1. CY2009 Medicare Plan Ratings: November 2008 Release for Open Enrollment Alice Lee-Martin, PharmD Liz Goldstein, Ph.D. Center for Drug and Health Plan Choice

2. 2 Agenda Changes to the Plan Ratings Plan Rating levels Assignment of Star Ratings Part D Categories and Topics Part C Categories and Topics

3. 3 www.medicare.gov

4. 4

5. 5 Drug Plan A H1234 Drug Plan B H0123

6. 6 www.medicare.gov Drug Plan A H1234 Drug Plan B H0123 Drug Plan C H0000

7. 7 Changes for CY2009 Medicare Plan Ratings Overall summary ratings for Part C and Part D Reorganized 4 Part D categories 4 Part D topics added, and 2 Part D topics deleted Changes to Part D star assignments at the category and topic level 6 Part C topics added Changes to calculation of CAHPS measures for both Part C and D Improved labels, language, and website functionality

8. 8 Four levels of Plan Ratings 1.Overall Summary Ratings for Part C and D: Summarizes all topics from the categories into a single rating. 2.Category level: Groups related topics into an area for a single rating. 3.Individual topic level: Single rating for a performance measure. 4.Data for each measure: Detailed data used to rate the contracts performance.

9. 9 Part C and D Overall Summary Ratings Separate overall composite scores calculated for Part C and Part D Summarizes a contracts performance across categories and underlying individual topics Rating based on adjusted averages of the individual topics Consistency in good performance will receive higher ratings Ratings will include half-stars to provide more differentiation between contracts

10. 10 Part D Plan Ratings – Category and Topic ratings Category-level stars are based on adjusted averages of individual topic level Topic-level stars are based on a hybrid methodology –Combine adjusted percentile distribution and two-stage clustering processes. –More meaningful cut-points between stars to show differences between plans performances –When applicable, adjustments made so the CMS standard falls within the three star rating level.

11. 11 Plan Ratings for Part D

12. 12 New CY2009 Part D Categories CY2008 – 3 categories Drug Plan Consumer Service Using Your Plan to get Your Prescriptions Filled Drug Pricing Information CY2009 – 4 categories Drug Plan Customer Service Member complaints and staying with drug plan Member experience with drug plan Drug pricing and patient safety

13. 13 CY2009 Part D Categories Provide more meaningful information to beneficiaries Are based on factor analysis that identify the most statistically appropriate grouping of measures Stratifies individual measures into larger domains that show the overall performance of a plan within specific areas

14. 14 Part D – Drug Plan Customer Service Measures Time on Hold when Customer Calls Drug Plan Calls Disconnected When Customer Calls Drug Plan Time on Hold When Pharmacist Calls Drug Plan Calls Disconnected When Pharmacist Calls Drug Plan Drug Plans timeliness in giving a decision for members who make an appeal Fairness of Drug Plans denials to a members appeal, based on an Independent Reviewer

15. 15 Part D- Member complaints and staying with drug plan Complaints about the Drug Plan's Benefits and Access to Prescription Drugs (per 1,000 members) Complaints about Joining and Leaving the Drug Plan (per 1,000 members) Complaints about the Drug Plan's Pricing and Out-of-pocket Costs (per 1,000 members) All Other Complaints about the Drug Plan (per 1,000 members) Members who stay with their current Drug Plan from one year to the next

16. 16 Part D- Member satisfaction with drug plan All measures are derived from the Part D CAHPS survey Drug Plan Provides Information or Help When Members Need It Members Overall Rating of Drug Plan Members Ability to Get Prescriptions Filled Easily When Using the Drug Plan

17. 17 Part D - Drug pricing information and patient safety Completeness of the Drug Plans Information on Members Who Need Extra Help Drug Plan Provides Current Information on Costs and Coverage for Medicares Website Drug Plans prices that did not increase more than expected during the year Drug Plans Prices on Medicares Website Are Similar to the Prices Members Pay at the Pharmacy Drug Plans Members 65 and Older Who Received Prescriptions for Certain Drugs with a High Risk of Side Effects, when There May Be Safer Drug Choices

18. 18 CY2009 Medicare Part D Plan Ratings Topics Retired measures: Total complaints about the Drug Plan (revised to new all other complaint rate) Pharmacists Have Up-to-date Plan Enrollment Information (4Rx measure) 17 measures => 19 measures CY2008 CY2009

19. 19 CY2009 Medicare Part D Plan Ratings Measures (continued) New: All Other Complaints about the Drug Plan (per 1,000 members) Members Who Stay with Their Current Drug Plan from One Year to the Next Drug plans prices on the Medicares website are similar to prices members pay at the pharmacy Drug Plans Members > 65 years old who received prescriptions for certain drugs with a high risk of side effects

20. 20 New Part D Measure: Member retention Members who stay with their current Drug Plan from one year to the next The percent of non-LIS members who are enrolled as of December 2007 and who remain enrolled in January 2008 with the same parent organization

21. 21 New Part D Measure: MPDPF prices vs. PDE Drug plans prices on the Medicares website are similar to prices members pay at the pharmacy MPDPF and PDE data for drugs in the 6 classes of clinical concern evaluated to identify variation between MPDPF-PDE prices

22. 22 New Part D Measure: >65 years old receiving high risk drugs Drug Plans Members 65 and older who received prescriptions for certain drugs with a high risk of side effects, when safer drug choices may be possible The percent of enrollees 65 years of age and older who received at least one prescription for a high-risk medication, using 2007 PDE data and drugs identified to have serious side effects in patients 65 and older

23. 23 New (revised) Part D Measure: All other complaints All Other Complaints about the Drug Plan (per 1,000 members) Replaces previous Total Complaints as all complaint measures are grouped in one domain for CY2009 Using CTM data, the rate of complaints not related to the other complaint measures (Benefits and Access, Joining and Leaving the Drug Plan, or Pricing and Out-of-pocket Costs)

24. 24 2009 Part D Summary Score Distributions

25. 25 Part D – Drug Plan Customer Service

26. 26 Part D - Member complaints and staying with drug plan

27. 27 Part D- Member satisfaction with drug plan

28. 28 Part D - Drug pricing information and patient safety

29. 29 Plan Ratings for Part C

30. 30 CY 2009 Part C Categories The categories remain the same as CY 2008; however, titles have been revised as a result of consumer feedback –Staying Healthy: Screenings, Tests and Vaccines –Getting Timely Care from Doctors and Specialists –Ratings of Health Plan Responsiveness and Care –Managing Chronic (Long-Lasting) Conditions –How Well and Quickly Health Plans Handled Appeals

31. 31 Part C – Staying Healthy: Screenings, Tests and Vaccines Existing Measures –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

32. 32 Part C – Staying Healthy: Screenings, Tests and Vaccines New Measures –Two year change scores for members physical and mental health status –Osteoporosis Testing in Older Women –Physical Activity in Older Adults

33. 33 Part C - Getting Timely Care from Doctors and Specialists Existing Measures –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)

34. 34 Part C – Ratings of Health Plan Responsiveness and Care Existing Measures –Doctors who Communicate Well –Getting Appointments and Care Quickly –Customer Service –Overall Rating of Health Care Quality –Overall Rating of Health Plan –Call Answer Timeliness

35. 35 Part C - Managing Chronic (Long- Lasting) Conditions Existing Measures –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

36. 36 New Measures –Fall Risk Management –Management of Urinary Incontinence in Older Adults Part C - Managing Chronic (Long-Lasting) Conditions

37. 37 Part C – How Well and Quickly Health Plans Handled Appeals Existing Measures –Plan Makes Timely Decisions about Appeals –Reviewing Appeals Decisions

38. 38 Special Needs Plans Since early 2007, the Geriatric Measurement Panel (GMAP) of the National Committee for Quality Assurance (NCQA) has been funded by CMS to develop quality measures for evaluating SNPs. As a first phase of this work, thirteen existing HEDIS measures were chosen to measure the quality of care of SNPs and a set of three Structure and Process measures. Data from four of the thirteen HEDIS measures are available on www.cms.hhs.gov/SpecialNeedsPlans/ beginning mid November.www.cms.hhs.gov/SpecialNeedsPlans/ First year of data collection for SNPs. Many plans too new or too small to collect HEDIS data. This is the first phase of a more comprehensive strategy to collect quality data regarding SNPs.

39. 39 CY 2009 CAHPS Data Part C and D Individual measures and stars are based off of the mean of the distribution rather than top box responses The mean are converted to the percentage of the best possible score each contract earned The star ratings are determined by percentile rankings with statistical testing

40. 40 2009 Part C Summary Score Distributions

41. 41 Part C – Staying Healthy: Screenings, Tests and Vaccines

42. 42 Part C - Getting Timely Care from Doctors and Specialists

43. 43 Part C – Ratings of Health Plan Responsiveness and Care

44. 44 Part C – Managing Chronic (Long-Lasting) Conditions

45. 45 Part C – How Well and Quickly Health Plans Handled Appeals

46. 46 Other Improvements for CY2009 Category and topic labels revised from continued consumer testing New website functionality Print on demand of plan ratings available by state or contract Links to other information resources, e.g. Medicare appeals

47. 47 Questions? PartDMetrics@cms.hhs.gov Alice Lee-Martin 410-786-1103 Alice.leemartin@cms.hhs.gov Liz Goldstein 410-786-6665 Elizabeth.goldstein@cms.hhs.gov Contact Information