ACHP Members Among Top Medicare Plans in the Country

Seven members of the Alliance of Community Health Plans (ACHP) received 5 stars, the highest quality score awarded to health plans participating in the Medicare program. Only nine plans in the country received this rating for their combined Medicare Advantage and Part D offerings. A total of 31 coverage options offered by ACHP members received 5, 4.5, and 4 stars in the combined 2012 Medicare Advantage and Medicare Part D Star Ratings released Wednesday by the Centers for Medicare and Medicaid Services (CMS).

“The investments that community-based health plans have long made in the delivery of care and development of close partnerships with patients and providers led to this outstanding performance,” said Patricia Smith, ACHP President and CEO. “And the quality incentive payments that Congress put in place for the Medicare Advantage program appear to be effective. Health plans are working hard to improve care and be rated among the best.” Eleven ACHP members increased their quality score from the 2011 Medicare star ratings.

Congress created quality incentive payments in Medicare Advantage to promote health plan efforts to achieve high clinical quality and consumer satisfaction, as well as improved patient outcomes. ACHP member organizations 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.    

Seattle-based ACHP member Group Health Cooperative received 5 stars in the 2012 ratings. ACHP Board Chair Scott Armstrong, who is also President and CEO of Group Health Cooperative, attributes the success to a team effort fostered by the health plan’s integrated structure. “As part of Group Health Cooperative’s focus on improving quality in Medicare Advantage, we put together a team of clinical and health plan leaders to ensure that the best patient care is achieved on all metrics. The team tracks Lean leadership dashboards and workplans for improvement. Even patients were engaged through a campaign in Vitality, our Medicare member publication.”

Security Health Plan of Wisconsin, another 5-star ACHP member plan, strives to deliver high-quality health care and continually improve upon the quality of services for its members. Security Health Plan, a physician-sponsored, non-profit HMO, understands the importance of keeping members informed so they can make educated health care decisions. Security Health Plan provides educational information and telephone coaching through its disease management programs and wellness initiatives. The health plan attributes its success to a continued focus on improving customer service practices and, as a result, has increased member satisfaction. One service that helps members be actively involved with their care is a shared decision making program offered by Security Health Plan. Nurses and social workers on staff at Security Health Plan talk with members who have difficult health care decisions to make for themselves —such as which type of medical care is right for them or even when to stop treatment and enter hospice care. By helping members use a shared decision-making tool, the care managers help members have a better understanding of their options and potential outcomes. Members are then able to communicate with their providers the choices with which they are most comfortable.

ACHP members also were recently named among the top-performing health plans by the National Committee for Quality Assurance (NCQA). In the 2011-2012 Health Plan Rankings announced on September 20, nine of the nation’s top 10 Medicare plans are offered by ACHP member plans. Six of the top 10 commercial plans (private) and seven of the top 10 Medicaid plans are offered by ACHP members. ACHP counts 22 community-based health plans and provider organizations as members, providing health care coverage to approximately 16 million people.

CMS’ star rating system considers 50 quality measures, such as lowering hospital readmissions, ensuring members receive recommended cancer screenings, and providing an optimal member experience with the health plan. The measures cover clinical quality, patient satisfaction and compliance with regulatory requirements. CMS uses the 5-star rating system to monitor health plans to ensure that they meet Medicare’s quality standards. The ratings provide Medicare beneficiaries with a tool to compare the quality of care and customer service that Medicare health and drug plans offer, helping consumers make better health care choices. CMS has established a Special Enrollment Period in which Medicare beneficiaries can enroll in a 5-star Medicare Advantage plan at any point during the year, whereas other plans are limited to enrolling members October 15 through December 7, 2011.

The ratings are posted on CMS’ Website, Medicare.gov. Plan performance summary star ratings are assessed each year and may change from one year to the next.

ACHP Members Receive Top Ratings for 2012

5-Star Plans

Group Health Cooperative (HMO)

Kaiser Permanente Senior Advantage of Colorado (HMO)

Kaiser Permanente Senior Advantage of the Northwest (HMO)

Kaiser Permanente Senior Advantage of California (HMO)

Kaiser Permanente Senior Advantage of Hawaii (HMO)

Martin’s Point Generations Advantage (HMO)

Advocare - Security Health Plan of Wisconsin (HMO)

 4.5-Star Plans

CDPHP Medicare Choices (HMO)

CDPHP Medicare Choices (PPO)

Fallon Community Health Plan (HMO)

Geisinger Gold (HMO) - Geisinger Health Plan

HealthPartners (HMO Cost)

Independent Health (HMO)

Independent Health (PPO)

Kaiser Permanente Medicare Plus of Ohio (HMO Cost)

Kaiser Permanente Medicare Plus of the Mid-Atlantic States (HMO Cost)

Kaiser Permanente Senior Advantage of Georgia (HMO)

Priority Health Medicare (HMO)

Rocky Mountain Health Plans (HMO Cost)

Scott & White Health Plan SeniorCare (HMO Cost)

Tufts Health Plan Medicare Preferred (HMO)

UCare (HMO Contract H2459)

UCare (HMO Contract H4270)

4-Star Plans

Capital Health Plan (HMO)

Geisinger Gold - Geisinger Health Plan (PPO)

HealthPartners (HMO)

Presbyterian Health Plan Senior Care (PPO)

Priority Health Medicare (PPO)

UCare (HMO Contract H2456)

UPMC Health Plan (HMO)

UPMC Health Plan (PPO)