Medicare Part D

Medicare STAR Measures (48 measures for Part C and D)

The Centers for Medicare & Medicaid Services (CMS) uses a STAR Rating System to measure how well Medicare Advantage and Part D Health Plans are performing.  CMS scores how well Health Plans perform in several categories including quality of care and customer service.  CMS rating of Health Plans range from one to five STARs, with five being the highest and one being lowest performing Health Plan.

Medicare Part D

  • 14 measures
  • Mainly pharmacy related measures (examples below):
    • The percent of Health Plan members with a prescription for hypertension, diabetes and/or Cholesterol medication(S) who fill their prescription often enough to cover 80% or more of the time they are supposed to be taking the medication:
      • Hypertension (Medication Adherence)
      • Cholesterol Management (Medication Adherence)
      • Diabetes A1c Control (Medication Adherence)
      • Statin Therapy for Patient Diabetes (SPD): (40-75 age)
      • At least one dispensing event for a high or moderate-intensity statin medication during the measurement year.

Member survey:

  • Consumer Assessment of Healthcare Providers and Systems (CAHPS)
  • CAHPS is a patient experience survey

 

  • Medicare Health Outcomes Survey (HOS)
    • Baseline and Follow-up HOS:
    • Baseline Survey:
      • Survey asked patient how they perceived their current mental and physical health status
      • Follow-up Survey (2 years later same members):
        • Same members are surveyed to ask patient how they perceived their mental and physical health status.
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