5 Star Program
Welcome to the 2013 5 star bonus program and measurement year.
Medicare Star Ratings is a government pay-for-performance program for Medicare Advantage and Part D prescription drug plans. The Centers for Medicare & Medicaid Services (CMS) uses Star Ratings as an indicator of how well we serve Medicare beneficiaries, especially by improving health outcomes and closing gaps in care. There are a total of 9 domains (topic areas) comprised of up to 55 individual measures which are reported through HEDIS® (Healthcare Effectiveness Data and Information Set). CAHPS (Consumer Assessment of Healthcare Providers & Systems) and HOS (Health Outcome Survey) scores are also combined to establish the health plans star ratings.
Each measure has specific eligible population criteria that have to be met in order to be included in the sample. Your membership panel may not meet criteria to fall within all 13 measures.
The 2013 HEDIS® 5-STAR Bonus Program will include the following 13 measures:
- Adult BMI Assessment (ABA)
- Breast Cancer Screening (BCS)
- Colorectal Cancer Screening (COL)
- FOBT – Fecal Occult Blood Test
- Flexible Sigmoidoscopy
- Glaucoma Screening in Older Adults (GSO)
- Cholesterol Management for Patients with Cardiovascular Conditions (CMC)
- Comprehensive Diabetes Care (CDC)
- Cholesterol Screening
- Eye Exam
- Kidney Disease Monitoring
- Blood Sugar Controlled
- Cholesterol Controlled
- Care for Older Adult (COA)
- Medication review
- Functional status assessment
- Pain screening
Last Update: June 13, 2013 at 2:20 pm