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
4.74-4.50 $80 PMPY
4.49-4.00 $40 PMPY
3.99-3.75 $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 25 if all 12 measures are included.

12 measures tracked in 2022

      Measure Thresholds
2022
Star ID
Measure name MA-PCPi weight 1-Star 2-Star 3-Star 4-Star 5-Star
C01 Breast cancer screening  1 <47% 47% 66% 73% 80%
C02 Colorectal cancer screening 1 <48% 48% 66% 75% 83%
C09 Eye exam for patients with diabetes 1 <57% 57% 67% 76% 83%
C11 Hemoglobin A1c control for patients with diabetes 3 <43% 43% 65% 77% 86%
D08 Medication adherence for diabetes medications 3 <77% 77% 83% 87% 91%
D09 Medication adherence for hypertension (RAS antagonists) 3 <76% 76% 84% 88% 92%
D10 Medication adherence for cholesterol (statins) 3 <77% 77% 83% 87% 91%
D12 Statin use in persons with diabetes 1 <77% 77% 82% 86% 90%
Patient experience performance percentages
NA Getting needed care 3 NA <92% 92% 94% 96%
NA Care coordination 3 NA <81% 81% 88% 90%
NA Doctor patient conversations  2 NA <52% 52% 58% 65%
NA Access to care  1 NA NA <25% 25% 50%

Example bonus calculation

2022 Star ID Measure name Measure performance percentage Quality rating MA-PCPi weight MA-PCPi weighted quality rating
C01 Breast cancer screening  73% 4 1 4
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 diabetes 65% 3 3 9
D08 Medication adherence for diabetes medications 91% 5 3 15
D09 Medication adherence for hypertension (RAS antagonists) 86% 3 3 9
D10 Medication adherence for cholesterol (statins) 87% 4 3 12
D12 Statin use in persons with diabetes 90% 5 1 5
NA Getting needed care 96% 5 3 15
NA Care coordination 90% 5 3 15
NA Doctor patient conversations  59% 4 2 8
NA Access to care  50% 5 1 5
      Total 25 106
In this example, the Average Star Rating for the 2022 program year would be 4.24

New in 2022

Expand All add_circle_outline

In 2022, the patient experience measure is being expanded into 3 measures within the Average Star Rating calculation:

  • Getting needed care
  • Care coordination
  • Doctor-patient conversations

Data from the UnitedHealthcare patient experience survey is used to calculate performance for the 3 patient experience measures. Each measure represents an average of the patient experience survey questions within each category.

Example patient experience score calculation

Getting needed care: (95% + 95% + 93%)/3 = 94% ➞ 4 Star
Care coordination: (87% + 89% + 88%)/3 = 88% ➞ 4 Star
Doctor-patient conversations: (64% + 65% + 66%)/3 = 65% ➞ 5 Star

A single weighted access to care measure has been added within the Average Star Rating Bonus. Performance for this new measure will be determined based on the percentage of months in the program term that access to care activities are reported in Practice Assist on the following metrics:

  • Routine access
  • Same-day access
  • Wait time
  • Referral time
  • Pre-visit planning

Example access to care measure score calculation

  • Provider group submits access to care metrics in 6 unique months during the program year
  • Six unique months of submission (12 months during program year)
  • 6/12 = 50% = 5 Star
The patient experience measures are UnitedHealthcare measures. The weight and Star performance thresholds for these measures are determined by UnitedHealthcare.