Medicare Advantage Stars
The Centers for Medicare and Medicaid Services (CMS) rates Medicare Advantage plans and prescription drug plans separately on a scale of one to five stars, with five representing the highest quality. The Star Rating for Medicare Advantage plans is an overall measure of the plan's quality, and is a cumulative indicator of: quality of care, access to care, beneficiary satisfaction, customer service, and responsiveness to member needs. The intent of the program is to tie quality of care to financial reimbursements, whereby rewarding high performing plans and forcing low performing plans to exit the market.
Inter-Plan Medicare Advantage Care Management and Provider Engagement Program
Highmark is committed to working with you to improve and maintain our members' health and will participate in the Inter-Plan Medicare Advantage Care Management and Provider Engagement Program for out of area (OOA) Blue Cross Blue Shield plan members hosted by Highmark. The program aims to improve care management and data sharing strategies for the OOA Medicare Advantage (MA) Member population. Inter-plan data sharing will include Care Gap Closure for defined CMS quality metrics, Risk Adjustment programs, and the Retrospective Chart Retrieval Program.
Last updated on 5/11/2022 4:42:27 PM