1 Fact Sheet - 2014 Star Ratings Star Ratings are driving improvements in Medicare quality. This year there have been significant increases in the number of Medicare beneficiaries in high-performing Medicare Advantage (MA) plans. The information included in this Fact Sheet is based on the 2014 Star Ratings published on Medicare Plan Finder on October 8, 2013. The Centers for Medicare & Medicaid Services (CMS) publishes the Star Ratings each year to assist beneficiaries in finding the best plan for them and to determine Medicare Advantage Quality Bonus Payments. Moreover, they support the efforts of CMS to improve the level of accountability for the care provided by physicians, hospitals, and other providers, including enrollees of Medicare Advantage and Prescription Drug Plans. 2014 Enhancements Medicare Advantage with prescription drug coverage (MA-PD) sponsors are rated on up to 48 quality and performance measures, MA-only sponsors (without prescription drug coverage) are rated on up to 36 measures, while stand-alone PDP sponsors are rated on up to 15 measures. Measurement is done at the contract level. 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. Any measure removed from the Star Ratings is displayed on the informational page of www.cms.gov. Changes to existing measures are summarized in Attachment A. The Star Ratings measures span five broad categories: Outcomes Intermediate Outcomes Patient Experience Access Process For 2014, outcome and intermediate outcome measures 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 (there are no new measures for 2014). Last year the Part C and D quality improvement measures received a weight of 1, and this year the weights have been changed to 3 since they are no longer new measures. CMS continues to reduce the overall Star Rating for contracts with serious compliance issues, defined as the imposition of enrollment or marketing sanctions. Highlights of Contract Performance in 2014 Star Ratings Changes in Ratings from 2013 The average Star Rating weighted by enrollment for MA-PDs is 3.84, compared to 3.66 in 2013, and 3.41 in 2012. Approximately 38 percent of MA-PDs (162 contracts) that will be active in 2014 earned four stars or higher for their 2014 overall rating. Weighted by enrollment, these contracts serve approximately 52 percent of enrollees as can be seen in Table 1 below. This is a nearly 14 percentage point increase from 38 percent of enrollees in contracts with four or more stars last year.
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Fact Sheet - 2014 Star Ratings1 Fact Sheet - 2014 Star Ratings Star Ratings are driving improvements in Medicare quality. This year there have been significant increases in the number
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1
Fact Sheet - 2014 Star Ratings
Star Ratings are driving improvements in Medicare quality. This year there have been significant increases in
the number of Medicare beneficiaries in high-performing Medicare Advantage (MA) plans. The information
included in this Fact Sheet is based on the 2014 Star Ratings published on Medicare Plan Finder on October 8,
2013. The Centers for Medicare & Medicaid Services (CMS) publishes the Star Ratings each year to assist
beneficiaries in finding the best plan for them and to determine Medicare Advantage Quality Bonus Payments.
Moreover, they support the efforts of CMS to improve the level of accountability for the care provided by
physicians, hospitals, and other providers, including enrollees of Medicare Advantage and Prescription Drug
Plans.
2014 Enhancements
Medicare Advantage with prescription drug coverage (MA-PD) sponsors are rated on up to 48 quality and
performance measures, MA-only sponsors (without prescription drug coverage) are rated on up to 36 measures,
while stand-alone PDP sponsors are rated on up to 15 measures. Measurement is done at the contract level.
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.
Any measure removed from the Star Ratings is displayed on the informational page of www.cms.gov. Changes
to existing measures are summarized in Attachment A.
The Star Ratings measures span five broad categories:
Outcomes
Intermediate Outcomes
Patient Experience
Access
Process
For 2014, outcome and intermediate outcome measures 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 (there are no new measures for 2014). Last year the Part C and
D quality improvement measures received a weight of 1, and this year the weights have been changed to 3 since
they are no longer new measures. CMS continues to reduce the overall Star Rating for contracts with serious
compliance issues, defined as the imposition of enrollment or marketing sanctions.
Highlights of Contract Performance in 2014 Star Ratings
Changes in Ratings from 2013
The average Star Rating weighted by enrollment for MA-PDs is 3.84, compared to 3.66 in 2013, and 3.41 in
2012.
Approximately 38 percent of MA-PDs (162 contracts) that will be active in 2014 earned four stars or
higher for their 2014 overall rating.
Weighted by enrollment, these contracts serve approximately 52 percent of enrollees as can be seen in
Table 1 below.
This is a nearly 14 percentage point increase from 38 percent of enrollees in contracts with four or more