The Centers for Medicare & Medicaid Services (CMS) recently released their Star ratings data on how Medicare Advantage plans performed in 2014. These data cover a wide range of areas including:
- Screenings, Tests, and Vaccines
- Managing Chronic (Long-Term) Conditions
- Plan Responsiveness and Care
- Member Complaints, Problems Getting Services, and Choosing to Leave the Plan
- Health Plan Customer Service
Star ratings are especially important this year, because in next year’s open enrollment window QHP quality ratings will be published right next to price on insurance exchanges. This means that similarly priced plans with lower QHP ratings will see enrollment drop substantially.
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A hot topic in health across the industry is diabetes management. We took a look inside the Star data set to identify which plans were winning the war against diabetes.
The following 10 plans all got 5 star ratings on making sure their diabetic patients were staying healthy. They are in the top 3% of all Medicare plans evaluated by CMS. Diabetics in these plans had controlled sugar levels, were getting eye exams and were getting their kidneys monitored regularly.
California, Hawaii, Mid-Atlantic states
Kaiser Permanente dominated the Star rankings this year. Out of 400 Medicare plans only 9 received top star ratings across the board- 5 of those 9 were Kaiser Permanente plans. In fact, 81% of people in a 5 star rated plan are Kaiser Permanente members. Kaiser Permanente’s core is an integrated care model, which relies on the coordination of staff and care teams to surround disease from all angles.
Gundersen started in 1995 as self insured employee plan, but then expanded to serve other plans in the area. They also got high marks on the prevelence of preventative screenings and controlling high blood pressure.
Massachusetts, Rhode Island
Tufts is one of the most innovative health plans in the US. They have brought in cutting edge services like genomic tumor screening for prostate cancer and high touch coordinated care teams. They also have a robust care portal that includes real time information on a member’s copay.
This is the first year any Medicare plan in Arizona received a 5 star overall rating. They offer comprehensive Medicare benefits and extra preventative care for members.
SCAN earned an overall 4.5 rating. They cover 170k members in California and Arizona. SCAN is focused on getting clincians from all parts of healthcare involved in patient health. They have a pharmacy quality program that engages and incentivizes pharmacists to take an enhanced role in how healthcare is distributed. Pharmacists are used to improve medication safety and compliance which is especially important for those with chronic disease.
Simply Healthcare is the Magic Johnson of Medicare plans. Seriously. They have a partnership with Magic Johnson Enterprises through which they get aid and advice on how to access minority communities. They also provide extra health maintanence benefits in addition to what Medicare reimburses for no charge.
Though it seems like all you hear about Humana these days is talks of a merger, it is nice to see that they continue to provide their members with high quality healthcare. They have 2.5 million lives in 4 star converage. Additionally, Humana got top marks in customer services measures.
CIGNA pops onto the list again with their Healthspring plans in Florida and Arizona. Their chronic disease management approach involves care teams enabled by detailed analytics.