Notice ID: 220691
“CMS is committed to continuing to improve the Parts C and D quality and performance measurement system to increase the focus on improving beneficiary outcomes, beneficiary experience, population health, and efficiency of health care delivery. To that end, CMS has been working to enhance our current system to further refine the way we measure quality and performance of MA and Part D contracts. As new measures are developed and adopted, CMS incorporates them into the Star Ratings published each year on the Medicare Plan Finder website.”
“Currently, Medicare Advantage with prescription drug coverage (MA-PD) contracts are rated on approximately 38 unique quality and performance measures, MA-only contracts (without prescription drug coverage) are rated on approximately 28 measures, while Part D contracts are rated on approximately 12 measures. Each year, CMS conducts a comprehensive review of the measures that make up the Star Ratings, taking into consideration the reliability of the measures, clinical recommendations, feedback received from stakeholders, and data issues. Display measures are not a part of the Star Ratings but consist of measures that have been transitioned out of the Star Ratings, measures that will be introduced into the Star Ratings in future years, or measures displayed for informational purposes. These measures are available on www.cms.gov.”
“MA-PD contracts are rated on a total of 9 topic areas (domains) that cover both health and drug issues, MA-only contracts are measured on 5 topic areas, and Part D contracts are rated on 4 topic areas. For each individual measure, CMS assigns a Star Rating based on a 5-star scale. CMS also assigns a Star Rating for each of the domains, a Part C and/or Part D summary rating, and an overall rating that summarizes performance on all measures for each contract. This rating system was designed to aid beneficiary selection of a health and/or drug plan during the open enrollment period. It is also used by CMS for identifying low-performing contracts for compliance actions and to determine Quality Bonus Payments (QBPs) for MA contracts.”
“In addition, CMS is working to expand our efforts to report differences in performance on additional Star Ratings measures for subgroups of beneficiaries with social risk factors Page 2 of 5 (SRFs). We are exploring the feasibility of developing a health equity index that would summarize performance among those with SRFs across multiple measures into a single score…”
