Medicare Plan Ratings?

[Winter_123]

In the past, I have gone to the medicare website and have seen the plan ratings for various medicare advantage plans and thought.....okay, fine, whatever.... but have not really gotten smart about how those ratings (you know the stars) are derived and what they mean. Probably I have violated twelve CMS regulations by not knowing and my private parts will fall off for admitting it but here goes: What do those frigging stars mean anyway?

I just got appointed with a small regional carrier and their plans have the most stars of any plans in the state so I am thinking that is a good thing. Yes, I can and will ask them but I am asking you right now, and yes I know they relate to quality and all of that but what is the method of measurement?

Thank you indeed.

 

[Josh]

They actually measure it across a lot of things which may or may not give an accurate depiction of the quality of the plan. If you go here Medicare.gov - MOC: Home and click "Learn More About Health Plans and Medigap Policies in Your Area" and look at plans in any area it will let you click on the different sections plans get rated on. As with any other types of surveys and polls, the answers can get skewed, but if a plan has an exceptionally low rating then there is probably a problem and whatever plan has the top ratings (indicated also by numbers in the Medicare and You book for your area) probably has done more than a few things right. Any plan in the middle could probably be just as good as the ones with the higher ratings but got beat up under one section of the rating system because of flaws in the rating model. Does that make sense and help?

 

[Winter_123]

They actually measure it across a lot of things which may or may not give an accurate depiction of the quality of the plan. If you go here Medicare.gov - MOC: Home and click "Learn More About Health Plans and Medigap Policies in Your Area" and look at plans in any area it will let you click on the different sections plans get rated on. As with any other types of surveys and polls, the answers can get skewed, but if a plan has an exceptionally low rating then there is probably a problem and whatever plan has the top ratings (indicated also by numbers in the Medicare and You book for your area) probably has done more than a few things right. Any plan in the middle could probably be just as good as the ones with the higher ratings but got beat up under one section of the rating system because of flaws in the rating model. Does that make sense and help?

No, I still dont get it yet. Obviously there are performance and quality areas. I am trying to understand how they arrive at the results. Do they do consumer surveys or performance audits or what? Where can I read about how they assess each area. Is there an overview of that somewhere on the site?

 

[Josh]

No, I still dont get it yet. Obviously there are performance and quality areas. I am trying to understand how they arrive at the results. Do they do consumer surveys or performance audits or what? Where can I read about how they assess each area. Is there an overview of that somewhere on the site?

From the site:
This summary rating gives an overall score on the health plan's quality and performance on 33 different topics in 5 categories:

Staying healthy: screenings, tests, and vaccines. Includes how often members got various screening tests, vaccines, and other check-ups that help them stay healthy.
Managing chronic (long-term) conditions. Includes how often members with different conditions got certain tests and treatments that help them manage their condition.
Ratings of health plan responsiveness and care. Includes ratings of member satisfaction with the plan.
Health plan member complaints, appeals, and choosing to leave the health plan. Includes how often members have made complaints against the plan and how often members choose to leave the plan.
Health plan telephone customer service. Includes how well the plan handles calls from members.
The information described above is gathered from several different sources. In some cases it is based on member surveys, information from clinicians, or information from plans. In other cases it is based on results from Medicare's regular monitoring activities.

One of the ways they rate plans is based on the number of complaints they get from members on a per thousand basis. That usually also includes when the members call Medicare for plan information (the implication being that the plan isn't answering their questions). They also follow disenrollment numbers, track claims to find out what type of utilization members have (are they going to their PCP visits, routine screenings, etc), and "secret shop" phone calls to test the responsiveness of the plans customer service as well as the accuracy of the information provided.

If you want to see the specific areas you should look up plans in any area and at the top click on "View plan quality and performance ratings for all available plans" in the "Plan Ratings" section of the site and it will bring up another window that will give you a pile of more info on what exactly it is they measure. I'll try to post a youtube link in a bit.

 

[Winter_123]

From the site:
This summary rating gives an overall score on the health plan's quality and performance on 33 different topics in 5 categories:

Staying healthy: screenings, tests, and vaccines. Includes how often members got various screening tests, vaccines, and other check-ups that help them stay healthy.
Managing chronic (long-term) conditions. Includes how often members with different conditions got certain tests and treatments that help them manage their condition.
Ratings of health plan responsiveness and care. Includes ratings of member satisfaction with the plan.
Health plan member complaints, appeals, and choosing to leave the health plan. Includes how often members have made complaints against the plan and how often members choose to leave the plan.
Health plan telephone customer service. Includes how well the plan handles calls from members.
The information described above is gathered from several different sources. In some cases it is based on member surveys, information from clinicians, or information from plans. In other cases it is based on results from Medicare's regular monitoring activities.

One of the ways they rate plans is based on the number of complaints they get from members on a per thousand basis. That usually also includes when the members call Medicare for plan information (the implication being that the plan isn't answering their questions). They also follow disenrollment numbers, track claims to find out what type of utilization members have (are they going to their PCP visits, routine screenings, etc), and "secret shop" phone calls to test the responsiveness of the plans customer service as well as the accuracy of the information provided.

If you want to see the specific areas you should look up plans in any area and at the top click on "View plan quality and performance ratings for all available plans" in the "Plan Ratings" section of the site and it will bring up another window that will give you a pile of more info on what exactly it is they measure. I'll try to post a youtube link in a bit.

Thank you . Good stuff indeed. Always looking to stuff something new into my brain every day.