CMS created the Five-Star Quality Rating System to help Medicare beneficiaries, their families and their caregivers compare Medicare Advantage plans more easily and make the best choice for their health care needs. Medicare Advantage plans get an overall rating—from one star (lowest) to five stars (highest)—that summarizes plan performance on specific quality measures. Plan ratings help Medicare beneficiaries review their current plan or choose a plan that performs well. CMS has rated Peoples Health plans under contract H1961 at 4 stars or higher plan since 2014. Visit our website for more information about our current star rating.
Categories on which plans are rated include but are not limited to:
- Screenings, tests and vaccines (staying healthy)
- Plan member experience and access to care
- Care coordination
- Customer service
- Medicare audit findings
- Managing chronic conditions
- Member complaints and appeals
- Drug pricing and safety
- Medication safety and adherence
- Health plan responsiveness and care
Primary care physicians can help Peoples Health meet CMS-mandated measures by signing standing orders for targeted screenings and tests for their Peoples Health Medicare patients, granting us permission to assist these patients in scheduling and receiving these screenings and tests. Only your eligible patients for whom we have no record (i.e., claim) of the preventive screening or therapeutic monitoring event will be included in our outreach. Results of screenings and therapeutic monitoring tests are faxed to the PCP, and all results from any testing are available to PCPs and specialists via Member Viewer. Contact your Peoples Health representative for a standing order form or with any questions.
How Does CMS Collect This Data?
Plans are awarded one to five stars across numerous measures, based on:
- HEDIS (Healthcare Effectiveness Data and Information Set)
- CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey
- HOS (Health Outcomes Survey)
- Prescription drug event data
- CMS administrative data
While it is the plan that is rated, each provider in the plan’s network plays a role in determining the overall rating. Please review the categories below and on the following page. These are areas where providers can have the most impact on our CMS rating. We suggest providers and their staff become familiar with these elements to help ensure your Peoples Health patients receive the best available health care services.
- Screenings, Tests and Vaccines (Staying Healthy)
Rates the provision of preventive care services covered by Medicare (e.g., breast and colon cancer screenings, diabetic eye exams, and flu and pneumonia vaccine status), documentation of routine medical information (e.g., BMI). - Member Experience
Rates patients’ perceptions of their physical and mental health over time, as well as their perception of the care and information they receive from their provider’s office, plan and pharmacy. Also rates how well care is coordinated and how quickly and easily patients can obtain appointments, care, information and help. - Managing Chronic Conditions
Rates the management of chronic conditions, including diabetes, hypertension and osteoporosis; also rates the frequency with which patients discuss special health topics (e.g., incontinence, fall risks or physical activity) with their doctor. - Medication Safety and Adherence
Rates patient adherence to medication regimens for diabetes, hypertension and cholesterol, as well as use of high-risk medications.
Below are some examples of the member survey questions related to these categories. These examples may be useful in helping you understand how CMS is using feedback to determine ratings for these measures.
- In the last six months, when your personal doctor ordered a blood test, X-ray or other test for you, how often did someone from your personal doctor’s office follow up to give you those results?
- In the last six months, how often did your personal doctor seem informed and up to date about the care you got from specialists?
- In the last six months, how often did you get an appointment to see a specialist as soon as you needed?
- In the last six months, how easy was it to get appointments with specialists?
- In the last six months, how often did you see the person you came to see within 15 minutes of your appointment time?
- During the past four weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends or relatives)?