Transcript Document

Empowering a More Informed Consumer:
Medicare Plan Ratings
Medicare Advantage
Quality Measurement & Performance
Assessment Training Conference
April 8-9, 2008
Vikki Oates, M.A.S.
Liz Goldstein, Ph.D.
Center for Beneficiary Choices
Goals of Medicare Plan Ratings
To support the President’s Agenda on
health care transparency
To support the CMS Strategic Plan
To ensure that Medicare beneficiaries
receive the best healthcare and
prescription drug coverage available and
that they have the data necessary to
make informed decisions
– Internet
– Medicare & You handbook
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Power of the Medicare Plan
Ratings
 Establishes performance benchmarks:
– CMS’ long-term goal is to establish performance
benchmarks based on historical experience with
Part D
– Once benchmarks are established, CMS will work
with plans to improve performance
– If high performance in an area becomes standard
for all plans then a measure may be retired
 Provides composite scores for monitoring
purposes
 Creates a feedback loop
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Medicare Plan Ratings
Expansion of the number of Part C and
Part D measures
Making measures more accessible to
users of the Medicare’s health plan and
drug plan comparison websites
Measures will be evaluated and rated
at a domain and measure level
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Medicare Plan Ratings Integrated with the
Plan Finder and Medicare Options Compare
 Beneficiaries will have the opportunity to view the
measures at three levels:
 The highest level is the domain level, which
summarizes all measures in that area into a single
rating.
 From each domain, beneficiaries can drill down to
the summary level. This level will provide a rating
for each measure.
 Within each measure, a beneficiary can view details.
This level will show a rate, time, or statistic for each
measure.
 Both the domain and summary level ratings will be
based on a five-star scale
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Part D Plan Ratings
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Medicare.gov Website
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Accessing Plan Ratings
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Medicare Part D
Plan Ratings Measure Domains
Drug Plan Consumer Service
Using Your Plan to get Your
Prescriptions Filled
Drug Pricing Information
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Domain Overview
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Part D – Drug Plan Customer
Service Measures
Customer service wait time
Customer service disconnect rate
Pharmacy help desk average wait time
Pharmacy help desk average disconnect
rate
Beneficiary ability to get help from the
plan
Beneficiary rating of plan
Total customer service complaints
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Individual Measures
Plan A
Plan B
Plan C
(S0000)
(S0001)
(S0002)
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Part D- Using Your Plan to Get
Your Prescriptions Filled
 Getting prescriptions easily
 Pharmacists have up- to- date Plan
enrollment information
 Pharmacists have up-to-date information on
Plan members who need extra help
 Complaints about the Plan’s benefits and
access to prescription drugs
 Complaints about joining or leaving the Plan
 Delays in appeals decisions
 Reviewing appeals decisions
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Part D - Drug Pricing
Information
Availability of drug coverage and cost
information
How often the Plan’s drug prices change
Complaints about the Plan’s pricing and
out –of-pocket costs
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PDP Domain Summary
5 Stars
2 Stars
4 Stars
1 Star
3 Stars
Insuff Data
Number of
Contracts
70
60
50
40
30
20
10
0
Cust. Service
Getting Rx Filled
Domain
Note: Excludes new contracts. Data as of 10/25/07.
Rx Pricing Info
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MA-PD Domain Summary
5 Stars
2 Stars
4 Stars
1 Star
3 Stars
Insuff Data
Number of
Contracts
300
250
200
150
100
50
0
Cust. Service
Getting Rx Filled
Domain
Note: Excludes new contracts. Data as of 10/25/07
Rx Pricing Info
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Part C Plan Ratings
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Medicare Part C
Plan Ratings Measure Domains
Helping You Stay Healthy
Getting Care from Doctors and
Specialists
Getting Timely Information and Care
From Your Health Plan
Managing Chronic (Long-Lasting)
Conditions
Your Rights to Appeal
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Domain Overview
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Data Sources Supporting Medicare
Plan Ratings for Part C
 HEDIS
 CAHPS
 IRE data
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Part C – Helping You Stay
Healthy

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Breast Cancer Screening
Colorectal Cancer Screening
Cardiovascular Care – Cholesterol Screening
Diabetes Care – Cholesterol Screening
Glaucoma Testing
Appropriate Monitoring of Patients Taking
Long-term Medications
 Annual Flu Vaccine
 Pneumonia Vaccine
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Individual Measures
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Part C - Getting Care From
Your Doctors and Specialists


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Access to Primary Care Doctor Visits
Getting Needed Care without Delays
Doctor Follow up for Depression
Follow-up Visit after Hospital Stay for Mental
Illness (within 30 days of discharge)
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Part C – Getting Timely Information
and Care from Your Health Plan


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
Doctors who Communicate Well
Getting Appointments and Care Quickly
Overall Rating of Health Care Quality
Overall Rating of Health Plan
Call Answer Timeliness
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Part C - Managing Chronic
(Long-Lasting) Conditions

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
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
Osteoporosis Management
Diabetes Care – Eye Exam
Diabetes Care – Kidney Disease Monitoring
Diabetes Care – Blood Sugar Controlled
Diabetes Care –Cholesterol Controlled
Antidepressant Medication management (6 months)
Controlling Blood Pressure
Rheumatoid Arthritis Management
Testing to Confirm Chronic Obstructive Pulmonary
Disease
 Continuous Beta-Blocker Treatment
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Part C - Your Rights to
Appeal
 Plan Makes Timely Decisions about Appeals
 Reviewing Appeals Decisions
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Part C Domain Summary
Number of
Contracts
5 Stars
2 Stars
4 Stars
1 Star
3 Stars
120
100
80
60
40
20
0
Helping You Stay Dr/Specialist Care
Timely
Healthy
Information and
Care
Domain
Note: Excludes new contracts. Data as of 10/25/07.
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Part C Domain Summary, cont’d.
Number of
Contracts
5 Stars
2 Stars
4 Stars
1 Star
3 Stars
120
100
80
60
40
20
0
Managing
Chronic
Conditions
Your Rights
to Appeal
Domain
Note: Excludes new contracts. Data as of 10/25/07.
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Contact Information
Vikki Oates
410-786-3652
[email protected]
Liz Goldstein
410-786-6665
[email protected]
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