STAR RATING SYSTEM OVERVIEW - Medicare Advantage - Medicare Providers | Cigna
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STAR RATING SYSTEM
OVERVIEW
Month Day, Year
Medicare Advantage Presenter Name
Offered by Cigna Health and Life Insurance Company or its affiliatesWhat is the Five-Star Quality Rating System?
• The Centers for Medicare & Medicaid Services (CMS) uses a rating system to
measure quality in Medicare Advantage and prescription drug plans.
• The Five-Star Quality Rating System was originally developed to help Medicare
beneficiaries choose a Medicare Advantage Plan, but subsequently became a
mechanism to identify and reward high quality plans based on Star Rating outcomes.
• Medicare Advantage plans receive a star rating every year based on 40 to 50
measures:
– Excellent performance
– Very good performance
– Good performance
– Fair performance
– Poor performance
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2021 Cigna 2Why is the star rating important?
Breaks down all aspects that determine if a Medicare Advantage plan functions well
(e.g., patient care, preventive care, patient satisfaction, drug plan, administrative
functions, and more).
Enables patients to compare plans, which helps them make educated decisions about
the health plans and physicians they select.
Gives an overall quality and performance rating for each Medicare Advantage plan for
the types of services they offer.
The program emphasizes engagement with a primary care provider.
Health plans rated four or five stars receive Quality Bonus Payments from CMS to
manage their patients’ care and offer improved benefits.
Five-star plans are eligible to market and enroll patients year-round.
ALL Medicare Advantage health plans are scored the same way
and must participate in the star rating program.
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2021 Cigna 3Composition of star ratings
The 2023 star ratings (MY2021) are expected to consist of 40 measures across the following
six domains:
Number of
Percent of total
Stars domain Description metrics (projected
(weighted)*
2023 stars)
HEDIS®
(Healthcare Effectiveness Clinical-based metrics 11 Measures 14%
Data and Information Set)
PDE (Prescription Drug
Pharmacy-based metrics Five measures 12%
Events)
CAHPS
(Consumer Assessment of Customer survey measuring
Nine measures 36%
Healthcare Providers and perception of the care they receive
Systems)
HOS (Health Outcomes Customer survey measuring
Five measures 10%
Survey) perception of their own health
Administrative Operational-based metrics Eight measures 28%
Measures year-over-year
Improvement Two measures -
improvement
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2021 Cigna 4Star measure weights and cut-points
Star measures are categorized into the following three measures and weighted accordingly:
Measure type Description Weight Example
Process Driving and capturing health events 1 Reducing risk of falling
Driving and capturing health events and Improving or maintaining
Outcomes 3
their outcomes physical health
Patient Experience and Patient experience with the health plan and
4 Care coordination
Access their provider
Star ratings are assigned to individual measures using star cut-points, which are derived
from national performance using cluster methodology.
– Due to the methodology used to develop cut-points, they change from year to year.
Cut-points:
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2021 Cigna 5CONSUMER ASSESSMENT OF
HEALTHCARE PROVIDERS AND
SYSTEMS (CAHPS)
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2021 Cigna 6The CAHPS survey: The annual survey is mailed to
randomly selected patients. It asks
them about their experiences with
CAHPS accounts
their health care providers,
for 36% of the specialists, and health plan.
star rating
Provider-
Other
influenced
measures measures
Rating of drug
Getting Getting plan
Rating of
appointments Care Flu
needed health care
and care coordination vaccine Getting needed
care quickly quality prescription drugs
Rating of
health plan
Customer
service
The survey runs from early March to the end of May.
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2021 Cigna 7HEALTH OUTCOMES SURVEY Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2021 Cigna 8
• The Health Outcomes Survey (HOS) is
The HOS Survey: an annual, two-part, survey mailed to a
new random sample of patients. The
sample group receiving the baseline
HOS accounts survey in 2021, will receive a follow-up
survey in 2023.
for 10% of total
• Patients are asked about their perception
star rating of their own health and measures the
Medicare Advantage plan’s ability to
improve or maintain health of patients
over time.
Improving and
maintaining
Fall risk Urinary
physical and Physical activity
management incontinence
mental health
Change in mental health
Change in physical
over time
health over time
(anxiety/depression)
The survey runs from mid-July to the end of November.
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2021 Cigna 9HEALTHCARE EFFECTIVENESS DATA AND
INFORMATION SET
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2021 Cigna 10What are HEDIS measures?
• The purpose of the Healthcare Effectiveness Data and Information Set (HEDIS) measures is to
ensure customers receive effective care, have access to care, etc.
• The HEDIS measures are developed by National Committee for Quality Assurance (NCQA) and
chosen by Centers for Medicare and Medicaid Services (CMS) as a way to measure the quality of
care delivered by Medicare Advantage (MA) plans.
• The HEDIS measures can vary year to year, as NCQA and CMS can eliminate measures and
incorporate new ones.
• There are various measures used in HEDIS that directly impact our star rating, including:
o Breast cancer screening
o Colorectal cancer screening
o Comprehensive diabetes care
- Eye exams, kidney disease monitoring, and blood sugar control
o Controlling blood pressure
o Care for older adults (Special Needs Plans (SNP) customers only)
- Medication review, pain assessment, functional status
o Osteoporosis management
o Statins use for patients with cardiovascular conditions
o Transition of care: medication reconciliation post-discharge
o Hospital readmissions
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2021 Cigna 11MEDICARE PART D
Medication adherence, statin use, and medication therapy
management program completion rate
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2021 Cigna 12Medicare Part D overview
Every time a patient fills a prescription under Medicare Part D, the prescription
drug plan sponsor must submit a summary record to CMS. They use the data
from this record, along with the other part D clinical measures, to ensure that
prescription drug plans are being administered in an effective way.
The Cigna Medicare Part D stars team is focused on the clinical pharmacy
measures, which include the following:
– Medication adherence for oral diabetes medication
– Medication adherence for hypertension
– Medication adherence for cholesterol
– Statin use in persons with diabetes
– MTM program completion rate for CMR
The data for the Medicare Part D measures is collected through claims and
comprehensive medication review (CMR) for the medication therapy
management (MTM) measure.
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2021 Cigna 13CIGNA AND YOU
How Cigna can help you achieve the best star rating
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2021 Cigna 14How the Cigna stars team can support you
Patient PCP office
satisfaction educational Telephonic
surveys materials and outreach
training
Conduct patient Provide (posters, brochures, flyers, Call patients to help schedule
satisfaction surveys (on etc.) that PCPs can display in their PCP appointments, preventive
paper or electronically) for offices and distribute to patients screenings related to HEDIS
eligible PCP offices, and about various health topics to gap closure, and address
report results while sharing support care gap closure among barriers to medication
strategies for improvement PCP offices. adherence.
with office.
Mailings Vendor efforts Reporting
Send mailings to patients to Support provider’s HEDIS and Produce regular
remind them about flu shots, Medicare Part D star measure reporting to assist
patient satisfaction survey gap closure through vendor providers with quality
completion, preventive efforts – medication refill measure performance.
screening scheduling, reminder calls to patients, in-
medication adherence, etc. home A1C and Fecal Occult
Blood Test (FOBT) mailings to
patients each fall, etc.
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2021 Cigna 15EDUCATIONAL RESOURCES
Guided conversations and tools
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2021 CignaHow to order educational materials
1. Select material from the Cigna catalog (order form), which you can get from
your Cigna network operations representative
2. Specify quantity and preferred language for each piece
3. Specify order shipping address
*If you want to receive your order in multiple locations, please fill an order form
for each location/shipping address.
4. Send order form to your Cigna representative
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2019 Cigna 17All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. PCOMM-2021-951 08/21 © 2021 Cigna. Some content provided under license.
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