Medicare Advantage with prescription drug coverage (MA-PD) contracts are rated on up to 44 unique quality and performance measures; MA-only contracts (without prescription drug coverage) are rated on up to 32 measures; and stand-alone PDP contracts are rated on up to 15 measures. Each year, CMS conducts a comprehensive review of the measures that make up the Star Ratings, considering the reliability of the measures, clinical recommendations, feedback received from stakeholders, and data issues.
The Star Ratings measures span 5 broad categories:
- Intermediate Outcomes
- Patient Experience
Medicare Star Ratings Weighted By Importance To Beneficiaries
For the 2017 Star Ratings, outcomes and intermediate outcomes continue to be weighted 3 times as much as process measures, and patient experience and access measures are weighted 1.5 times as much as process measures. CMS assigns a weight of 1 to all new measures. The Part C and D quality improvement measures receive a weight of 5 to further reward contracts for the strides they made to improve the care provided to Medicare enrollees.
Highlights of Contract Performance in 2017 Star Ratings
Changes in Ratings from 2016
- Approximately 49 percent of MA-PDs (178 contracts) that will be active and rated in 2017 earned 4 stars or higher for their 2017 overall rating.
- Weighted by enrollment, close to 68 percent of MA-PD enrollees are in contracts with 4 or more stars.
- The number of active and rated contracts, and the percent of MA-PD enrollees weighted by enrollment in contracts with 4 or more stars in 2017 is approximately the same in 2017 as compared to 2016.
- In 2017, weighted by enrollment, over 90% of MA-PD enrollees are in contracts with ratings of 3.5 or more stars.
23 contracts are highlighted on MPF with a high performing (gold star) icon: 14 are MA-PD contracts (Table 3), 3 are MA-only contracts (Table 4), and 6 are PDPs (Table 5).
The 12 new 5-star contracts for this year are:
- KS Plan Administrators, LLC (H0332)
- BCBS of Massachusetts HMO Blue, Inc. (H2261)
- Aultcare Health Insurance Corporation (H3664)
- Physicians Health Choice of Texas, LLC (H4527)
- CDPHP Universal Benefits, Inc. (H5042)
- Optimum Healthcare, Inc. (H5594)
- Kaiser Foundation HP, Inc. (H6052)
- Anthem Insurance Co. & BCBSMA & BCBSRI & BCBSVT (S2893)
- Excellus Health Plan, Inc. (S3521)
- BCBS of Michigan Mutual Insurance Company (S5584)
- Wellmark IA & SD, & BCBS MN, MT, NE, ND,& WY (S5743)
- Dean Health Insurance, Inc. (S9701)
Tax Status and Performance
Organizations that are non-profit tend to receive higher ratings than those that are for-profit. For MA-PDs, approximately 70% of the non-profit contracts received 4 or more stars compared to 39% of the for-profit MA-PDs. Similarly, for PDPs approximately 63% of non-profit PDPs received 4 or more stars compared to 24% of the for-profit PDPs. Non-profit organizations also performed better than for-profit organizations last year.
Length of Time in Program and Performance
On average, higher Star Ratings are associated with more experience in the MA program. We see a similar pattern for PDPs.
Center for Medicare and Medicaid Services has changed the way they identify Medicare Advantage health plans (MA-PD) and the prescription drug plans (PDP). They no longer add a column for the state the MA-PD or PDP is offered in. Consequently, it is a little more difficult to find the Star Ratings for the plans in your county. The contract number is printed on all marketing material for the plans. With the contract number and marketing name, you should be able to scroll through the 2017 Medicare Advantage Star Ratings spread sheet and find the information.
Spread Sheet Column Definitions
- 2017 Part C Summary refers to the Star Rating for the health care services of the plan.
- 2017 Part D Summary refers to the Star Rating of the prescription drug portion of the MA-PD plans.
- SNP: Special Needs Plan
- Sanction Deduction: whether there have been any adjustments because the plan was put on sanction during the year.
All this information was pulled from Medicare’s 2017 Report Card Master Table spread sheet attached. The master table will include the ratings for the plans for each of the measurements that go into assigning the overall Star Rating of the MA-PD or PDP plan. Even though the Star Ratings are for 2017, they apply to plans being offered for 2018 as a guide for Medicare beneficiaries to select the best plan for their health care and prescription drug needs.