Medicare Advantage Quality Measurement & Performance Assessment Training Conference April 8-9,...

Medicare Advantage Quality Measurement & Performance

Assessment Training ConferenceApril 8-9, 2008

Empowering a More Informed Consumer:Medicare Plan Ratings

Vikki Oates, M.A.S.Liz Goldstein, Ph.D.

Center for Beneficiary Choices

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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

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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

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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

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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

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Part D Plan Ratings

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Medicare.gov Website

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Accessing Plan Ratings

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Medicare Part D Plan Ratings Measure Domains

Drug Plan Consumer ServiceUsing Your Plan to get Your

Prescriptions FilledDrug Pricing Information

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Domain Overview

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Customer service wait timeCustomer service disconnect ratePharmacy help desk average wait timePharmacy help desk average disconnect

rateBeneficiary ability to get help from the

planBeneficiary rating of planTotal customer service complaints

Part D – Drug Plan Customer Service Measures

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Individual Measures

Plan A

(S0000)Plan B

(S0001)

Plan C

(S0002)

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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

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Part D - Drug Pricing Information

Availability of drug coverage and cost information

How often the Plan’s drug prices changeComplaints about the Plan’s pricing and

out –of-pocket costs

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PDP Domain SummaryN

um

ber

of

Con

tracts

0

10

20

30

40

50

60

70

Cust. Service Getting Rx Filled Rx Pricing Info

5 Stars 4 Stars 3 Stars2 Stars 1 Star Insuff Data

DomainNote: Excludes new contracts. Data as of 10/25/07.

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MA-PD Domain SummaryN

um

ber

of

Con

tracts

0

50

100

150

200

250

300

Cust. Service Getting Rx Filled Rx Pricing Info

5 Stars 4 Stars 3 Stars2 Stars 1 Star Insuff Data

DomainNote: Excludes new contracts. Data as of 10/25/07

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Part C Plan Ratings

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Medicare Part C Plan Ratings Measure Domains

Helping You Stay HealthyGetting Care from Doctors and

SpecialistsGetting Timely Information and Care

From Your Health PlanManaging Chronic (Long-Lasting)

ConditionsYour Rights to Appeal

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Domain Overview

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Data Sources Supporting Medicare Plan Ratings for Part C

HEDIS CAHPS IRE data

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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

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Individual Measures

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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)

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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

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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

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Part C - Your Rights to Appeal

Plan Makes Timely Decisions about Appeals Reviewing Appeals Decisions

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Part C Domain Summary

0

20

40

60

80

100

120

Helping You StayHealthy

Dr/ Specialist Care TimelyInformation and

Care

5 Stars 4 Stars 3 Stars2 Stars 1 Star

Nu

mb

er

of

Con

tracts

DomainNote: Excludes new contracts. Data as of 10/25/07.

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Part C Domain Summary, cont’d.

0

20

40

60

80

100

120

ManagingChronic

Conditions

Your Rightsto Appeal

5 Stars 4 Stars 3 Stars2 Stars 1 Star

Nu

mb

er

of

Con

tracts

DomainNote: Excludes new contracts. Data as of 10/25/07.

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Vikki Oates410-786-3652

vikki.oates@cms.hhs.gov

Liz Goldstein410-786-6665

Elizabeth.goldstein@cms.hhs.gov

Contact Information