Your practice can earn an annual bonus when you achieve an Average Star Rating of 3.75 or higher.
| 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 |
| 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% |
| 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 | |||||
In 2022, the patient experience measure is being expanded into 3 measures within the Average Star Rating calculation:
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:
Example access to care measure score calculation