The Centers for Medicare & Medicaid Services (CMS) has developed Medicare Advantage plan quality measurements called Star Ratings.
CMS Star Ratings are used to rate qualify plan performance for:
Medicare Advantage (Part C), including special needs plans
Prescription drug plans (Part D)
Operational measures such as call center metrics, complaints, etc.
Healthcare Effectiveness Data and Information Set (HEDIS) measures
Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures, such as customer satisfaction
CMS Star Ratings are published annually on the CMS website to inform consumers about plan performance.
Care Provider Role in CMS Star Ratings
Many measures require complete, up-to-date encounter data.
Some measures track treatment of chronic conditions such as diabetes management, controlling blood pressure and medication adherence.
Please encourage your patients who are Medicare Advantage and prescription drug benefit plan members to have an annual physical or well visit to document body mass index (BMI), medications, vital signs and any changes in the member’s health status.
If you have any questions about UnitedHealthcare’s commitment to Medicare Star Ratings, or need additional information or assistance in accessing reports, please contact your Network Management Contract Representative or Provider Advocate.
You can also call the Health Care Measurement Resource Center at 866-270-5588 for assistance with questions regarding report access or site registration. Representatives are available Monday - Friday from 8 a.m. - 5 p.m. Central Time.