2016 HUMANA HEALTH PLANS OF PUERTO RICO, INC. (H4007) Star Rating Details |
Humana Gold Plus SNP-DE H4007-016 (HMO SNP) (H4007-016-0)
Benefit Details
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The Humana Gold Plus SNP-DE H4007-016 (HMO SNP) (H4007-016-0) in Guayanilla, PR: CMS MA Region 30 which includes: PR Plan Monthly Premium: $0.00 Deductible: $360 |
Star Rating Category & Measures | 2016 | 2015 |
Overall Star Rating [?] | 3.5 | 3.5 |
Summary Rating of Prescription Drug Plan Quality [?] | 3.5 | 3.5 |
Drug Plan Customer Service [?] | 5 | NtED |
- Call Center — Foreign Language Interpreter and TTY Availability [?]
| 5 | NoD |
- Drug Plan Makes Timely Decisions about Appeals [?]
| 5 | 5 |
- Fairness of Drug Plan’s Appeal Decisions [?]
| NtED | NtED |
Member Complaints and Changes in the Drug Plan’s Performance [?] | 4 | 4 |
- Complaints about the Drug Plan (higher score is better - means fewer complaints) [?]
| 3 | 3 |
- Members Choosing to Leave the Plan (higher score is better - means fewer members leaving) [?]
| 3 ![down from last year](https://q1medicare.com/pics/downArrowRed.gif) | 4 |
- Beneficiary Access and Performance Problems (higher score is better - means fewer serious problems) [?]
| 3 | NoD |
- Drug Plan Quality Improvement (if any) [?]
| 5 | 5 |
Member Experience with the Drug Plan [?] | 4 ![down from last year](https://q1medicare.com/pics/downArrowRed.gif) | 5 |
- Members’s Rating of Drug Plan [?]
| 5 | 5 |
- Ease of Getting Prescriptions Filled When Using the Plan [?]
| 3 ![down from last year](https://q1medicare.com/pics/downArrowRed.gif) | 4 |
Drug Safety and Accuracy of Drug Pricing [?] | 3 | 3 |
- Medicare.gov Plan Finder Drug Price Accuracy (higher score is better) [?]
| 3 ![down from last year](https://q1medicare.com/pics/downArrowRed.gif) | 4 |
| 5 | 5 |
- Medication Adherence for Diabetes Medications [?]
| 3 ![up from last year](https://q1medicare.com/pics/upArrowGreen.gif) | 1 |
- Medication Adherence for Hypertension (RAS antagonists) [?]
| 2 ![up from last year](https://q1medicare.com/pics/upArrowGreen.gif) | 1 |
- Medication Adherence for Cholesterol (Statins) [?]
| 2 ![up from last year](https://q1medicare.com/pics/upArrowGreen.gif) | 1 |
- MTM Program Completion Rate for CMR [?]
| 2 | NoD |
Summary Rating of Health Plan Quality [?] | 3.5 ![up from last year](https://q1medicare.com/pics/upArrowGreen.gif) | 3 |
Staying Healthy: Screenings, Tests and Vaccines [?] | 4 | 4 |
- Breast Cancer Screening [?]
| 5 | NoD |
- Colorectal Cancer Screening [?]
| 4 ![down from last year](https://q1medicare.com/pics/downArrowRed.gif) | 5 |
| 1 | 1 |
- Improving or Maintaining Physical Health [?]
| 2 ![down from last year](https://q1medicare.com/pics/downArrowRed.gif) | 5 |
- Improving or Maintaining Mental Health [?]
| 5 ![up from last year](https://q1medicare.com/pics/upArrowGreen.gif) | 3 |
- Monitoring Physical Activity [?]
| 3 ![up from last year](https://q1medicare.com/pics/upArrowGreen.gif) | 2 |
- Checking to See if Members Are at a Healthy Weight [?]
| 5 ![up from last year](https://q1medicare.com/pics/upArrowGreen.gif) | 4 |
Managing Chronic (Long Term) Conditions [?] | 3 | 3 |
- Special Needs Plan (SNP) Care Management [?]
| 3 | 3 |
- Care for Older Adults — Medication Review [?]
| 5 ![up from last year](https://q1medicare.com/pics/upArrowGreen.gif) | 4 |
- Care for Older Adults — Functional Status Assessment [?]
| 4 | 4 |
- Care for Older Adults — Pain Assessment [?]
| 4 | 4 |
- Osteoporosis Management in Women who had a Fracture [?]
| 2 ![up from last year](https://q1medicare.com/pics/upArrowGreen.gif) | 1 |
- Diabetes Care — Eye Exam [?]
| 3 ![down from last year](https://q1medicare.com/pics/downArrowRed.gif) | 4 |
- Diabetes Care — Kidney Disease Monitoring [?]
| 4 | 4 |
- Diabetes Care — Blood Sugar Controlled [?]
| 4 ![up from last year](https://q1medicare.com/pics/upArrowGreen.gif) | 1 |
- Controlling Blood Pressure [?]
| 3 ![down from last year](https://q1medicare.com/pics/downArrowRed.gif) | 4 |
- Rheumatoid Arthritis Management [?]
| 1 | 1 |
- Reducing the Risk of Falling [?]
| 3 ![down from last year](https://q1medicare.com/pics/downArrowRed.gif) | 4 |
- Plan All-Cause Readmissions [?]
| 4 ![up from last year](https://q1medicare.com/pics/upArrowGreen.gif) | 3 |
Member Experience with Health Plan [?] | 3 | 3 |
- Ease of Getting Needed Care and Seeing Specialists [?]
| 3 | 3 |
- Getting Appointments and Care Quickly [?]
| 2 ![up from last year](https://q1medicare.com/pics/upArrowGreen.gif) | 1 |
- Health Plan Provides Information or Help When Members Need It [?]
| 3 ![up from last year](https://q1medicare.com/pics/upArrowGreen.gif) | 2 |
- Member’s Rating of Health Care Quality [?]
| 5 ![up from last year](https://q1medicare.com/pics/upArrowGreen.gif) | 4 |
- Member’s Rating of Health Plan [?]
| 5 | 5 |
- Coordination of Members’s Health Care Services [?]
| 1 | 1 |
Member Complaints and Changes in the Health Plan’s Performance [?] | 4 | 4 |
- Complaints about the Health Plan (higher score is better - means fewer complaints) [?]
| 3 | 3 |
- Members Choosing to Leave the Plan (higher score is better - means fewer members leaving) [?]
| 3 ![down from last year](https://q1medicare.com/pics/downArrowRed.gif) | 4 |
- Beneficiary Access and Performance Problems (higher score is better - means fewer serious problems) [?]
| 3 | NoD |
- Health Plan Quality Improvement (if any) [?]
| 5 ![up from last year](https://q1medicare.com/pics/upArrowGreen.gif) | 4 |
Health Plan Customer Service [?] | 4 ![down from last year](https://q1medicare.com/pics/downArrowRed.gif) | 5 |
- Health Plan Makes Timely Decisions about Appeals [?]
| 4 ![down from last year](https://q1medicare.com/pics/downArrowRed.gif) | 5 |
- Fairness of Drug Plan’s Appeal Decisions [?]
| 4 | 4 |
- Call Center — Foreign Language Interpreter and TTY Availability [?]
| 4 | NoD |