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Understanding the 2019 CMS Star Ratings - Managing Chronic (Long Term) Conditions HD2

Does the plan do a good job caring for people who have long-lasting or chronic conditions? This category addresses how well each plan helps people with chronic or long lasting health conditions. It includes whether people with certain conditions, such as diabetes or high blood pressure, are getting recommended care. For example, it may include whether people with diabetes are getting recommended care, whether people with high blood pressure are able to maintain a healthy blood pressure, whether people with bone fractures are tested for brittle bones, and whether people with arthritis are taking drugs to manage their condition. It also has information about how often members are readmitted to the hospital (if this happens very often, it is a cause for concern). If you have a chronic health condition such as diabetes, high blood pressure, or arthritis, this information may be especially important to you.

This category is based on 15 sub-categories:




This information is from two sources: A survey of Medicare health plan enrollees (the Health Outcomes Survey) conducted in 2017 and clinical quality data collected in 2017 from Medicare health plans. The results have been independently validated.

Additional data source information for each sub-category is outlined below.



Special Needs Plan (SNP) Care Management

Members whose plan did an assessment of their health needs and risks. Percent of members whose plan did an assessment of their health needs and risks in the past year. The results of this review are used to help the member get the care they need. (Medicare collects this information only from Medicare Special Needs Plans. Medicare does not collect this information from other types of plans.)

Data Source:
Medicare health plans reported these data for 2017. The results have been independently validated.

This measure has a weight of 1.0 when combined with other measures to calculate the summary ratings.



Care for Older Adults — Medication Review

Yearly review of all medications and supplements being taken. Percent of plan members whose doctor or clinical pharmacist has reviewed a list of everything they take (prescription and non-prescription drugs, vitamins, herbal remedies, other supplements) at least once a year. (This information about a yearly review of medications is collected for Medicare Special Needs Plans only. These plans are a type of Medicare Advantage Plan designed for certain types of people with Medicare. Some Special Needs Plans are for people with certain chronic diseases and conditions, some are for people who have both Medicare and Medicaid, and some are for people who live in an institution such as a nursing home.)

Data Source:
This information is from clinical quality data collected in 2017 from Medicare health plans. The results have been independently validated.

This measure has a weight of 1.0 when combined with other measures to calculate the summary ratings.



Care for Older Adults — Functional Status Assessment

Yearly assessment of how well plan members are able to do activities of daily living. Percent of plan members whose doctor has done a "functional status assessment" to see how well they are able to do "activities of daily living" (such as dressing, eating, and bathing). (This information about the yearly assessment is collected for Medicare Special Needs Plans only. These plans are a type of Medicare Advantage Plan designed for certain types of people with Medicare. Some Special Needs Plans are for people with certain chronic diseases and conditions, some are for people who have both Medicare and Medicaid, and some are for people who live in an institution such as a nursing home.)

Data Source:
This information is from clinical quality data collected in 2017 from Medicare health plans. The results have been independently validated.

This measure has a weight of 1.0 when combined with other measures to calculate the summary ratings.



Care for Older Adults — Pain Assessment

Yearly pain screening or pain management plan Percent of plan members who had a pain screening or pain management plan at least once during the year. (This information about pain screening or pain management is collected for Medicare Special Needs Plans only. These plans are a type of Medicare Advantage Plan designed for certain types of people with Medicare. Some Special Needs Plans are for people with certain chronic diseases and conditions, some are for people who have both Medicare and Medicaid, and some are for people who live in an institution such as a nursing home.)

Data Source:
This information is from clinical quality data collected in 2017 from Medicare health plans. The results have been independently validated.

This measure has a weight of 1.0 when combined with other measures to calculate the summary ratings.



Osteoporosis Management in Women who had a Fracture

Percent of female plan members who broke a bone and got screening or treatment for osteoporosis within 6 months.

Data Source:
This information is from clinical quality data collected in 2017 from Medicare health plans. The results have been independently validated.

This measure has a weight of 1.0 when combined with other measures to calculate the summary ratings.



Diabetes Care — Eye Exam

Eye exam to check for damage from diabetes. Percent of plan members with diabetes who had an eye exam to check for damage from diabetes during the year.

Data Source:
This information is from clinical quality data collected in 2017 from Medicare health plans. The results have been independently validated.

This measure has a weight of 1.0 when combined with other measures to calculate the summary ratings.



Diabetes Care — Kidney Disease Monitoring

Kidney function testing for members with diabetes. Percent of plan members with diabetes who had a kidney function test during the year.

Data Source:
This information is from clinical quality data collected in 2017 from Medicare health plans. The results have been independently validated.

This measure has a weight of 1.0 when combined with other measures to calculate the summary ratings.



Diabetes Care — Blood Sugar Controlled

Plan members with diabetes whose blood sugar is under control. Percent of plan members with diabetes who had an A-1-C lab test during the year that showed their average blood sugar is under control.

Data Source:
This information is from clinical quality data collected in 2017 from Medicare health plans. The results have been independently validated.

This measure has a weight of 3.0 when combined with other measures to calculate the summary ratings.



Controlling Blood Pressure

Percent of plan members with high blood pressure who got treatment and were able to maintain a healthy pressure.

Data Source:
This information is from clinical quality data collected in 2017 from Medicare health plans. The results have been independently validated.

This measure has a weight of 3.0 when combined with other measures to calculate the summary ratings.



Rheumatoid Arthritis Management

Percent of plan members with Rheumatoid Arthritis who got one or more prescription(s) for an anti-rheumatic drug.

Data Source:
This information is from clinical quality data collected in 2017 from Medicare health plans. The results have been independently validated.

This measure has a weight of 1.0 when combined with other measures to calculate the summary ratings.



Reducing the Risk of Falling

Percent of plan members with a problem falling, walking or balancing who discussed it with their doctor and got treatment for it during the year.

Data Source:
This information is from the Health Outcomes Survey conducted with Medicare Health Plan enrollees between 04/01/2017 – 07/31/2017.

This measure has a weight of 1.0 when combined with other measures to calculate the summary ratings.



Improving Bladder Control

Percent of plan members with improvements in bladder control.

Data Source:
This information is from the Health Outcomes Survey conducted with Medicare Health Plan enrollees between 04/01/2017 – 07/31/2017.

This measure has a weight of 1.0 when combined with other measures to calculate the summary ratings.


Medication Reconciliation Post-Discharge

Data Source:
This information is from clinical quality data collected in 2017 from Medicare health plans. The results have been independently validated.

This measure has a weight of 1.0 when combined with other measures to calculate the summary ratings.


Plan All-Cause Readmissions

Readmission to a hospital within 30 days of being discharged (more stars are better because it means fewer members are being readmitted). Percent of senior plan members discharged from a hospital stay who were readmitted to a hospital within 30 days, either for the same condition as their recent hospital stay or for a different reason. (Patients may have been readmitted back to the same hospital or to a different one. Rates of readmission take into account how sick patients were when they went into the hospital the first time. This "risk-adjustment" helps make the comparisons between plans fair and meaningful.)

Data Source:
This information is from clinical quality data collected in 2017 from Medicare health plans. The results have been independently validated.

This measure has a weight of 3.0 when combined with other measures to calculate the summary ratings.



Statin Therapy for Patients with Cardiovascular Disease

The Plan Makes Sure Members with Heart Disease Get the Most Effective Drugs to Treat High Cholesterol This rating is based on the percent of plan members with heart disease who get the right type of cholesterol-lowering drugs. Health plans can help make sure their members are prescribed medications that are more effective for them.

Data Source:
This information is from clinical quality data collected in 2017 from Medicare health plans. The results have been independently validated.


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  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
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  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
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