Date

Fact sheet

2017 Star Ratings

2017 Star Ratings

One of the Centers for Medicare & Medicaid Services’ (CMS) most important strategic goals is to improve the quality of care and general health status for Medicare beneficiaries. CMS publishes the Part C and D Star Ratings each year to: measure quality in Medicare Advantage (MA) and Prescription Drug Plans (PDPs or Part D plans), assist beneficiaries in finding the best plan for them, and determine MA Quality Bonus Payments. Moreover, the ratings support the efforts of CMS to improve the level of accountability for the care provided by physicians, hospitals, and other providers. Star Ratings are driving improvements in Medicare quality. The information included in this Fact Sheet is evidence of such improvement and is based on the 2017 Star Ratings published on Medicare Plan Finder (MPF) on October 12, 2016. 

Background

Medicare Advantage with prescription drug coverage (MA-PD) contracts are rated on up to 44 unique quality and performance measures; MA-only contracts (without prescription drug coverage) are rated on up to 32 measures; and stand-alone PDP contracts are rated on up to 15 measures. Each year, CMS conducts a comprehensive review of the measures that make up the Star Ratings, considering the reliability of the measures, clinical recommendations, feedback received from stakeholders, and data issues. All measures transitioned from the Star Ratings are included in the display measures available on this page http://go.cms.gov/partcanddstarratings. Changes to existing measures are summarized in Attachment A of this document. The 2017 Star Ratings also include an adjustment to account for the socioeconomic status of enrollees. This adjustment is described in Attachment B.

The Star Ratings measures span five broad categories:

  • Outcomes
  • Intermediate Outcomes
  • Patient Experience
  • Access
  • Process

For the 2017 Star Ratings, outcomes and intermediate outcomes continue to be weighted three times as much as process measures, and patient experience and access measures are weighted 1.5 times as much as process measures. CMS assigns a weight of 1 to all new measures. The Part C and D quality improvement measures receive a weight of 5 to further reward contracts for the strides they made to improve the care provided to Medicare enrollees.

Highlights of Contract Performance in 2017 Star Ratings[1]

Changes in Ratings from 2016

  • Approximately 49 percent of MA-PDs (178 contracts) that will be active and rated in 2017 earned four stars or higher for their 2017 overall rating.
  • Weighted by enrollment, close to 68 percent of MA-PD enrollees are in contracts with four or more stars.
  • The number of active and rated contracts, and the percent of MA-PD enrollees weighted by enrollment in contracts with four or more stars in 2017 is approximately the same in 2017 as compared to 2016.
  • In 2017, weighted by enrollment, over 90% of MA-PD enrollees are in contracts with ratings of 3.5 or more stars.

Table 1: 2014 - 2017 Overall Star Rating Distribution for MA-PD Contracts*

Overall Rating
2014
2015
2016
2017
Number of Contracts
%
% Weighted By Enrollment
Number of Contracts
%
% Weighted By Enrollment
Number of Contracts
%
% Weighted By Enrollment
Number of Contracts
%
% Weighted By Enrollment
5 stars
11
2.55
9.56
11
2.78
9.88
12
3.25
10.23
14
3.85
9.80
4.5 stars
64
14.85
20.55
61
15.44
19.59
65
17.62
25.02
67
18.41
23.65
4 stars
87
20.19
21.68
86
21.77
30.32
102
27.64
35.71
97
26.65
34.57
3.5 stars
143
33.18
30.49
136
34.43
26.78
112
30.35
19.55
107
29.40
22.40
3 stars
109
25.29
16.63
73
18.48
10.98
66
17.89
8.60
67
18.41
8.87
2.5 stars
16
3.71
1.09
26
6.58
2.37
12
3.25
0.90
12
3.30
0.72
2 stars
1
0.23
0.01
2
0.51
0.08
0
0.00
0.00
0
0.00
0.00
Total Number of Contracts
431
100
 
395
100
 
369
100
 
364
100
 
Average Star Rating*
3.86
3.92
4.03
4.00

Table 2 details the trend in the average Part D ratings unweighted and weighted by enrollment for PDPs per rating category for the period of 2014 to 2017. The last row details the trend in the average Part D rating weighted by enrollment for PDPs for the same period.

  • Approximately 49 percent of PDPs (27 contracts) that will be active and rated in 2017 received four or more stars for their 2017 Part D rating.
  • Weighted by enrollment, close to 41 percent of PDP enrollees are in contracts with four or more stars.
  • There is nearly a 9 percentage point increase in PDP enrollees in contracts with four or more stars compared to 2016, despite the number of PDP contracts decreasing each year.

Table 2: 2012 - 2017 Part D Rating Distribution for PDPs 

Part D Rating
2014
2015
2016
2017
Number of Contracts
%
% Weighted By Enrollment
Number of Contracts
%
% Weighted By Enrollment
Number of Contracts
%
% Weighted By Enrollment
Number of Contracts
%
% Weighted By Enrollment
5 stars
5
6.94
0.13
3
4.92
1.5
2
3.39
0.13
6
10.91
2.28
4.5 stars
6
8.33
3.34
11
18.03
7.28
10
16.95
1.63
8
14.55
0.65
4 stars
16
22.22
5.29
17
27.87
43.94
12
20.34
29.95
13
23.64
37.74
3.5 stars
18
25.00
52.39
18
29.51
40.4
12
20.34
21.76
16
29.09
25.55
3 stars
17
23.61
14.16
7
11.48
0.61
14
23.73
38.88
9
16.36
31.84
2.5 stars
8
11.11
5.62
3
4.92
5.99
8
13.56
7.65
3
5.45
1.94
2 stars
1
1.39
0.00
1
1.64
0.01
1
1.69
0.01
0
0.00
0.00
1.5 stars
1
1.39
19.07
1
1.64
0.27
0
0.00
0.00
0
0.00
0.00
Total Number of Contracts
72
100
 
61
100
 
59
100
 
55
100
 
Average Star Rating*
3.05
3.75
3.40
3.55

* The average Star Rating is weighted by enrollment.

5-Star Contracts

23 contracts are highlighted on MPF with a high performing (gold star) icon: 14 are MA-PD contracts (Table 3), 3 are MA-only contracts (Table 4), and 6 are PDPs (Table 5).

The 12 new 5-star contracts for this year are:

  • KS Plan Administrators, LLC (H0332)
  • BCBS of Massachusetts HMO Blue, Inc. (H2261)
  • Aultcare Health Insurance Corporation (H3664)
  • Physicians Health Choice of Texas, LLC (H4527)
  • CDPHP Universal Benefits, Inc. (H5042)
  • Optimum Healthcare, Inc. (H5594)
  • Kaiser Foundation HP, Inc. (H6052)
  • Anthem Insurance Co. & BCBSMA & BCBSRI & BCBSVT (S2893)
  • Excellus Health Plan, Inc. (S3521)
  • BCBS of Michigan Mutual Insurance Company (S5584)
  • Wellmark IA & SD, & BCBS MN, MT, NE, ND,& WY (S5743)
  • Dean Health Insurance, Inc. (S9701)

Table 3: MA-PD Contracts Receiving the 2017 High Performing Icon

Contract

Contract Name

Enrolled 10/2016

Non-EGHP Service Area*

EGHP Service Area*

5 Star Last Year

SNP

H0332

KS Plan Administrators, LLC

30,769

4 counties in TX

251 counties in TX

No

No

H0524

Kaiser Foundation HP, INC.

1,086,961

31 counties in CA

Not applicable

Yes

Yes

H0630

Kaiser Foundation HP of CO

104,117

17 counties in CO

Not applicable

Yes

Yes

H2150

Kaiser Foundation of the Mid-Atlantic Sts.

68,575

D.C., 11 counties in MD, 9 counties in VA

Not applicable

Yes

No

H2256

Tufts Associated Health Maintenance Organization

107,311

10 counties in MA

Not applicable

Yes

Yes

H2261

BCBS of Massachusetts HMO BLUE, Inc.

10,302

11 counties in MA

Not applicable

No

No

H2462

Group Health Plan, Inc. (MN)

53,633

87 counties in MN, 8 counties in WI

Not applicable

Yes

No

H3664

Aultcare Health Insuring Corporation

21,048

12 counties in OH

Most of the U.S.

No

No

H4527

Physicians Health Choice of Texas LLC

31,035

19 counties in TX

Not applicable

No

Yes

H5042

CDPHP Universal Benefits, Inc.

3,827

Not applicable

62 counties in NY

No

No

H5262

Gundersen Health Plan

14,462

1 county in IA, 8 counties in WI

Not applicable

Yes

No

H5594

Optimum Healthcare, Inc.

45,153

25 counties in FL

Not applicable

No

Yes

H5652

Sierra Health and Life Insurance Company, Inc.

4,630

1 county in CO, 1 county in KS, 2 counties in MA, 3 counties in MD, 1 county in MI, 2 counties in NJ, 2 counties in PA, 2 counties in TX, 1 county in VA

Not applicable

Yes

Yes

H9003

Kaiser Foundation HP of the N W

84,567

9 counties in OR, 4 counties in WA

1 county in OR, 1 county in WA

Yes

No

*An EGHP is a non-Employer Group and Employer Group Health Plan.

Table 4: MA-only Contracts Receiving the 2017 High Performing Icon[2]

Contract

Contract Name

Enrolled 10/2016

Non-EGHP Service Area

EGHP Service Area

5 Star Last Year

H1651

Medical Associates Health Plan, Inc.

10,930

6 counties in IA, 1 county in IL

Not applicable

Yes

H5264

Dean Health Plan, Inc.

23,739

8 counties in WI

Not applicable

Yes

H6052

Kaiser Foundation HP, Inc.

867

21 counties in CA

Not applicable

No

 

Table 5: PDP Contracts Receiving the 2017 High Performing Icon

Contract

Contract Name

Enrolled 10/2016

Non-EGHP Service Area

EGHP Service Area

5 Star Last Year

S0655

Tufts Insurance Company

8,524

Not applicable

35 regions

Yes

S2893

Anthem Insurance Co. & BCBSMA & BCBSRI & BCBSVT

155,120

1 region - Central New England (Connecticut, Massachusetts, Rhode Island, and Vermont)

37 regions

No

S3521

Excellus Health Plan, Inc.

9,486

Not applicable

39 regions

No

S5584

BCBS of Michigan Mutual Insurance Company

46,659

1 region – Michigan

38 regions

No

S5743

Wellmark IA & SD, & BCBS MN, MT, NE, ND,& WY

288,017

1 region - Upper Midwest and Northern Plains (Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming)

33 regions

No

S9701

Dean Health Insurance, Inc.

34,369

Not applicable

35 regions

No

Low Performers

There are 2 contracts identified on the MPF with the Low Performing Icon (LPI) for consistently low quality ratings as detailed in Table 6. Both contracts are receiving the LPI for Part C summary ratings of 2.5 or fewer stars from 2015 through 2017.

Table 6: 2017 Contracts with a Low Performing Icon (LPI)

Contract

Contract Name

Parent Organization

Reason for LPI

Enrolled 10/2016

H5985

Phoenix Health Plans, Inc.

Tenet Healthcare Corporation

Part C

13,777

H6801

GHS Managed Health Care Plans, Inc.

Health Care Service Corporation

Part C

4,550

*These contracts are eligible for termination at the end of 2017. 

Tax Status and Performance

Organizations that are non-profit tend to receive higher ratings than those that are for-profit. For MA-PDs, approximately 70% of the non-profit contracts received four or more stars compared to 39% of the for-profit MA-PDs. Similarly, for PDPs approximately 63% of non-profit PDPs received four or more stars compared to 24% of the for-profit PDPs. Non-profit organizations also performed better than for-profit organizations last year.

Below is the ratings distribution by tax status for MA-PD (Table 7) and PDP (Table 8) contracts.

Table 7: Distribution of Overall Star Ratings for For-profit and Non-profit MA-PDs

2017 Overall Rating

Number of For-Profit

% For- Profit

% Weighted By Enrollment For-Profit

Number of Non-Profit

% Non- Profit

% Weighted By Enrollment Non-Profit

5 stars

4

1.67

0.98

10

8.00

27.57

4.5 stars

33

13.81

20.88

34

27.20

29.22

4 stars

59

24.69

37.96

38

30.40

27.74

3.5 stars

77

32.22

27.63

30

24.00

11.86

3 stars

58

24.27

11.73

9

7.20

3.09

2.5 stars

8

3.35

0.81

4

3.20

0.53

Total Number of Contracts

239

100

 

125

100

 

Table 8: Distribution of Part D Ratings for For-profit and Non-profit PDPs

2017 Part D Rating

Number of For-Profit

% For- Profit

% Weighted By Enrollment For-Profit

Number of Non-Profit

% Non- Profit

% Weighted By Enrollment Non-Profit

5 stars

2

6.67

0.19

3

12.50

40.09

4.5 stars

2

6.67

0.14

6

25.00

14.37

4 stars

7

23.33

38.72

6

25.00

18.60

3.5 stars

10

33.33

25.73

6

25.00

25.41

3 stars

7

23.33

33.25

2

8.33

0.16

2.5 stars

2

6.67

1.97

1

4.17

1.37

Total Number of Contracts

30

100

 

24

100

 

Length of Time in Program and Performance

On average, higher Star Ratings are associated with more experience in the MA program. We see a similar pattern for PDPs. The tables below show the distribution of ratings by the number of years in the program (MA-PDs are shown in Table 9 and PDPs in Table 10).

Table 9: Distribution of Overall Star Ratings by Length of Time in Program for MA-PDs

2017 Overall Rating

Count Less than 5 years

% Less than 5 years

Count 5 years to less than 10 years

% 5 years to less than 10 years

Count 10 years or Greater

% 10 years or Greater

5 stars

0

0.00

3

3.45

11

5.05

4.5 stars

7

11.86

7

8.05

53

24.31

4 stars

12

20.34

26

29.89

59

27.06

3.5 stars

12

20.34

28

32.18

67

30.73

3 stars

22

37.29

22

25.29

23

10.55

2.5 stars

6

10.17

1

1.15

5

2.29

2 stars

0

0.00

0

0.00

0

0.00

1.5 stars

0

0.00

0

0.00

0

0.00

1 star

0

0.00

0

0.00

0

0.00

Total Number of Contracts

59

 

218

 

87

 

Table 10: Distribution of Part D Ratings by Length of Time in Program for PDPs

2017 Part D Rating

Count Less than 5 years

% Less than 5 years

Count 5 years to less than 10 years

% 5 years to less than 10 years

Count 10 years or Greater

% 10 years or Greater

5 stars

1

8.33

1

7.14

4

10.53

4.5 stars

1

8.33

3

21.43

4

10.53

4 stars

0

0.00

4

28.57

9

23.68

3.5 stars

3

25.00

1

7.14

12

31.58

3 stars

2

16.67

2

14.29

5

13.16

2.5 stars

1

8.33

1

7.14

1

2.63

2 stars

0

0.00

0

0.00

0

0.00

1.5 stars

0

0.00

0

0.00

0

0.00

1 star

0

0.00

0

0.00

0

0.00

Total Number of Contracts

12

 

38

 

14

 

Performance of Contracts Eligible to Receive Low Income Subsidy (LIS) Auto-assignees

Most contracts with a Star Rating and eligible to receive LIS auto-assignees (LIS contracts) continue to earn a Star Rating of 3 or more (Table 11).

  • Approximately the same percentage of contracts earned a Star Rating of three or more in 2017 compared to 2016.

Table 11: Distribution of Part D Ratings for PDPs Eligible to Receive LIS Auto-assignees

Part D Rating

2014 Number of LIS Contracts

2014 % of LIS Contracts

2015 Number of LIS Contracts

2015 % of LIS Contracts

2016 Number of LIS Contracts

2016 % of LIS Contracts

2017 Number of LIS Contracts

2017 % of LIS Contracts

5 stars

0

0.00

0

0.00

0

0.00

1

7.14

4.5 stars

0

0.00

1

5.88

0

0.00

0

0.00

4 stars

4

20.00

4

23.53

2

13.33

3

21.43

3.5 stars

6

0.00

8

47.06

4

26.67

2

14.29

3 stars

6

30.00

2

11.76

7

46.67

6

42.86

2.5 stars

3

15.00

1

5.88

2

13.33

2

14.29

2 stars

0

0.00

0

0.00

0

0.00

0

0.00

1.5 stars

1

5.00

1

5.88

0

0.00

0

0.00

1 star

0

0.00

0

0.00

0

0.00

0

0.00

Total Number of Contracts

20

 

17

 

15

 

14

 

Geographic Variation

The following eight maps illustrate the average Star Ratings weighted by enrollment per county for MA-PDs and PDPs across the U.S., including territories, between 2014 and 2017.[3] These maps exclude the employer group health plans. Counties shaded in green indicate that the average overall Star Rating weighted by enrollment in the county for MA-PDs or average Part D rating for PDPs is four or more stars. Counties shaded in yellow indicate that the average rating weighted by enrollment for the county for MA-PDs or PDPs is three stars. Areas shaded in orange indicate that the average rating weighted by enrollment is less than three stars. Areas in gray indicate data are not available for those counties. Among the changes and updates are:

  • The availability of highly rated MA-PDs has increased since 2014.
  • The MA-PD maps for 2017 compared to 2014 show the distribution of Star Ratings across the country shifting toward higher rated plans as compared to 2014.
  • The PDP map for 2017 compared to 2016 shows that there is a shift in the distribution of Star Ratings across the country and a large increase in the number of plans with four or more stars (regions represented by darker shades of green).
  • In 2017 the average rating weighted by enrollment for PDPs across the county is at least three stars.

Map 1

Map 2

Map 3

Map 4

Map 5

Map 6

Map 7

Map 8

Average Star Rating for Each Measure

Below we list the average Star Ratings for 2014, 2015, 2016, and 2017 Part C and D measures (Tables 12 and 13). In general, Star Ratings have gone up from 2014 to 2017 for most measures.[4] 

Table 12: Average Star Rating by Part C Measure

2017 Measure

Number

Measure

2014 Average Star

2015 Average Star

2016 Average Star

2017 Average Star

C01

Breast Cancer Screening

3.3

n/a - not used in 2015

3.6

4.0

C02

Colorectal Cancer Screening

3.9

4.2

3.2

3.2

C03

Annual Flu Vaccine

3.4

3.3

3.3

3.3

C04

Improving or Maintaining Physical Health

4.5

4.6

3.3

2.6

C05

Improving or Maintaining Mental Health

2.0

2.5

3.3

3.6

C06

Monitoring Physical Activity

2.4

2.2

2.9

2.9

C07

Adult BMI Assessment

3.8

3.8

4.1

4.4

C08

Special Needs Plan (SNP) Care Management

n/a – new in 2015

2.7

2.5

3.0

C09

Care for Older Adults – Medication Review

3.6

3.9

4.3

4.4

C10

Care for Older Adults – Functional Status Assessment

3.4

3.4

3.9

4.0

C11

Care for Older Adults – Pain Assessment

3.2

4.0

4.1

4.5

C12

Osteoporosis Management in Women who had a Fracture

1.9

2.1

2.5

2.7

C13

Diabetes Care – Eye Exam

4.0

3.7

3.1

3.4

C14

Diabetes Care – Kidney Disease Monitoring

4.5

4.2

3.3

3.6

C15

Diabetes Care – Blood Sugar Controlled

3.3

3.3

3.9

3.7

C16

Controlling Blood Pressure

3.5

3.7

3.4

4.0

C17

Rheumatoid Arthritis Management

3.7

3.5

3.2

3.9

C18

Reducing the Risk of Falling

3.4

3.3

2.7

2.4

C19

Plan All-Cause Readmissions

3.5

3.0

3.3

3.3

C20

Getting Needed Care

3.6

3.4

3.5

3.3

C21

Getting Appointments and Care Quickly

3.5

3.5

3.4

3.3

C22

Customer Service

3.5

3.5

3.5

3.3

C23

Rating of Health Care Quality

3.7

3.7

3.4

3.4

C24

Rating of Health Plan

3.4

3.4

3.3

3.2

C25

Care Coordination

3.4

3.4

3.4

3.4

C26

Complaints about the Health Plan

3.0

4.2

3.9

4.6

C27

Members Choosing to Leave the Plan

3.7

4.3

4.2

4.3

C28

Beneficiary Access and Performance Problems

3.4

n/a - not used in 2015

4.2

4.2

C29

Health Plan Quality Improvement

3.5

3.5

3.4

3.1

C30

Plan Makes Timely Decisions about Appeals

4.1

4.2

4.1

3.8

C31

Reviewing Appeals Decisions

3.3

3.7

3.6

3.7

C32

Call Center – Foreign Language Interpreter and TTY Availability

4.4

n/a - not used in 2015

4.3

4.2

 

Table 13: Average Star Rating by Part D Measure for MA-PDs

2017 Measure

Number

Measure

2014 MA-PD

Average Star

2015 MA-PD

Average Star

2016 MA-PD

Average Star

2017 MA-PD

Average Star

D01

Call Center – Foreign Language Interpreter and TTY Availability

3

n/a – not used in 2015

4.2

4.3

D02

Appeals Auto–Forward

3.4

3.6

4.5

3.9

D03

Appeals Upheld

3.3

3.7

3.3

2.9

D04

Complaints about the Drug Plan

3

4.2

3.9

4.6

D05

Members Choosing to Leave the Plan

3.7

4.3

4.2

4.3

D06

Beneficiary Access and Performance Problems

3.3

n/a – not used in 2015

4.2

4.1

D07

Drug Plan Quality Improvement

3.7

4.1

3.8

3.6

D08

Rating of Drug Plan

3.4

3.5

3.3

3.3

D09

Getting Needed Prescription Drugs

3.5

3.4

3.4

3.6

D10

MPF Price Accuracy

3.9

4.6

3.5

4.7

D11

High Risk Medication

3.6

3.2

4.1

3.7

D12

Medication Adherence for Diabetes Medications

3.7

3.5

3.9

3.5

D13

Medication Adherence for Hypertension (RAS antagonists)

3.7

3.1

4.1

4.0

D14

Medication Adherence for Cholesterol (Statins)

3.6

3.3

4.0

3.5

D15

MTM Program Completion Rate for CMR

n/a – new in 2016

n/a – new in 2016

2.3

2.4

Table 14: Average Star Rating by Part D Measure for PDPs

2017 Measure

Number

Measure

2014 PDP

Average Star

2015 PDP

Average Star

2016 PDP

Average Star

2017 PDP

Average Star

D01

Call Center – Foreign Language Interpreter and TTY Availability

3.7

n/a – not used in 2015

4.0

3.6

D02

Appeals Auto–Forward

2.7

2.5

4.1

4.1

D03

Appeals Upheld

3.3

3.9

3.1

3.3

D04

Complaints about the Drug Plan

3.4

4.3

3.5

4.3

D05

Members Choosing to Leave the Plan

3.3

3.7

3.6

4.4

D06

Beneficiary Access and Performance Problems

3.8

n/a – not used in 2015

3.9

4.4

D07

Drug Plan Quality Improvement

3.6

4.2

3.8

3.8

D08

Rating of Drug Plan

3.7

3.9

3.2

3.4

D09

Getting Needed Prescription Drugs

4.1

3.8

3.6

3.6

D10

MPF Price Accuracy

4.1

4.7

4.7

4.8

D11

High Risk Medication

2.8

2.7

3.1

3.6

D12

Medication Adherence for Diabetes Medications

3.1

3.0

2.7

3.3

D13

Medication Adherence for Hypertension (RAS antagonists)

3.6

3.8

3.6

3.7

D14

Medication Adherence for Cholesterol (Statins)

3.6

4.2

3.5

3.6

D15

MTM Program Completion Rate for CMR

n/a – new in 2016

n/a – new in 2016

2.3

2.8

 

Attachment A – 2017 Star Ratings Measure Changes

Below are some additional changes to the 2017 Star Ratings in terms of the measures included.

Specification Changes

  • Part C & D measures: C30 – Plan Makes Timely Decisions about Appeals, C31 – Reviewing Appeals Decisions, and D03 – Appeals Upheld: updated each to change re-opening deadline from April 1, 2016 to May 1, 2016.
  • Part D measure D03 – Appeals Upheld: removed exclusion for hospice stay.
  • Part C & D measures: C28 & D06 – Beneficiary Access and Performance Problems: return to its normal weight of 1.5.
  • Part C & D measures C29 – Health Plan Quality Improvement and D07 – Drug Plan Quality Improvement: the CAHPS low reliability “hold harmless” rule has been implemented for contracts affected by very low reliability exclusion of enrollees with less than 6 months in the 2015 survey.
  • Part C measure C29 – Health Plan Quality Improvement: added the following measures to the calculation (C01 – Breast Cancer Screening, C26 – Complaints about the Health Plan, C30 – Plan Makes Timely Decisions about Appeals, and C32 – Call Center – Foreign Language Interpreter and TTY Availability).
  • Part D measure D07 – Drug Plan Quality Improvement: added the following measures to the calculation (D01 – Call Center – Foreign Language Interpreter and TTY Availability, D03 – Appeals Upheld, D04 – Complaints about the Drug Plan, and D15 – MTM Program Completion Rate for CMR).

Additions

  • None

Transitioned Measures

Transitioned measures are measures that have moved to the display page which can be found on the CMS website at this address: http://go.cms.gov/partcanddstarratings

  • None

Retired measures

  • None

Attachment B – 2017 Interim Analytical Adjustment for Socioeconomic Status

As announced in the final 2017 Call Letter[5] and detailed in the Medicare Part C & D Star Rating Technical Notes[6], CMS implemented an interim analytical adjustment, the Categorical Adjustment Index (CAI). The CAI is a factor that is added to or subtracted from a contract’s overall and/or summary Star Ratings to adjust for the average within-contract disparity in performance associated with a contract’s percentages of beneficiaries with Low Income Subsidy/Dual Eligible (LIS/DE) and disability status. The value of the CAI varies by a contract’s percentages of beneficiaries with Low Income Subsidy/Dual Eligible (LIS/DE) and disability status.

Below are the changes to the 2017 Star Ratings process to incorporate the interim analytical adjustment for socioeconomic status.

  • The summary and overall rating calculation formulas were updated to include the CAI adjustment methodology.
  • For contracts whose non-employer service area only covers Puerto Rico, an additional adjustment, a contract-level modified LIS/DE percentage, was determined to address the lack of LIS in Puerto Rico to categorize the contracts for the Categorical Adjustment Index final adjustment category.
  • For contracts whose non-employer service area only covers Puerto Rico, the weights for the adherence measures (D12, D13 & D14) were set to zero (0) in the summary and overall rating calculations. The weights of the adherences were retained at three (3) for the improvement measure calculations.

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[1] Changes in the average Star Rating do not always reflect changes in performance since for some measures there have been significant changes in industry performance and shifts in the distribution of scores. The pre-determined star thresholds were removed for the 2016 Star Ratings. Some measures may have greater shifts from 2015 to 2016 compared to other time periods due to the revision to the methodology used to determine the rating.

[2] The final 2017 Call Letter can be found at:https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Announcement2017.pdf

[3] The Medicare Part C & D Star Rating Technical Notes can be found can be found on the CMS website at this address: http://go.cms.gov/partcanddstarratings

[4] Tables contained in this document may not have sums of percentages of 100.00 due to rounding.

[5] MA-only contracts cannot offer SNPs.

[6] Comparisons of Star Ratings across years do not reflect annual revisions made by CMS to the Star Ratings methodology or measure set.