CITIZENS CHOICE HEALTH PLAN HMO

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1 P L A N H E A L T H C H O I C E C I T I Z E N S 2015 THANKS FOR MAKING THE RIGHT CHOICE WITH CITIZENS CHOICE HEALTH PLAN HMO Navigating Your Way Through the CMS Star Ratings IR_15019EN

2 NAVIGATING YOUR WAY THROUGH THE 2015 CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) STAR RATINGS PROGRAM HAVE YOU HEARD ABOUT THE CMS STAR RATINGS PROGRAM? These ratings are given to the plans by The Centers for Medicare and Medicaid Services (CMS) and are based on how well a health plan is providing clinical quality, customer service and member satisfaction. We have provided this short navigation guide in hopes that it will help you understand the program a little better and provide you with information to enhance your overall health. IF YOU HAVE ANY QUESTIONS ABOUT THE MEDICARE STAR QUALITY RATING SYSTEM, OR YOUR BENEFITS, PLEASE: CALL MEMBER SERVICES CCHP (2247), (TTY 711) 8:00 am - 8:00 pm PST, 7 days a week VISIT to learn more 2

3 2015 STAR NAVIGATION GUIDE TABLE OF CONTENTS PG 4 PG 9 Unlocking the Medicare Star Rating System Frequently Asked Questions (FAQ s) Contact Information PG 5 PG 10 Keys to Understanding the Medicare Star Quality Rating What Should I Do with This Information? Your 2015 Star Preventative Care Checklist PG 6 INSERT Looking Inside: Health Plan (Part C) Measures Drug Plan (Part D) Measures Shooting Star Rewards Program Form 3

4 UNLOCKING THE MEDICARE STAR RATING SYSTEM WHAT IS IT? The Centers for Medicare & Medicaid Services (CMS) is a branch of the U.S. Department of Health and Human Services. CMS provides information for health professionals, regional governments, and consumers. CMS developed the Medicare Star Quality Rating System. CMS uses information from member satisfaction surveys, plans, and health care providers to give overall performance star ratings to health plans. These ratings help members compare plans based on quality and performance. A health plan receives a rating from one «to five «««««stars. The overall health plan rating gives patients a single summary score that makes it easy for members to compare plans based on quality and performance. TO LEARN MORE ABOUT THE MEDICARE STAR QUALITY RATING SYSTEM 4 CALL MEMBER SERVICES CCHP (2247), (TTY 711) 8:00 am - 8:00 pm PST, 7 days a week VISIT to learn more

5 KEYS TO UNDERSTANDING THE MEDICARE STAR QUALITY RATING Stars for each plan show how well the plan performs in a particular category. Star ratings range from 1 star to 5 stars, where a rating of 1 star means poor quality, 2 stars means below average quality, 3 stars means average quality, 4 stars means above average quality and 5 stars means excellent quality. «««««EXCELLENT PERFORMANCE ««««ABOVE AVERAGE PERFORMANCE «««AVERAGE PERFORMANCE ««BELOW AVERAGE PERFORMANCE «POOR PERFORMANCE 5

6 LOOKING INSIDE PART C - HEALTH PLAN MEASURES STAYING HEALTHY ANNUAL APPOINTMENT, SCREENINGS, TESTS AND VACCINES: Breast Cancer Screening Colon Cancer Screening Flu Vaccine Monitoring Physical/Mental Health Body Mass Index (BMI) Osteoporosis Management (women who have had a fracture) Diabetes Care Eye Exams (to check damage from diabetes) Kidney function test (to check damage from diabetes) Blood Sugar Controlled Controlling Blood Pressure Rheumatoid Arthritis Management Reducing the Risk of Falling 6 KEEP FOR REFERENCE

7 LOOKING INSIDE PART C - HEALTH PLAN MEASURES (CONT.) MANAGING CHRONIC (LONG TERM) CONDITIONS* SUCH AS: Osteoporosis Management (in a women who had a fracture) Diabetes Care Diabetes Care Eye Exam Diabetes Care Kidney Disease Monitoring Diabetes Care Blood Sugar Controlled Controlling Blood Pressure Rheumatoid Arthritis Management Reducing the Risk of Falling Plan All- Cause Readmissions PLAN RESPONSIVENESS AND CARE Ease of Getting Needed Care and Seeing Specialist Getting Appointments and Care Quickly Getting Information or Help When Needed Overall Quality of Health Care Received Overall Rating of the Health Plan How Well Plans Coordinate Members Care PLAN GRIEVANCES AND APPEALS Number of Complaints per 1,000 members Beneficiary Access and Performance Problems Members Choosing to Leave the Health Plan Improvement in the Health Plan s Performance PLAN CUSTOMER SERVICE Timely decisions to member appeals Call Center Foreign Language Interpreter and TTY Availability * Items on list may not pertain to you or your health status. KEEP FOR REFERENCE 7

8 DRUG PLAN CUSTOMER SERVICE Call Center Foreign Language Interpreter and TTY Availability Drug Plan Makes Timely Decisions about Appeals Fairness of Drug Plan s Response to Members Appeals MEMBER COMPLAINTS, PROBLEMS GETTING SERVICES, AND CHOOSING TO LEAVE THE PLAN Complaints about the Drug Plan Beneficiary Access and Performance Problems Member Choosing to Leave the Plan Improvement in the Drug Plan s Performance MEMBER EXPERIENCE WITH DRUG PLAN Members Overall Rating of Drug Plan Getting Needed Prescription Drugs MTM Program Completion Rate for Comprehensive Medication Review DRUG PRICING AND PATIENT SAFETY Drug plan provides accurate pricing information for the Medicare MPF (Medicare s Plan Finder) Website High Risk Medication Taking Oral Diabetes Medications as Directed Taking Blood Pressure Medication as Directed for Hypertension Taking Cholesterol Medication as Directed 8 LOOKING INSIDE PART D DRUG PLAN MEASURES KEEP FOR REFERENCE

9 FREQUENTLY ASKED QUESTIONS What should I do with this information? YOU CAN: Educate yourself on the CMS Medicare Star Rating Measures by using this guide. Discuss and review your current overall health status. (see Pg. 10 for helpful checklist). Use the CCHP STAR checklist (see Pg. 10) when you see your CCHP Primary Care Physician (PCP) don t forget to discuss your overall health status as well as any upcoming recommended TESTS/SCREENINGS you may be DUE for with your PCP. Contact Citizens Choice Healthplan HMO should you have any questions about the CMS Star Quality Rating System. Keep the Screening/Test Reference List on Pg. 6, 7 & 8 for reference when filling out annual surveys you may receive. Return your Shooting Star Rewards Program Form when you complete your test/screenings in 2015 for your gift card(s). (see Star Rewards form insert for participation guidelines). FOR MORE INFORMATION To learn more about the Medicare Star Quality Rating System CALL MEMBER SERVICES CCHP (2247), (TTY 711) 8:00 am - 8:00 pm PST, 7 days a week VISIT to learn more You can also order additional rewards forms by calling Member Services at the numbers above. 9

10 SHOOTING STAR PREVENTATIVE CARE CHECKLIST CCHP HMO cares about our members overall health. Make sure you discuss your overall health status with your Primary Care Physician (PCP). Actual Tests/Screenings and health Status questions should be discussed with your Primary Care Physician (PCP) on your next visit to identify which may be applicable to you. You may not need to discuss all of these items as they may not apply to you. However, if they do, this will provide you a good checklist of what to discuss with your (PCP) on your next visit. Annual Check Up Breast Cancer Screening Colon Cancer Screening Prostate Cancer Screening Glaucoma Screening Hearing Exam Flu Vaccine Pneumonia Vaccine Body Mass Index (BMI) Diabetes Care Eye Exams (to check damage from diabetes) Blood Sugar test (to ensure blood sugar is under control) Kidney function test (to check damage from diabetes) Cholesterol test (to ensure an acceptable level of bad (LDL) cholesterol) Osteoporosis Management (women who have had a fracture) COPD (Pulmonary Disease) Management Review of Overall Patient Status Physical Activity Monitoring Physical/Mental Health Weight Management Previous Falls? Fall Prevention Rheumatoid Arthritis Management Bladder Control (if applicable) Overall Medication Review Getting Needed Care Getting appointments and Care Quickly Advanced Directive Proactive healthcare decisions should you not be able to speak for yourself You will receive calls from our Concierge team reminding you of the tests/screenings you are DUE for. Take your STAR REWARDS FORM and this checklist to your CCHP PCP to discuss and complete tests/screenings. You can earn reward(s) for completing certain DUE tests/screenings. See Star Rewards form insert for participation guidelines. * Items on checklist above may not pertain to you or your individual health status. 10 KEEP FOR REFERENCE

11 Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next. Citizens Choice Health Plan is an HMO plan with a Medicare contract. Enrollment in Citizens Choice Health Plan depends on contract renewal. This information is available for free in other languages. Please contact our Member Services: CCHP (2247) TTY: 711, 8:00 AM to 8:00 PM, seven days a week. Esta información está disponible en otros idiomas sin costo alguno. Por favor comunicarse al Departamento de Membresía: CCHP (2247) TTY: 711, de 8:00 a.m. a 8:00 p.m., los siete días de la semana CCHP (2247), (TTY 711) 8:00 am - 8:00 pm, seven days a week

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