CMS 5 STARS PROGRAM MedPOINT Management

Planning for the Future Healthcare Reform will require significant change to Medicare Advantage plans transforming them into an integrated health delivery system concentrating on quality of care outcomes within the next 1-5 years. What are the consequences?? There will be pressure to correctly screen, document and perform precise coding or chronic disease along with exceeding quality performance measures related to HDIS and national survey instruments (HOS and CAHPS). The federal government will essentially be paying for quality outcomes based on STARs/HEDIS ratings. 4/17/2017 MedPOINT Management STARs PROGRAM Overview

WHAT ARE THE CMS STARs?? CMS created the 5-STAR Quality Rating System for Medicare Advantage plans to compare Medicare Advantage plans more easily, and to help identify areas about which they may want to ask questions. The STARS are a quality rating system that gives each plan a rating of between 1 and 5 stars. Plans with 5 stars are considered to be highly above average in quality, and plans with 1 star are considered to be very below average in quality. 4/17/2017 MedPOINT Management STARs PROGRAM Overview

Why is STARS rating significant? WHAT ARE THE CMS STARS?? (CONTINUED) STAR RATINGS are CMS Ratings for Part C and D Medicare Plans The original purpose of STAR ratings was to enable Medicare beneficiaries to compare quality among Medicare Advantage Plans on the Medicare Prescription Drug Plan Finder (MPDPF). As part of Health Care Reform, CMS will begin a quality bonus payment in 2012 for MA Plans based on the Five Star Ratings. In the fall of 2006, CMS posted Plan ratings based on a 3 star scale For 2008, Annual Enrollment Period (AEP), CMS introduced a 5 Star scale. [5=highly above average; 1=very below average] STAR Ratings are updated annually during the AEP Why is STARS rating significant? 4/17/2017 MedPOINT Management STARs PROGRAM Overview

HOW are star ratings measured? Health Plans receive an overall STAR rating and ratings by domain PART C Domain I: Staying Healthy: Screenings, Tests and Vaccines Domain II: Managing Chronic (Long Lasting) Conditions Domain III: Rating of Health Plan Responsiveness and Care Domain IV: Member Complaints, Appeals and Choosing to Leave the Health Plan Domain V: Customer Service PART D Domain I: Drug Plan Customer Service Domain III: Member Experience with the Health Plan Domain IV: Drug Pricing and Patient Safety 4/17/2017 MedPOINT Management STARs PROGRAM Overview

CMS Star Ratings – Data Sources HEDIS: A widely used set of performance measures in the managed care industry, developed and maintained by NCQA CAHPS (Consumer Assessment of Healthcare Providers and Systems): Comprehensive family of surveys that ask consumers and patient to evaluate interpersonal aspects of health care. HOS (Health Outcomes Survey): Patient reported outcomes measure used in Medicare managed care. All managed care organizations with MA contracts must participate. CTM (Complaints Tracking Module): Complaint rates per 1,000 are adjusted to a 30-day basis CMS Audit: Findings of CMS audits, ad hoc and compliance actions that occurred during the 14-month past performance review period MBDS (Medicare Beneficiary Database Suite of Systems) A collection of individual applications and services that access a single source for Medicare beneficiary demographic data IRE: Independent Review Entity: An independent entity contracted by CMS to review Medicare health plans’ adverse reconsideration of organization determinations Phone Monitoring: Call center data collected by CMS PDE Data: Prescription Drug Event Data: Data was obtained from PDE data files submitted by drug plans to Medicare for the reporting period MARx: Medicare Advantage Prescription Drug System: This data presents the percentage of new enrollment requests from beneficiaries that the plan submitted to Medicare within 7 days of the application date. 4/17/2017 MedPOINT Management STARs PROGRAM Overview

Basis for the STAR ratings The ratings are based on Part C & D Measures. Star rating based on average of 53 measures which are continually updated. 36 Part C measures 17 Part D measures 4/17/2017 MedPOINT Management STARs PROGRAM Overview

Data Sources by weight DATA SOURCE DOMAINS WT VALUE % STARS HEDIS Part C: I & II 24.5 30.82% PDE Data Part D: IV 16 20.13% CAHPS Part C: I & III 14 17.61 % HOS Part C: I & II 9 11.32% IRE Part C: V 6 7.55% Phone Monitoring Part C: V 4.5 5.66% CTM Part C: IV 1.5 1.89% CMS Audit Part C: IV 1.5 1.89% MBDS Part C: IV 1.5 1.89% MARx Part D: I 1 1.26% TOTAL 79.5 100% 4/17/2017 MedPOINT Management STARs PROGRAM Overview

HEDIS MEASURES Breast Cancer Screening Colorectal Screening CV Colorectal Screening Monitoring of Long Term Patient’s Medication Diabetes-Colorectal Screening Diabetes-Kidney Monitoring Diabetes-Blood Sugar Control Diabetes-Cholesterol Control 4/17/2017 MedPOINT Management STARs PROGRAM Overview

HEDIS MEASURES (CONTINUED) Glaucoma Testing Access to Primary Care Doctor Visits Osteoporosis Management Diabetes Eye Care Controlling Blood Pressure Rheumatoid Arthritis Management Testing to Confirm COPD 4/17/2017 MedPOINT Management STARs PROGRAM Overview

CAHPS MEASURES Annual Flu Vaccine Pneumonia Vaccine Ease of Getting Needed Care and Seeing Specialists Doctors Who Communicate Well Getting Appointments and Care Quickly Overall rating of Health Care Quality Overall rating of the Health Plan Customer Service Member complaints Appeals 4/17/2017 MedPOINT Management STARs PROGRAM Overview

Health Outcomes Survey Improving Bladder Control (Physicians need to initiate discussion) Reducing the Risk of Falling (Discuss balance problems, trouble walking and other risk factors) Monitoring Physical Activity (Advise patient how to start, increase or maintain) Improving or Maintaining Physical Health (Gauge status at each visit) Improving or Maintaining Mental Health (Gauge status at each visit) ---------------------------------------------------------------------------------------------------------- USE THE ANNUAL WELLNESS VISIT AS A VEHICLE TO SET THE STAGE. 4/17/2017 MedPOINT Management STARs PROGRAM Overview