Goals of Medicare Plan Ratings

2. 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

3. 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

4. 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

5. 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

6. Part D Plan Ratings

7. Medicare.gov Website

8. Accessing Plan Ratings

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

10. Domain Overview

11. 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

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

13. 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

14. 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

15. PDP Domain Summary Number of Contracts Domain Note: Excludes new contracts. Data as of 10/25/07.

16. MA-PD Domain Summary Number of Contracts Domain Note: Excludes new contracts. Data as of 10/25/07

17. Part C Plan Ratings

18. 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 Medicare Part C Plan Ratings Measure Domains

19. Domain Overview

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

21. 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

22. Individual Measures

23. 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)

24. 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

25. 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

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

27. Part C Domain Summary Number of Contracts Domain Note: Excludes new contracts. Data as of 10/25/07.

28. Part C Domain Summary, cont’d. Number of Contracts Domain Note: Excludes new contracts. Data as of 10/25/07.

29. Vikki Oates 410-786-3652 vikki.oates@cms.hhs.gov Liz Goldstein 410-786-6665 Elizabeth.goldstein@cms.hhs.gov Contact Information