What is the Star Rating Program? Every year, the Centers for Medicare and Medicaid Services (CMS) evaluates the performance of plans offering Medicare Advantage coverage. CMS assigns plans a rating ranging from 1 and 5 stars, based on their performance on the measures included in the program. Some of these areas evaluated include: How our members evaluate the health plan’s medical and health care services How well preventive care and condition management is provided How well the plan helps members with their prescription drugs This evaluation is divided into health services and pharmacy services for our patients, resulting in an overall rating. This score may vary from year to year, and depends on member adherence to their medical care and treatment. How do I help improve the star rating? An important part of the Star Rating involves our member’s compliance with preventive screenings, the management of existing conditions, and the proper use of and adherence to medications. We encourage you to consult your primary care physician or trusted doctor to undergo your preventive screenings. Your doctor can assist you with options for managing your conditions. What are preventive measures? Preventives measures consist of a series of health test or screenings that everyone should undergo to stay healthy and prevent disease.These tests vary based on age, gender and existing health conditions. Completing preventive tests on time helps your health conditions under control and leads to a better quality of life. Preventive tests for women: Breast Cancer Screening Required exam: Mammography Who should have this test: Women between 40 and 74 years old Frequency: One every two years Osteoporosis Management in Women Had a Fracture Required exam: Bone Density Test Who should have this test: Women aged 67-85 who have sustained a fracture (the examination must be performed within the first six months following the date of the fracture) Frequency: Every two years Preventive measures: Colorectal Cancer Screening Required exam: May be one of the following: Fecal Occult Blood (must be carried out during the current year) Sigmoidoscopy (carried out during the current year or in the preceding four years) Colonoscopy (carried out during the current year or during the preceding nine years) Who should have this test: Anyone from 45 to 75 years old Flu Vaccine Description: Vaccine to prevent the spread of influenza Who should be vaccinated: Everyone over 50 years of age Frequency: Once a year Preventive tests for patients with diabetes: Glycemic Status Assessment for Patients with Diabetes (GSD) Test: Glycosylated hemoglobin test (HbA1c) Who should have this test: Any patient between the ages of 18 and 75 with a diagnosis of type I and type II diabetes Frequency: Every 3 to 6 months (the result must be within control limits, with a value of less than 9.0%) Eye Exam for Patients with Diabetes Required exam: Dilated eye or retinal exam for the detection of diabetic retinopathy Who should have this test: Any patient between 15 and 75 years of age with a diagnosis of type I or type II diabetes Frequency: Every year Kidney Health Evaluation for patients with Diabetes Required test: Estimated glomerular filtration rate (eGFR) test and quantitative urine microalbumin to creatinine ratio (uACR) test Test: Blood test and urine test Estimated glomerular filtration rate test (eGFR) – blood Albumin-creatinine test (uACR) – urine Who should have this test: Patients aged 18 to 85 with a diagnosis of type I and type II diabetes Frequency: Once a year Remember to talk to your doctor about the following topics: Bladder Control Problems (urinary incontinence) Preventing Falls Recommendations for Physical Activity Nutrition General Care for Your Physical and Mental Health Advance Directives Annual physical exam Vaccinations Laboratory tests Medication reconciliation after hospital discharge Emergency room visits
