Star Ratings Explained

http://smartretailingrx.com/regulatory-public-affairs/star-ratings-explained/

From the article:

What star ratings are and why they matter to community pharmacies.

Star ratings matter a great deal to Medicare Advantage (MA) plans because these ratings affect their revenue, reimbursements and enrollment.[i] Since many of your customers are enrolled in MA and MA Prescription Drug Plans (MAPDPs) and because the care you provide as community pharmacies can affect star rating outcome measures, it pays to have a basic understanding of what they are, why they matter, and the impact your pharmacy can have on them.

CMS originally developed star ratings in 2008 as a system to help consumers compare quality among competing Medicare Advantage plans. Now, CMS is also using the star ratings as a financial incentive to reward high-quality plans with bonuses and rebates.[ii]

To help consumers select a Medicare Advantage plan, the federal government has instituted the star ratings program. Each year, every Medicare Advantage plan (Part D) is rated[iii] on a scale of 1 to 5 stars based on how well the plan performed in the following areas:

• Helping members stay healthy
• Managing chronic conditions
• Members’ experience with their health plan
• Members’ complaints or problems getting services and improvement in performance
• Health plan’s customer service

In addition, Medicare drug plans (Part C) are rated on how well they perform on:

• Drug plan customer service
• Members’ complaints or problems getting services, and improvement in performance
• Members’ experience with the drug plan
• Patient safety and accuracy of drug pricing

In total, these ratings involve more than 50 different measures.

It will be interesting if chronic pain pts will have the same rights as others with chronic conditions or they will continue to have to fight for adequate treatment or accept being treated as “second class” patients ?

Filed under: General Problems