We at Primary Care Specialists understand that our patients have a choice as to where they go for their medical and health needs. We strive every day to provide the best care possible and our hard work shows. Our patients ranked us number 1!
What Are CMS Star Ratings?
The Centers for Medicare & Medicaid Services (CMS) uses a five-star quality rating system to measure Medicare beneficiaries’ experiences with their health plans and the health care system. This rating system applies to the Medicare Advantage (MA) line of business.
The program is a key component in financing health care benefits for Medicare Advantage plan enrollees. In addition, ratings are posted on the CMS consumer website, www.medicare.gov, to give beneficiaries help in choosing among the MA plans offered in their areas.
This program is designed to promote improvement in quality and recognize primary care providers for demonstrating increases in performance measures over defined periods of time.
How Are Star Ratings Derived?
A Medicare Advantage health plan’s rating is based on measures in five categories:
• Staying healthy: screenings, tests and vaccines
• Managing chronic (long-term) conditions
• Tracking members’ experiences with the health plan
• Monitoring members’ complaints, problems getting services and improvement in the plan’s performance
• Evaluating health plan customer service
Ratings for a Medicare Advantage Drug Plan (MAPD) and Medicare Prescription Drug Plan (PDP) are based on measures in four categories:
• Drug plan customer service
• Members’ complaints, problems getting services and improvement in the plan’s performance
• Members’ experiences with the drug plan
• Patient safety and accuracy of drug pricing
Benefits to Physicians and Health Care Providers
• Improved patient relations
• Improved health plan relations
• Increased awareness of patient safety issues
• Greater focus on preventive medicine and early disease detection
• Strong benefits to support chronic condition management
Benefits to Members
• Improved relations with their doctors
• Greater health plan focus on access to care
• Increased levels of customer service
• Greater focus on preventive services for peace of mind, early detection and health care that matches their individual needs
Humana is strongly committed to providing high-quality Medicare health plans that meet or exceed all CMS quality benchmarks. The CMS Star ratings system is structured so that pay-for-performance funding is used to protect or, in some cases, to increase benefits and to keep member premiums low.
Humana encourages members to become engaged in their preventive and chronic-care management through outreach, screening opportunities and Medicare member rewards.