Arizona Priority Care’s goal is to improve population health, assist and guide providers, provide excellent service to improve member experience, and reduce healthcare costs. Our Star program is designed provide an integrative plan to deliver high quality value-based healthcare in the primary care setting, utilizing advanced technology and innovative best practices.
What is a STAR Rating?
Every year The Centers for Medicare & Medicaid Services (CMS) evaluate Health Plans on a Five-Star Quality Rating System, to measure the quality of health provided to members enrolled in Medicare Advantage (MA) and Prescription Drug Plans (PDP). This Star rating determines compensation for Medicare Advantage plans and helps guide consumers on Health Plan quality performance.
CMS is constantly evaluating the effectiveness of the measures set that contribute to Star performance and measures are subject to change annually.
Health Effectiveness Data Information Set (HEDIS®) and Quality Measures?
HEDIS, a product developed and trademarked by the National Committee Quality Assurance (NCQA), are a set of measurable quality measures reported annually. Some measures contribute to the overall Star rating.
Consumer Assessment of Health Providers and Systems (CAHPS®)?
CAHPS, a product of the Agency of Healthcare Research and Quality (AHRQ), is a standardized survey for members to rate their experiences in the healthcare system. Surveys are administered annually to a random sample of members enrolled in MA plans.
Measures contribute to the overall Star rating and include, but are not limited to:
- Yearly Flu Vaccine
- Getting Needed Care
- Getting Appointments and Care Quickly
- Customer Service
- Care Coordination
- Rating of Health Care Quality
- Rating of Health Plan
What is the Health Outcome Survey (HOS)?
HOS surveys provide meaningful data for quality improvements and contribute to overall Star rating. HOS is administered annually to a random sample of members enrolled in MA plans for a baseline and are re-surveyed two years later. HOS Measures include, but are not limited to:
- Improving or Maintaining Physical Health
- Improving or Maintaining Mental Health
- Monitoring Physical Activity
- Improving Bladder Control
- Reducing the Risk of Falling
DIRECT CONTRACTING ENTITY
All-Cause Unplanned Admission for Patients with Multiple Chronic Conditions
A measurement of outcomes for acute, unplanned admissions (per 100 person-years at risk of admission), for beneficiaries ages 65 years or older who have two or more of the following nine conditions:
- Acute myocardial infarction
- Alzheimer’s disease and related disorders or senile dementia
- Atrial fibrillation
- Chronic kidney disease
- Chronic obstructive pulmonary disease or asthma
- Heart failure
- Stroke or transient ischemic attack
Risk Standardized All Condition Readmission
Percentage of Medicare beneficiaries hospitalized and readmitted to a hospital within 30 days of their discharge.
HOW CAN AZPC HELP YOU?
Arizona Priority Care is dedicated to working with our providers to continuously improve the quality of our partnership. Arizona Priority Care provides a variety of services to best assist you and your individual needs. AZPC Star Program offers providers tools and data at least monthly to help continually engage members and deliver necessary healthcare to members, based on their individualistic needs and recommendations.
Arizona Priority Care offers education to network providers and staff in multiple ways.
- Universities are available annually that focus on star measures, annual changes, best practices, and education of AZPC initiatives.
- AZPC will meet with primary care offices regularly to provide monthly education and guidance on how to capture star measures and prioritize efforts.
- AZPC offers to meet with providers and staff one-on-one to offer individualized education based on the needs of the practice, including documentation, billing requirements, and best practices.
Tools & Training
AZPC’s advanced technology empowers providers and staff to take control and manage their population effectively. To receive more information about AZPC’s q.Metrics tool contact your provider relations representative.
Questions or Comments?
Please feel free to contact Arizona Priority Care with any questions or comments regarding our efforts to ensure safe, quality care for our members. Email: HCC.STARS@AzPriorityCare.com