Medicare Advantage Quality Measurement & Performance Assessment Training Conference April 8-9, 2008 Empowering a More Informed Consumer: Medicare Plan Ratings Vikki Oates, M.A.S. Liz Goldstein, Ph.D. Center for Beneficiary Choices

2  To support the President’s Agenda on health care transparency  To support the CMS Strategic Plan  To ensure that Medicare beneficiaries receive the best healthcare and prescription drug coverage available and that they have the data necessary to make informed decisions –Internet –Medicare & You handbook Goals of Medicare Plan Ratings

3 Power of the Medicare Plan Ratings  Establishes performance benchmarks: –CMS’ long-term goal is to establish performance benchmarks based on historical experience with Part D –Once benchmarks are established, CMS will work with plans to improve performance –If high performance in an area becomes standard for all plans then a measure may be retired  Provides composite scores for monitoring purposes  Creates a feedback loop

4 Medicare Plan Ratings  Expansion of the number of Part C and Part D measures  Making measures more accessible to users of the Medicare’s health plan and drug plan comparison websites  Measures will be evaluated and rated at a domain and measure level

5 Medicare Plan Ratings Integrated with the Plan Finder and Medicare Options Compare  Beneficiaries will have the opportunity to view the measures at three levels:  The highest level is the domain level, which summarizes all measures in that area into a single rating.  From each domain, beneficiaries can drill down to the summary level. This level will provide a rating for each measure.  Within each measure, a beneficiary can view details. This level will show a rate, time, or statistic for each measure.  Both the domain and summary level ratings will be based on a five-star scale

6 Part D Plan Ratings

7 Medicare.gov Website

8 Accessing Plan Ratings

9 Medicare Part D Plan Ratings Measure Domains  Drug Plan Consumer Service  Using Your Plan to get Your Prescriptions Filled  Drug Pricing Information

10 Domain Overview

11  Customer service wait time  Customer service disconnect rate  Pharmacy help desk average wait time  Pharmacy help desk average disconnect rate  Beneficiary ability to get help from the plan  Beneficiary rating of plan  Total customer service complaints Part D – Drug Plan Customer Service Measures

12 Individual Measures Plan A (S0000) Plan B (S0001) Plan C (S0002)

13 Part D- Using Your Plan to Get Your Prescriptions Filled  Getting prescriptions easily  Pharmacists have up- to- date Plan enrollment information  Pharmacists have up-to-date information on Plan members who need extra help  Complaints about the Plan’s benefits and access to prescription drugs  Complaints about joining or leaving the Plan  Delays in appeals decisions  Reviewing appeals decisions

14 Part D - Drug Pricing Information  Availability of drug coverage and cost information  How often the Plan’s drug prices change  Complaints about the Plan’s pricing and out –of-pocket costs

15 PDP Domain Summary Number of Contracts Domain Note: Excludes new contracts. Data as of 10/25/07.

16 MA-PD Domain Summary Number of Contracts Domain Note: Excludes new contracts. Data as of 10/25/07

17 Part C Plan Ratings

18 Medicare Part C Plan Ratings Measure Domains  Helping You Stay Healthy  Getting Care from Doctors and Specialists  Getting Timely Information and Care From Your Health Plan  Managing Chronic (Long-Lasting) Conditions  Your Rights to Appeal

19 Domain Overview

20 Data Sources Supporting Medicare Plan Ratings for Part C  HEDIS  CAHPS  IRE data

21 Part C – Helping You Stay Healthy  Breast Cancer Screening  Colorectal Cancer Screening  Cardiovascular Care – Cholesterol Screening  Diabetes Care – Cholesterol Screening  Glaucoma Testing  Appropriate Monitoring of Patients Taking Long-term Medications  Annual Flu Vaccine  Pneumonia Vaccine

22 Individual Measures

23 Part C - Getting Care From Your Doctors and Specialists  Access to Primary Care Doctor Visits  Getting Needed Care without Delays  Doctor Follow up for Depression  Follow-up Visit after Hospital Stay for Mental Illness (within 30 days of discharge)

24 Part C – Getting Timely Information and Care from Your Health Plan  Doctors who Communicate Well  Getting Appointments and Care Quickly  Overall Rating of Health Care Quality  Overall Rating of Health Plan  Call Answer Timeliness

25 Part C - Managing Chronic (Long-Lasting) Conditions  Osteoporosis Management  Diabetes Care – Eye Exam  Diabetes Care – Kidney Disease Monitoring  Diabetes Care – Blood Sugar Controlled  Diabetes Care – Cholesterol Controlled  Antidepressant Medication management (6 months)  Controlling Blood Pressure  Rheumatoid Arthritis Management  Testing to Confirm Chronic Obstructive Pulmonary Disease  Continuous Beta-Blocker Treatment

26 Part C - Your Rights to Appeal  Plan Makes Timely Decisions about Appeals  Reviewing Appeals Decisions

27 Part C Domain Summary Number of Contracts Domain Note: Excludes new contracts. Data as of 10/25/07.

28 Part C Domain Summary, cont’d. Number of Contracts Domain Note: Excludes new contracts. Data as of 10/25/07.

29 Vikki Oates Liz Goldstein Contact Information