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Goals of Medicare Plan Ratings

Learn about the goals and benefits of Medicare Plan Ratings, how they support healthcare transparency, empower beneficiaries, and improve overall healthcare quality. Access comprehensive ratings and measures through the integrated Plan Finder and Medicare Options Compare tool on the Medicare.gov website. Stay informed and make informed decisions about your Medicare coverage.

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Goals of Medicare Plan Ratings

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  1. 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. 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. 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. 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. Part D Plan Ratings

  6. Medicare.gov Website

  7. Accessing Plan Ratings

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

  9. Domain Overview

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

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

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

  16. Part C Plan Ratings

  17. 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

  18. Domain Overview

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

  20. 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. Individual Measures

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

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

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

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

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