomes and effectively manage long-term conditions.
We continue to work with our providers to help our members stay healthy by evaluating how often they receive screenings, vaccines, checkups and other preventive services.
Health Partners Plans has a dedicated team focused on monitoring our star ratings and designing specific interventions for the measures that have not achieved the highest possible scores. Our overall goal is to improve the health of our members, attract new members and continue offering competitive reimbursement to our providers. We continually evaluate the star ratings and the individual measures that comprise them.
Health Partners Plans is also working with specific providers participating in our Quality Care Plus Program, which rewards providers for their performance based on a number of quality (HEDIS/Star) measures.
How You Can Help
We encourage our providers to continue to offer stellar services to our members. You help impact our star ratings by:
- Making sure your patients receive routine screening tests and preventive services
- Helping patients manage their chronic conditions, such as high blood pressure, arthritis and diabetes
- Helping patients choose safe medications
- Ensuring patients are continually taking their medications
- Submitting claims and documenting all services thoroughly and accurately
- Understanding the impact that you and your office staff have on our members’ satisfaction with their healthcare experience