Highest, Lowest 2017 CMS Star Ratings for Medicare plans

cms-five-stars WFGvoL

CMS released 2017 Star Ratings for Medicare Advantage and Part D plans, with nearly half of all Medicare Advantage with Part D plans earning an overall rating of four stars or higher.

The star ratings measure Medicare Advantage and Part D plan quality and determine Medicare Advantage quality bonus payments.

CMS conducts an annual review of quality and performance measures that make up the star ratings, considering reliability of the measures, clinical recommendations, stakeholder feedback and data issues.

Below are the 23 plans that received a 5-star rating, the highest possible.

Medicare Advantage with prescription drug coverage

KelseyCare Plan Administrators
Enrollment: 30,769
Service area: Only nonemployer group plans in four counties in Texas; employer group plans in 251 Texas counties

Kaiser Foundation Health Plan
Enrollment: 1,086,961
Service area: 31 counties in California

Kaiser Foundation Health Plan of Colorado
Enrollment: 104,117
Service area: 17 counties in Colorado

Kaiser Foundation of the Mid-Atlantic States
Enrollment: 68,575
Service area: District of Columbia, 11 counties in Maryland, 9 counties in Virginia

Tufts Associated Health Maintenance Organization
Enrollment: 107,311
Service area: 10 counties in Massachusetts

Blue Cross Blue Shield of Massachusetts HMO Blue
Enrollment: 10,302
Service area: 11 counties in Massachusetts

Group Health Plan
Enrollment: 53,633
Service area: 87 counties in Minnesota, eight counties in Wisconsin

AultCare
Enrollment: 21,048
Service area: Only nonemployer group policies in 12 counties in Ohio; employer group plans in most of the U.S.

Physicians Health Choice of Texas
Enrollment: 31,035
Service area: 19 counties in Texas

Capital District Physicians’ Health Plan Universal Benefits
Enrollment: 3,827
Service area: 62 counties in New York

Gundersen Health Plan
Enrollment: 14,462
Service area: One county in Iowa, 8 counties in Wisconsin

Optimum HealthCare
Enrollment: 45,153
Service area: 25 counties in Florida

Sierra Health and Life
Enrollment: 4,630
Service area: One county in Colorado, one county in Kansas, two counties in Massachusetts, three counties in Maryland, one county in Michigan, two counties in New Jersey, two counties in Pennsylvania, two counties in Texas, one county in Virginia 

Kaiser Foundation Health Plan of the Northwest 
Enrollment: 84,567
Service area: Only nonemployer group plans in nine counties in Oregon and four counties in Washington; employer group plans in one county in Oregon and one county in Washington

Medicare Advantage only

Medical Associates Health Plan
Enrollment: 10,930
Service area: Six counties in Iowa, one county in Illinois

Dean Health Plan
Enrollment: 23,739
Service area: Eight counties in Wisconsin

Kaiser Foundation Health Plan
Enrollment: 867
Service area: 21 counties in California

Standalone prescription drug plans 

Tufts Insurance
Enrollment: 8,524
Service area: 35 regions

Anthem, BCBS of Massachusetts, BCBS of Rhode Island, BCBS of Vermont
Enrollment: 155,120
Service area: Only nonemployer group plans in one region including Connecticut, Massachusetts, Rhode Island and Vermont; employer group plans in 37 regions

Excellus Health Plan
Enrollment: 9,486
Service area: 39 regions

BCBS of Michigan
Enrollment: 46,659
Service area: Only nonemployer group plans in one Michigan region; employer group plans in 38 regions

Wellmark Iowa and South Dakota, BCBS of Minnesota, Montana, Nebraska, North Dakota and Wyoming
Enrollment: 288,017
Service area: Only nonemployer group plans in one region including Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota and Wyoming; employer group plans in 33 regions

Dean Health
Enrollment: 34,369
Service area: 35 regions

Below are the two contracts that consistently identified as low ranking, with 2.5 or fewer stars from 2015 to 2017. 

Phoenix Health Plans
Parent organization: Tenet Healthcare 
Reason for low performance: Part C
Enrollment: 13,777

GHS Managed Health Care Plans
Parent organization: Health Care Service Corporation
Reason for low performance: Part C 
Enrollment: 4,550 

More articles about payer issues:
Blue Shield, NorthBay Healthcare spar over contract issues
CMS communication office gets a Twitter handle
One-fourth of Americans know uninsured rate is at historic low

To receive the latest hospital and health system business and legal news and analysis from Becker’s Hospital Review, sign-up for the free Becker’s Hospital Review E-weekly by clicking here.

via CMS: Highest, lowest 2017 star ratings for Medicare plans

Related Posts Plugin for WordPress, Blogger...
This entry was posted in Industry News and tagged , , , . Bookmark the permalink.