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Average Star Rating Bonus

Your practice can earn an annual bonus when you achieve an Average Star Rating of 3.75 or higher.

Payment structure

MA-PCPi Average Star Rating Payment amount*
4.75 and above $125 PMPY
4.50 - 4.74 $80 PMPY
4.00 - 4.49 $40 PMPY
3.75 - 3.99 $20 PMPY
3.74 and below $0
*(PMPY = Per MA-PCPi customer per year)

How Star Ratings are determined

  1. First, we determine the percentage of your patients who meet the criteria across 12 program measures (see chart for details)
  2. Next, we determine which Star Rating the percentage corresponds to for each measure
  3. We look at the weight for each program measure, which reflects its relative importance
  4. Each measure is given a quality rating based on the measure’s weight and calculated Star Rating
  5. Your Average Star Rating is calculated by adding the weighted quality ratings and dividing the sum by the total number of weights. The total number of weights is 27 if all 12 measures are included.

12 measures tracked in 2023

      Measure Thresholds
2023
Star ID
Measure name MA-PCPi weight 1-Star 2-Star 3-Star 4-Star 5-Star
C01 Breast cancer screening  1 <51% 51% 64% 73% 81%
C02 Colorectal cancer screening 1 <56% 56% 66% 74% 81%
C09 Eye exam for patients with diabetes 1 <50% 50% 64% 73% 82%
C11 Hemoglobin A1c control for patients with diabetes 3 <56% 56% 70% 80% 88%
D08 Medication adherence for diabetes medications 3 <81% 81% 85% 88% 92%
D09 Medication adherence for hypertension (RAS antagonists) 3 <82% 82% 86% 89% 91%
D10 Medication adherence for cholesterol (statins) 3 <81% 81% 85% 89% 92%
D12 Statin use in persons with diabetes 1 <82% 82% 85% 88% 92%
C16 Statin Therapy for Patients with Cardiovascular Disease 1 <79% 79% 83% 86% 90%
Patient experience performance percentages
NA Getting needed care 4 NA <88% 88% 92% 95%
NA Care coordination 4 NA <84% 84% 88% 93%
NA Doctor patient conversations  2 NA <52% 52% 58% 66%

Example bonus calculation

2023 Star ID Measure name Measure performance percentage Quality rating MA-PCPi weight MA-PCPi weighted quality rating
C01 Breast cancer screening  72% 3 1 3
C02 Colorectal cancer screening 84% 5 1 5
C09 Eye exam for patients with diabetes 77% 4 1 4
C11 Hemoglobin A1c control for patients with diabetes7 75% 3 3 9
D08 Medication adherence for diabetes medications 91% 4 3 12
D09 Medication adherence for hypertension (RAS antagonists) 86% 3 3 9
D10 Medication adherence for cholesterol (statins) 89% 4 3 12
D12 Statin use in persons with diabetes 90% 4 1 4
C16 Statin Therapy for Patients with Cardiovascular Disease 88% 4 1 4
NA Getting needed care 96% 5 4 20
NA Care coordination 90% 4 4 16
NA Doctor patient conversations  59% 4 2 8
      Total 27 106
In this example, the Average Star Rating for the 2023 program year would be 3.93
The patient experience measures are UnitedHealthcare measures. The weight and Star performance thresholds for these measures are determined by UnitedHealthcare.