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Understanding the 2019 CMS Star Ratings - Staying Healthy: Screenings, Tests and Vaccines HD1
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.
Does the plan do a good job detecting and preventing illness? This category addresses how well each plan works to detect and prevent illness, and improve or maintain the physical and mental health of its members. For example, it may include whether plan members get regular screenings for certain types of cancer or conditions and whether plan members get certain vaccines.

This category is based on seven (7) sub-categories:



The staying healthy: screenings, tests and vaccines data comes from two sources: A survey of Medicare health plan enrollees (the Health Outcomes Survey) conducted in 2017. 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.




Breast Cancer Screening

Percent of female plan members aged 52-74 who had a mammogram during the past 2 years.

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.




Colorectal Cancer Screening

Percent of plan members aged 50-75 who had appropriate screening for colon cancer.

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.




Annual Flu Vaccine

Percent of plan members who got a vaccine (flu shot) prior to flu season.

Data Source:
This information is from a survey conducted with Medicare Health Plan enrollees between 03/2018 – 06/2018.

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




Improving or Maintaining Physical Health

Percent of all plan members whose physical health was the same or better than expected after two years.

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 3.0 when combined with other measures to calculate the summary ratings.




Improving or Maintaining Mental Health

Percent of all plan members whose mental health was the same or better than expected after two years.

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 3.0 when combined with other measures to calculate the summary ratings.




Monitoring Physical Activity

Percent of senior plan members who discussed exercise with their doctor and were advised to start, increase or maintain their physical activity 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.




Checking to See if Members Are at a Healthy Weight

Adult BMI assessment. Percent of plan members with an outpatient visit who had their "Body Mass Index" (BMI) calculated from their height and weight and recorded in their medical records.

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.


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