Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates health plans using 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). The STAR rating determines compensation for Medicare Advantage plans and helps guide consumers on Health Plan quality performance.

CMS constantly evaluates the effectiveness of the measures set that contribute to STARS performance, and the measures are subject to change annually.

2024 Center for Medicare and Medicaid Services STAR Ratings

HEDIS, a product developed and trademarked by the National Committee for Quality Assurance (NCQA), consists of measurable quality measures reported annually, with some measures contributing to the overall STAR rating.

NCQA – HEDIS and Performance Measurements

HOS surveys provide meaningful data for quality improvements and contribute to the overall STAR rating. The annual administration of HOS surveys are 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

Quality Measures

All-Cause Unplanned Admission for Patients with Multiple Chronic Conditions

The following conditions are associated with beneficiaries 65 years or older who have two or more of the following nine conditions (The Measurement of outcomes for acute and unplanned admissions per 100 person-years at risk of admission).

• Acute myocardial infarction
• Alzheimer’s disease and related disorders or senile dementia
• Atrial fibrillation
• Chronic kidney disease
• Chronic obstructive pulmonary disease or asthma
• Depression
• Diabetes
• Heart failure
• Stroke or transient ischemic attack

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.

Health Measures contribute to the overall STARS rating that include, but not limited to:

• Yearly Flu Vaccine
• Accessing Needed Care
• Getting Appointments and Care Quickly
• Customer Service
• Care Coordination
• Rating of Health Care Quality
• Rating of Health Plan

Risk Standardized All Condition Readmission

Percentage of Medicare beneficiaries hospitalized and readmitted to a hospital within 30 days of discharge.

Education

Arizona Priority Care offers education to network providers and staff in multiple ways.

• Universities that focus on star measures, annual changes, best practices, and education of AZPC STARS Program initiatives are available annually.
• AZPC will regularly meet with primary care offices monthly to provide education and guidance on capturing star measures and prioritizing efforts.
• AZPC offers to meet with providers and staff one-on-one to provide individualized education based on the practice’s needs, 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.