HOS and the Medicare Star Ratings
Medicare Star Ratings Overview
CMS developed the Medicare Star Ratings in order to help consumers compare health plans and providers based on quality and performance, and to reward top-performing health plans. The Medicare Plan Finder (MPF) tool allows consumers to search for health plans in their geographic area and compare cost estimates and coverage information. CMS rates the relative quality of service and care provided by MAOs based upon a five-star rating scale that utilizes the contract level HOS measures combined with other measurement results. The Medicare Star Ratings help Medicare beneficiaries compare MA plans, help educate consumers on quality, and make quality data more transparent and comparable among plans. Up to 46 unique quality measures are included in the 2019 Medicare Part C and D Star Ratings, including success in providing preventive services, managing chronic illness, access to care, Healthcare Effectiveness Data and Information Set (HEDIS®) measures, the Consumer Assessment of Healthcare Providers and Systems (CAHPS©) survey, and responsiveness.
Five HOS measures (two functional health measures and three HEDIS Effectiveness of Care measures) are included in the annual Medicare Part C Star Ratings:
The functional health measures are derived from the Veterans RAND 12-Item Health Survey (VR-12) portion of the HOS, which serves as the core measure for the physical component summary (PCS) and mental component summary (MCS) scores. These measures are reported in each MAO’s annual HOS Performance Measurement Report that is posted on the Health Plan Management System (HPMS). These results are derived from a combination of case-mix adjusted PCS and MCS change scores and death status based on the baseline and two-year follow up surveys. The Medicare Part C Star Ratings measure for Improving or Maintaining Physical Health is the combined Physical Health Percent Better+Same result, and the Improving or Maintaining Mental Health measure is the combined Mental Health Percent Better+Same result.
The HEDIS Effectiveness of Care measures are also collected from the HOS in a series of questions that ask beneficiaries about information and care they receive from their health care providers. These measures are reported in each MAO’s annual HOS Baseline Report that is posted on the HPMS. The measures are obtained from the combined data for the baseline cohort and a follow up cohort from the same measurement year (i.e., a round of data). Questions are collected to derive the following four HEDIS measures: Management of Urinary Incontinence in Older Adults, Physical Activity in Older Adults, Fall Risk Management, and Osteoporosis Testing in Older Women. Three rates from these four measures are utilized by CMS for the Medicare Part C Star Ratings: Improving Bladder Control is the Treatment of Urinary Incontinence rate, Monitoring Physical Activity is the Advising Physical Activity rate, and Reducing the Risk of Falling is the Managing Fall Risk rate.
CMS continues to make enhancements to the HPMS HOS module to increase functionality and improve overall usability. When accessing the HOS module under “Quality and Performance,” HPMS users will note two choices under “Survey Responses” in the navigation menu. From the first choice, “Star Ratings Validation,” MAOs may select the Star Ratings Measures report to review their HOS Star Ratings results from the HOS Baseline and Performance Measurement reports and to review their MAO’s Star Ratings data during the plan preview periods. The results include the functional health measures and the HEDIS Effectiveness of Care measures for the selected cohorts of data (Cohort 13 and future cohorts). Users may also select the Improving or Maintaining Physical Health (PCS) report and the Improving or Maintaining Mental Health (MCS) report. The corresponding information for the two functional health measures is displayed for all completed cohorts beginning with Cohort 1. The second choice “Aggregate Score Analysis” provides a table review of percentages for four physical health and two mental health measures from the HOS Performance Measurement report. Note that due to changes in the survey questions between baseline and follow up, the old and new methods for calculating the Percent Reporting Depressive Symptoms do not allow for comparison between the baseline and follow up measures for Cohorts 14-15. Beginning with the Cohort 16 results, the calculations of the Percent Reporting Depressive Symptoms at baseline and follow up were based on the same questions and algorithms and are therefore comparable.
The 2019 Medicare Part C Star Ratings will be used by CMS as the basis for quality bonus payments in the MA program in the 2020 quality bonus payment year. For the 2020 quality bonus payments, two HOS data sets will be used to obtain the measures. The HOS 2015-2017 Cohort 18 Merged Baseline and Follow Up data set will be used for the two functional health measures, and the combined HOS 2017 Cohort 20 Baseline and 2017 Cohort 18 Follow Up data set will be used for the three 2017 HEDIS Effectiveness of Care measures (see green highlighted text in the Timeline Table below).
The 2020 Medicare Part C Star Ratings will be used by CMS as the basis for quality bonus payments in the MA program in the 2021 quality bonus payment year. For the 2021 quality bonus payments, two HOS data sets will be used to obtain the measures. The HOS 2016-2018 Cohort 19 Merged Baseline and Follow Up data set will be used for the two functional health measures, and the combined HOS 2018 Cohort 21 Baseline and 2018 Cohort 19 Follow Up data set will be used for the three 2018 HEDIS Effectiveness of Care measures (see yellow highlighted text in the Timeline Table below).
Information about best practices in promoting quality preventive health care for the elderly and developing intervention strategies to impact patient outcomes is available in the 2012 MAO resource guide and 2011 technical report on the functional status of older adults in the Trainings section.
For more information about the Medicare Star Ratings, go to the CMS Star Ratings website. For any questions related to Medicare Part C and D Star Ratings, you may send an email inquiry directly to PartCandDStarRatings@cms.hhs.gov.
The Medicare HOS Survey Administration and Star Ratings Timeline Table below contains information about the HOS cohorts related to data collection, report dissemination, and the HOS results included in the CMS Medicare Part C Star Ratings. The complete table of all HOS cohorts since 1998 is available in the Program page.
Four HEDIS Effectiveness of Care Measures collected by HOS are calculated from the combined round of baseline and follow up data by reporting year: Management of Urinary Incontinence in Older Adults; Physical Activity in Older Adults; Fall Risk Management; and Osteoporosis Testing in Older Women. Beginning with the 2012 Medicare Star Ratings, the Osteoporosis Testing in Older Women measure has been moved to the display measures on the CMS website and is not part of the Star Ratings.
This page was last modified on 02/15/2019