Six members of the Alliance of Community Health Plans (ACHP) earned 5 stars from the Centers for Medicare and Medicaid Services (CMS), the highest score awarded to health plans participating in the Medicare program. Only 14 plans (contracts) in the country received this rating. Overall, 27 Medicare plans (contracts) operated by ACHP members received 5, 4.5 and 4 stars in the star ratings released on Wednesday by CMS; plans offer combined Medicare Advantage (Part C) and prescription drug (Part D) coverage.
Additionally, two plans offered by ACHP members received 5 stars for their stand-alone Medicare plans (Part C). These high-rated plans from ACHP member organizations are available in 15 states and the District of Columbia.
“ACHP plans have a long history of high star ratings,” says ACHP President and CEO Ceci Connolly. “Our plans are committed to delivering affordable, high-quality coverage and care.”
“At HealthPartners, we are dedicated to supporting the best possible health for our members, and to being easy, simple and convenient for members to use,” says President and CEO Mary Brainerd. “We’re proud to have these efforts recognized by a 5-star rating. Most important, it’s an honor to see the meaningful difference we’re making in the lives of our members.”
The star rating system considers 44 quality measures, including those that gauge access to care, evaluate effective management of chronic conditions and assess how successfully plans are able to ensure their members adhere to prescribed medications.
The quality incentive payments are improving quality across the board, and scores have increased for all plans over the last several years. ACHP members promote evidence-based practice, engage patients in their care and align incentives with providers to ensure that Medicare patients get the right care when and where they need it.
Even so, HHS has failed to live up to its commitment to pay for quality. Due to a way the Quality Incentive Payment (QIP) program has been implemented, some 4- and 5- star plans are receiving the same QIP as 3-star plans in the same county. ACHP has made fixing this issue among its highest priorities and continues to advocate to HHS and Congress to fix what has become known as the “benchmark cap” issue.
“In those counties most affected by the benchmark cap, a 5-star plan can be paid the same as a 3-star plan ‘down the street’ – contrary to all notions of paying for value,” says Connolly. “A regulatory fix would protect the quality incentive payments the administration wants and protect thousands of seniors.”
Plan performance is assessed each year and may change from one year to the next.
ACHP plans receiving 5 stars for their combined Medicare Advantage and Part D plans:
CDPHP Medicare Choices (PPO)
Kaiser Permanente California
Kaiser Permanente Colorado
Kaiser Permanente Mid-Atlantic
Kaiser Permanente Northwest
ACHP plans receiving 5 stars for their stand-alone Medicare (Part C) plans:
Dean Health Plan
Kaiser Permanente Medicare Cost (H6052)