Summary Rating of Health Plan Quality

Summary Rating of Health Plan Quality
This summary rating gives an overall score of the plan’s quality and performance on many different topics that fall into 5 categories:

Staying healthy: screenings, tests, and vaccines: Includes whether members got various screening tests, vaccines, and other check-ups that help them stay healthy.
Managing chronic (long-term) conditions: Includes how often members with different conditions got certain tests and treatments that help manage their condition.
Member experience with the health plan: Includes ratings of member satisfaction with the plan.
Member complaints and changes in the health plan’s performance: Includes how often Medicare found problems with the plan and how often members had problems with the plan. Includes how much the plan’s performance has improved (if at all) over time.
Health plan customer service: Includes how well the plan handles member appeals.

This information is gathered from several different sources. In some cases it is based on member surveys, information from clinicians, or information from plans. In other cases, it is based on results from Medicare’s regular monitoring activities.