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1 The Centers for Medicare & Medicaid Services (CMS) strives to make information available to all. Nevertheless, portions of our files including charts, tables, and graphics may be difficult to read using assistive technology. Persons with disabilities experiencing problems accessing portions of any file should contact CMS through at

2 Empowering a More Informed Consumer: Medicare Plan Ratings Medicare Advantage Quality Measurement & Performance Assessment Training Conference April 8-9, 2008 Vikki Oates, M.A.S. Liz Goldstein, Ph.D. Center for Beneficiary Choices

3 Goals of Medicare Plan Ratings To support the President s Agenda on health care transparency To support the CMS Strategic Plan To ensure that Medicare beneficiaries receive the best healthcare and prescription drug coverage available and that they have the data necessary to make informed decisions Internet Medicare & You handbook 2

4 Power of the Medicare Plan Ratings Establishes performance benchmarks: CMS long-term goal is to establish performance benchmarks based on historical experience with Part D Once benchmarks are established, CMS will work with plans to improve performance If high performance in an area becomes standard for all plans then a measure may be retired Provides composite scores for monitoring purposes Creates a feedback loop 3

5 Medicare Plan Ratings Expansion of the number of Part C and Part D measures Making measures more accessible to users of the Medicare s health plan and drug plan comparison websites Measures will be evaluated and rated at a domain and measure level 4

6 Medicare Plan Ratings Integrated with the Plan Finder and Medicare Options Compare Beneficiaries will have the opportunity to view the measures at three levels: The highest level is the domain level, which summarizes all measures in that area into a single rating. From each domain, beneficiaries can drill down to the summary level. This level will provide a rating for each measure. Within each measure, a beneficiary can view details. This level will show a rate, time, or statistic for each measure. Both the domain and summary level ratings will be based on a five-star scale 5

7 Part D Plan Ratings 6

8 Medicare.gov Website 7

9 Accessing Plan Ratings 8

10 Medicare Part D Plan Ratings Measure Domains Drug Plan Consumer Service Using Your Plan to get Your Prescriptions Filled Drug Pricing Information 9

11 Domain Overview 10

12 Part D Drug Plan Customer Service Measures Customer service wait time Customer service disconnect rate Pharmacy help desk average wait time Pharmacy help desk average disconnect rate Beneficiary ability to get help from the plan Beneficiary rating of plan Total customer service complaints 11

13 Individual Measures Plan A (S0000) Plan B (S0001) Plan C (S0002) 12

14 Part D- Using Your Plan to Get Your Prescriptions Filled Getting prescriptions easily Pharmacists have up- to- date Plan enrollment information Pharmacists have up-to-date information on Plan members who need extra help Complaints about the Plan s benefits and access to prescription drugs Complaints about joining or leaving the Plan Delays in appeals decisions Reviewing appeals decisions 13

15 Part D - Drug Pricing Information Availability of drug coverage and cost information How often the Plan s drug prices change Complaints about the Plan s pricing and out of-pocket costs 14

16 PDP Domain Summary 5 Stars 4 Stars 3 Stars 2 Stars 1 Star Insuff Data Number of Contracts Cust. Service Getting Rx Filled Rx Pricing Info Domain Note: Excludes new contracts. Data as of 10/25/07. 15

17 MA-PD Domain Summary Stars 4 Stars 3 Stars 2 Stars 1 Star Insuff Data Number of Contracts Cust. Service Getting Rx Filled Rx Pricing Info Domain Note: Excludes new contracts. Data as of 10/25/07 16

18 Part C Plan Ratings 17

19 Medicare Part C Plan Ratings Measure Domains Helping You Stay Healthy Getting Care from Doctors and Specialists Getting Timely Information and Care From Your Health Plan Managing Chronic (Long-Lasting) Conditions Your Rights to Appeal 18

20 Domain Overview 19

21 Data Sources Supporting Medicare Plan Ratings for Part C HEDIS CAHPS IRE data 20

22 Part C Helping You Stay Healthy Breast Cancer Screening Colorectal Cancer Screening Cardiovascular Care Cholesterol Screening Diabetes Care Cholesterol Screening Glaucoma Testing Appropriate Monitoring of Patients Taking Long-term Medications Annual Flu Vaccine Pneumonia Vaccine 21

23 Individual Measures 22

24 Part C - Getting Care From Your Doctors and Specialists Access to Primary Care Doctor Visits Getting Needed Care without Delays Doctor Follow up for Depression Follow-up Visit after Hospital Stay for Mental Illness (within 30 days of discharge) 23

25 Part C Getting Timely Information and Care from Your Health Plan Doctors who Communicate Well Getting Appointments and Care Quickly Overall Rating of Health Care Quality Overall Rating of Health Plan Call Answer Timeliness 24

26 Part C - Managing Chronic (Long-Lasting) Conditions Osteoporosis Management Diabetes Care Eye Exam Diabetes Care Kidney Disease Monitoring Diabetes Care Blood Sugar Controlled Diabetes Care Cholesterol Controlled Antidepressant Medication management (6 months) Controlling Blood Pressure Rheumatoid Arthritis Management Testing to Confirm Chronic Obstructive Pulmonary Disease Continuous Beta-Blocker Treatment 25

27 Part C - Your Rights to Appeal Plan Makes Timely Decisions about Appeals Reviewing Appeals Decisions 26

28 Part C Domain Summary 5 Stars 4 Stars 3 Stars 2 Stars 1 Star Number of Contracts Helping You Stay Dr/Specialist Care Healthy Timely Information and Care Domain Note: Excludes new contracts. Data as of 10/25/07. 27

29 Part C Domain Summary, cont d. 5 Stars 4 Stars 3 Stars 2 Stars 1 Star Number of Contracts Managing Chronic Conditions Your Rights to Appeal Domain Note: Excludes new contracts. Data as of 10/25/07. 28

30 Contact Information Vikki Oates Liz Goldstein

An Update on Medicare Parts C & D Performance Measures

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