* * * * * equals excellent

* * * * equals very good

* * * equals good

* * equals fair

* equals poor

Many of the measures included in the CMS rating system are measures of preventive care and routine disease management. Some of these are listed below and are subject to change:

1.     Staying healthy - screening, tests and vaccines:

Colorectal cancer screening

Annual flu vaccine

Improving and maintaining physical and mental health

Monitoring physical activity

Adult body mass index assessment

2.     Managing chronic conditions:

SNP Care Management

Care for the older adult: medication review, functional status assessment and pain screening.

Managing osteoporosis in women who had a fracture

Obtaining diabetes care for eye exams, kidney disease monitoring, and blood sugar and cholesterol control

Controlling blood pressure

Managing rheumatoid arthritis

Improving bladder control

Reducing the risk of falling

Plan all-cause readmissions

Medication adherence and management (oral diabetics, hypertension and cholesterol medications)

With the growing focus on quality health care and plan member satisfaction, CMS assesses MA plan performance. The CMS assessment results in a star rating assigned to each plan. One of the assessment tools used is the Consumer Assessment of Healthcare Providers and Systems® (CAHPS) survey. Medicare beneficiaries who receive health care services through a MA-PD plan receive CAHPS surveys through the mail in late February.

The survey asks the Medicare beneficiary to assess his or her health and the care received from his or her primary care providers and specialists over the past six months. The survey includes questions regarding providers’ communication skills and the member’s perception about his or her access to needed health care services. Several questions directly correlate to a plan’s CMS star rating. The survey questions ask the member to report his or her opinion about access to care and the health plan’s customer service. It also asks the member to rate the communication received from his or her providers.

A second assessment tool used by CMS is the Health Outcomes Survey (HOS) to evaluate all managed care organizations with a MA contract. CMS randomly samples Medicare beneficiaries from each participating MA plan. Two years after the initial HOS survey, the same Medicare beneficiaries are surveyed again. The results are part of the effectiveness of care component of the HEDIS rates for the MA plan.

The rating system empowers consumers, families and caregivers with information to compare MA-PD plans. The measures of the rating system include preventive care and routine disease management. This information gives consumers, families and caregivers results to make an educated decision about their health care needs. The ratings are posted online and may be accessed at https://www.medicare.gov. Please note there are separate ratings for Part C (medical) and Part D (prescription drug) services.

IntegraNet encourages participating providers to help improve member satisfaction by:

Ensuring members receive appointments within acceptable time frames as outlined in the Access and Availability       Standards Table in this manual.

Educating members and talking to them during each visit about their preventive health care needs and disease       management goals.

Ensuring providers answer any questions members have regarding newly prescribed medications.

Ensuring members know to bring all medications and medical histories to their specialists and knows the purpose       of a specialist referral.

Allowing time during the appointment to validate members’ understanding of their health conditions and the       services required for maintaining a healthy lifestyle.

Referring members to the Member Services department and speaking to a case manager.