IMPROVE YOUR PATIENTS' CARE WITH THE GUIDANCE OF THE MEDICARE STAR RATING SYSTEM

In order to arm members with the know-how to make sound decisions about health care, the Centers for Medicare and Medicaid Services (CMS) use a rating system that evaluates the relative quality of private plans being offered to Medicare beneficiaries. Scored on a one- to five-star scale, with five stars representing the highest quality, members can use these ratings as a collective gauge of the quality of care, ease of access to care, provider responsiveness, and beneficiary approval of the plan. However, while these ratings were designed for members, providers may also reap tremendous benefits from reviewing these scores and learning how to help their Medicare patients receive improved customer service and quality care.

That’s why it’s important for our providers to familiarize themselves with the Medicare Star Rating System, as well as the important measures that will help improve our patients’ care. Currently, the rating system exists for both Part C and Part D, focusing on a variety of quality and service metrics that result from the following sources:

• Healthcare Effectiveness Data and Information Set (HEDIS^®):One of the most widely used set of healthcare performance measures in the United States, these scores are derived from administratively compliant members and medical record review compliant members. Key HEDIS^® measures to consider include breast cancer screening, diabetes care, and glaucoma testing, among others.
• Consumer Assessment of Healthcare Providers and Systems (CAHPS):This program asks patients to report on and evaluate their experiences with health care. Key CAHPS measures to consider include timely access to appointments and care, annual flu vaccine, and overall rating of health care quality.
• Health Outcomes Survey (HOS):Two-time survey designed to evaluate physical and mental health, and quality of life of Medicare beneficiaries. Key HOS measures to consider include testing for osteoporosis, reducing the risk of falling, and improving bladder control.

While the STARS ratings provide a tremendous benefit to members seeking exceptional medical care, it also serves as a reminder for you, as medical professionals, to never forget your primary goal: caring for your patients. Since WellCare’s scores are tied to important HEDIS^® initiatives such as the ones listed above, we may be able to improve our ratings simply by effectively serving our patients. Please keep these scores in mind as you work with our members.

Please see the attached WellCare Presentation for more information.