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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

November 2017

2018 Star Ratings Measure Quality and Patient Satisfaction


The Centers for Medicare and Medicaid Services (CMS) has recently released its 2018 Star Ratings measures, which gauge the quality of care delivered to members of Medicare Advantage plans and assess patient satisfaction. The Star Ratings program evaluates health plans’ performance on weighted measures related to clinical outcomes, patient experience, access to care, and general process.

Our providers’ commitment to care coordination and follow-up, patient outreach, and getting patients in for regular visits is vital to Harvard Pilgrim’s performance, as well as to patients’ perception of the quality of care they receive from their health plan and their health care providers.

Measures for 2018 Star Ratings are determined based on numerous HEDIS measures, Medicare Advantage and Prescription Drug Plan Consumer Assessment of Healthcare Providers and Systems (MA and PDP CAHPS) responses, the Medicare Health Outcomes Survey (HOS), and more. Topics include:

  • Medication adherence
  • Care and outreach regarding issues common in the Medicare Advantage population (e.g., diabetes, hypertension, cholesterol, medication therapy management, balance and falling, physical activity, and bladder control)
  • Members’ perception of their ability to get appointments in a timely manner
  • How well members believe their care is coordinated
  • How members rate their health plan and the quality of their prescription drug plan
  • Members’ perception of their physical and mental health and whether they have improved, declined, or stayed the same over the past year

Harvard Pilgrim recently completed a proxy survey that asked our Medicare Advantage members the same sorts of questions that are found in the surveys noted above. The proxy survey will help Harvard Pilgrim understand where patient experience is better, where it is not as strong, and what needs to be improved.

Harvard Pilgrim’s Network Medical Management team looks forward to sharing reports with feedback from the proxy survey with our large provider groups in 2018. We value our relationships with our trusted providers; together as partners, we can collaborate to deliver the best possible care to our members.

For any questions you may have about the program and what Harvard Pilgrim is doing to improve our performance, please contact Noreen Hurley by phone at 617-509-2111 or via email at noreen_hurley@harvardpilgrim.org.

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2018 Star Ratings Measure Quality and Patient Satisfaction

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PCPs and Behavioral Health Care Providers — Working Together

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PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Senior Vice President, Network Strategy

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator