medicare advantage quality measurement & performance assessment training conference april 8-9,...
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Medicare Advantage Quality Measurement & Performance
Assessment Training ConferenceApril 8-9, 2008
Empowering a More Informed Consumer:Medicare Plan Ratings
Vikki Oates, M.A.S.Liz Goldstein, Ph.D.
Center for Beneficiary Choices
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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
Goals of Medicare Plan Ratings
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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
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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
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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
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Part D Plan Ratings
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Medicare.gov Website
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Accessing Plan Ratings
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Medicare Part D Plan Ratings Measure Domains
Drug Plan Consumer ServiceUsing Your Plan to get Your
Prescriptions FilledDrug Pricing Information
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Domain Overview
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Customer service wait timeCustomer service disconnect ratePharmacy help desk average wait timePharmacy help desk average disconnect
rateBeneficiary ability to get help from the
planBeneficiary rating of planTotal customer service complaints
Part D – Drug Plan Customer Service Measures
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Individual Measures
Plan A
(S0000)Plan B
(S0001)
Plan C
(S0002)
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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
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Part D - Drug Pricing Information
Availability of drug coverage and cost information
How often the Plan’s drug prices changeComplaints about the Plan’s pricing and
out –of-pocket costs
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PDP Domain SummaryN
um
ber
of
Con
tracts
0
10
20
30
40
50
60
70
Cust. Service Getting Rx Filled Rx Pricing Info
5 Stars 4 Stars 3 Stars2 Stars 1 Star Insuff Data
DomainNote: Excludes new contracts. Data as of 10/25/07.
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MA-PD Domain SummaryN
um
ber
of
Con
tracts
0
50
100
150
200
250
300
Cust. Service Getting Rx Filled Rx Pricing Info
5 Stars 4 Stars 3 Stars2 Stars 1 Star Insuff Data
DomainNote: Excludes new contracts. Data as of 10/25/07
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Part C Plan Ratings
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Medicare Part C Plan Ratings Measure Domains
Helping You Stay HealthyGetting Care from Doctors and
SpecialistsGetting Timely Information and Care
From Your Health PlanManaging Chronic (Long-Lasting)
ConditionsYour Rights to Appeal
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Domain Overview
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Data Sources Supporting Medicare Plan Ratings for Part C
HEDIS CAHPS IRE data
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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
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Individual Measures
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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)
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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
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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
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Part C - Your Rights to Appeal
Plan Makes Timely Decisions about Appeals Reviewing Appeals Decisions
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Part C Domain Summary
0
20
40
60
80
100
120
Helping You StayHealthy
Dr/ Specialist Care TimelyInformation and
Care
5 Stars 4 Stars 3 Stars2 Stars 1 Star
Nu
mb
er
of
Con
tracts
DomainNote: Excludes new contracts. Data as of 10/25/07.
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Part C Domain Summary, cont’d.
0
20
40
60
80
100
120
ManagingChronic
Conditions
Your Rightsto Appeal
5 Stars 4 Stars 3 Stars2 Stars 1 Star
Nu
mb
er
of
Con
tracts
DomainNote: Excludes new contracts. Data as of 10/25/07.
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Vikki Oates410-786-3652
Liz Goldstein410-786-6665
Contact Information