TotalCare (HMO D-SNP) – Medicare Advantage Star Ratings Program

The Star Ratings program is scored on a five-point system, with one star being the lowest score and five stars being the highest. This score is calculated based on a weighted average of over 40 different quality measures, including:

• Healthcare Effectiveness Data and Information Set (HEDIS) measures.
• Member survey measures like Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Health Outcomes Survey (HOS).
• Prescription drug measures.
• Operational measures.

For more information on the Star Ratings program, the measures that are included in the program and the calculation methodology, visit Medicare Advantage and Part D Star Ratings | CMS.

A health plan’s Star Rating helps Medicare members evaluate the quality of care the plan provides. Additionally, Centers for Medicare & Medicaid Services (CMS) awards plans with a quality bonus payment for achieving high scores, which can be used to reduce costs for members and help fund supplemental benefits that Medicare doesn’t traditionally cover. Plans with performance levels under 3 stars for multiple years could result in compliance consequences.

Provider engagement is essential to the Alliance’s Medicare Star Ratings performance. Here are just a few ways providers can impact the overall score:

• Timely and complete documentation of preventive services (e.g., A1c, blood pressure, diabetic eye exams).
• Closing care gaps through proactive scheduling and follow-ups.
• Medication adherence support, including refill synchronization and counseling on side effects
• Coordinated care transitions to reduce readmissions.
• Promoting preventive screenings, such as colorectal and breast cancer screenings and vaccines like an annual flu vaccine.
• Accurate coding and data capture, which support HEDIS and Star measure accuracy.
• Encouraging member engagement, including participation in health assessments, care plans and satisfaction surveys.

The Alliance uses a Star Ratings Workgroup, a cross-functional team that monitors Star Ratings performance, recommends interventions and supports improvement across all measures. This program is also supported by several specialized workgroups that address measure-specific strategies. For accountability and transparency, this work is reported to the Quality Improvement and Health Equity committee structure as well as the Medicare Steering Committee.

For more information on the HEDIS measures, please refer to the HEDIS information page. For more information on Medicare surveys used to score Star Ratings measures, please refer to the CAHPS information page.