CY2009 Medicare Plan Ratings: November 2008 Release for Open Enrollment Alice Lee-Martin, PharmD Liz...
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Transcript of CY2009 Medicare Plan Ratings: November 2008 Release for Open Enrollment Alice Lee-Martin, PharmD Liz...
CY2009 Medicare Plan Ratings: November 2008 Release for Open Enrollment
Alice Lee-Martin, PharmDLiz Goldstein, Ph.D.
Center for Drug and Health Plan Choice
2
Agenda
Changes to the Plan Ratings
Plan Rating levels
Assignment of Star Ratings
Part D Categories and Topics
Part C Categories and Topics
3
www.medicare.gov
www.medicare.gov
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www.medicare.gov
www.medicare.gov
5
www.medicare.gov
www.medicare.gov
Drug Plan AH1234
Drug Plan BH0123
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www.medicare.gov
www.medicare.gov
Drug Plan AH1234
Drug Plan BH0123
Drug Plan CH0000
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Changes for CY2009 Medicare Plan Ratings
Overall summary ratings for Part C and Part D Reorganized 4 Part D categories 4 Part D topics added, and 2 Part D topics deleted Changes to Part D star assignments at the
category and topic level 6 Part C topics addedChanges to calculation of CAHPS measures for
both Part C and DImproved labels, language, and website
functionality
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Four levels of Plan Ratings
1. Overall Summary Ratings for Part C and D: Summarizes all topics from the categories into a single rating.
2. Category level: Groups related topics into an area for a single rating.
3. Individual topic level: Single rating for a performance measure.
4. Data for each measure: Detailed data used to rate the contract’s performance.
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Part C and D Overall SummaryRatings
Separate overall composite scores calculated for Part C and Part D
Summarizes a contract’s performance across categories and underlying individual topics
Rating based on adjusted averages of the individual topics
Consistency in good performance will receive higher ratings
Ratings will include half-stars to provide more differentiation between contracts
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Part D Plan Ratings – Category and Topic ratings
Category-level stars are based on adjusted averages of individual topic level
Topic-level stars are based on a hybrid methodology – Combine adjusted percentile distribution and
two-stage clustering processes. – More meaningful cut-points between stars to
show differences between plans’ performances – When applicable, adjustments made so the
CMS standard falls within the three star rating level.
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Plan Ratings for Part D
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New CY2009 Part D Categories
CY2008 – 3 categories
Drug Plan Consumer Service
Using Your Plan to get Your Prescriptions Filled
Drug Pricing Information
CY2009 – 4 categories Drug Plan Customer
Service Member complaints
and staying with drug plan
Member experience with drug plan
Drug pricing and patient safety
13
CY2009 Part D Categories
Provide more meaningful information to beneficiaries
Are based on factor analysis that identify the most statistically appropriate grouping of measures
Stratifies individual measures into larger domains that show the overall performance of a plan within specific areas
14
Part D – Drug Plan Customer Service Measures
Time on Hold when Customer Calls Drug Plan Calls Disconnected When Customer Calls Drug
Plan Time on Hold When Pharmacist Calls Drug Plan Calls Disconnected When Pharmacist Calls
Drug Plan Drug Plan’s timeliness in giving a decision for
members who make an appeal Fairness of Drug Plan’s denials to a member’s
appeal, based on an Independent Reviewer
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Part D- Member complaints and staying with drug plan
Complaints about the Drug Plan's Benefits and Access to Prescription Drugs (per 1,000 members)
Complaints about Joining and Leaving the Drug Plan (per 1,000 members)
Complaints about the Drug Plan's Pricing and Out-of-pocket Costs (per 1,000 members)
All Other Complaints about the Drug Plan (per 1,000 members)
Members who stay with their current Drug Plan from one year to the next
16
Part D- Member satisfaction with drug plan
All measures are derived from the Part D CAHPS survey
Drug Plan Provides Information or Help When Members Need It
Members’ Overall Rating of Drug Plan Members’ Ability to Get Prescriptions Filled
Easily When Using the Drug Plan
17
Part D - Drug pricing information and patient safety
Completeness of the Drug Plan’s Information on Members Who Need Extra Help
Drug Plan Provides Current Information on Costs and Coverage for Medicare’s Website
Drug Plan’s prices that did not increase more than expected during the year
Drug Plan’s Prices on Medicare’s Website Are Similar to the Prices Members Pay at the Pharmacy
Drug Plan’s Members 65 and Older Who Received Prescriptions for Certain Drugs with a High Risk of Side Effects, when There May Be Safer Drug Choices
18
CY2009 Medicare Part D Plan Ratings Topics
Retired measures: Total complaints about the Drug Plan (revised
to new “all other” complaint rate)
Pharmacists Have Up-to-date Plan Enrollment Information (4Rx measure)
17 measures => 19 measuresCY2008 CY2009
19
CY2009 Medicare Part D Plan Ratings Measures (continued)
New: All Other Complaints about the Drug Plan (per 1,000
members) Members Who Stay with Their Current Drug Plan
from One Year to the Next Drug plan’s prices on the Medicare’s website are
similar to prices members pay at the pharmacy Drug Plan’s Members > 65 years old who received
prescriptions for certain drugs with a high risk of side effects
20
New Part D Measure: Member retention
“Members who stay with their current Drug Plan from one year to the next”
The percent of non-LIS members who are enrolled as of December 2007 and who remain enrolled in January 2008 with the same parent organization
21
New Part D Measure: MPDPF prices vs. PDE
“Drug plan’s prices on the Medicare’s website are similar to prices members pay at the pharmacy”
MPDPF and PDE data for drugs in the 6 classes of clinical concern evaluated to identify variation between MPDPF-PDE prices
22
New Part D Measure: >65 years old receiving high risk drugs
“Drug Plan’s Members 65 and older who received prescriptions for certain drugs with a high risk of side effects, when safer drug choices may be possible”
The percent of enrollees 65 years of age and older who received at least one prescription for a high-risk medication, using 2007 PDE data and drugs identified to have serious side effects in patients 65 and older
23
New (revised) Part D Measure:All other complaints
“All Other Complaints about the Drug Plan (per 1,000 members)”
Replaces previous “Total Complaints” as all complaint measures are grouped in one domain for CY2009
Using CTM data, the rate of complaints not related to the other complaint measures (Benefits and Access, Joining and Leaving the Drug Plan, or Pricing and Out-of-pocket Costs)
24
2009 Part D Summary Score Distributions
0
20
40
60
80
100
120
140
160
180
1 1.5 2 2.5 3 3.5 4 4.5 5# of Stars
# o
f C
on
trac
ts
PDP
MA-PD
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Part D – Drug Plan Customer Service
0
50
100
150
200
250
300
350
1 2 3 4 5# of stars
# o
f co
ntr
acts
PDP
MA-PD
26
Part D - Member complaints and staying with drug plan
0
20
40
60
80
100
120
140
1 2 3 4 5# of stars
# o
f c
on
tra
cts
PDP
MA-PD
27
Part D- Member satisfaction with drug plan
0
20
40
60
80
100
120
140
1 2 3 4 5# of stars
# o
f c
on
tra
cts
PDP
MA-PD
28
Part D - Drug pricing information and patient safety
0
50
100
150
200
250
300
1 2 3 4 5# of stars
# o
f c
on
tra
cts
PDP
MA-PD
29
Plan Ratings for Part C
30
CY 2009 Part C Categories
The categories remain the same as CY 2008; however, titles have been revised as a result of consumer feedback– Staying Healthy: Screenings, Tests and
Vaccines– Getting Timely Care from Doctors and
Specialists– Ratings of Health Plan Responsiveness and
Care– Managing Chronic (Long-Lasting) Conditions– How Well and Quickly Health Plans Handled
Appeals
31
Part C – Staying Healthy: Screenings, Tests and Vaccines
Existing Measures– Breast Cancer Screening– Colorectal Cancer Screening– Cardiovascular Care – Cholesterol Screening– Diabetes Care – Cholesterol Screening– Glaucoma Testing– Appropriate Monitoring of Patients Taking
Long-term Medications– Annual Flu Vaccine– Pneumonia Vaccine
32
Part C – Staying Healthy: Screenings, Tests and Vaccines
New Measures– Two year change scores for member’s physical
and mental health status– Osteoporosis Testing in Older Women– Physical Activity in Older Adults
33
Part C - Getting Timely Care from Doctors and Specialists
Existing Measures– Access to Primary Care Doctor Visits– Getting Needed Care without Delays– Doctor Follow up for Depression– Follow-up Visit after Hospital Stay for Mental
Illness (within 30 days of discharge)
34
Part C – Ratings of Health Plan Responsiveness and Care
Existing Measures– Doctors who Communicate Well– Getting Appointments and Care Quickly– Customer Service– Overall Rating of Health Care Quality– Overall Rating of Health Plan– Call Answer Timeliness
35
Part C - Managing Chronic (Long-Lasting) Conditions
Existing Measures– Osteoporosis Management– Diabetes Care – Eye Exam– Diabetes Care – Kidney Disease Monitoring– Diabetes Care – Blood Sugar Controlled– Diabetes Care –Cholesterol Controlled – Antidepressant Medication management (6
months)– Controlling Blood Pressure– Rheumatoid Arthritis Management– Testing to Confirm Chronic Obstructive
Pulmonary Disease– Continuous Beta-Blocker Treatment
36
New Measures– Fall Risk Management– Management of Urinary Incontinence in Older
Adults
Part C - Managing Chronic (Long-Lasting) Conditions
37
Part C – How Well and Quickly Health Plans Handled Appeals
Existing Measures– Plan Makes Timely Decisions about Appeals– Reviewing Appeals Decisions
38
Special Needs Plans
Since early 2007, the Geriatric Measurement Panel (GMAP) of the National Committee for Quality Assurance (NCQA) has been funded by CMS to develop quality measures for evaluating SNPs.
As a first phase of this work, thirteen existing HEDIS measures were chosen to measure the quality of care of SNPs and a set of three Structure and Process measures.
Data from four of the thirteen HEDIS measures are available on www.cms.hhs.gov/SpecialNeedsPlans/ beginning mid November.
First year of data collection for SNPs. Many plans too new or too small to collect HEDIS data. This is the first phase of a more comprehensive
strategy to collect quality data regarding SNPs.
39
CY 2009 CAHPS Data Part C and D
Individual measures and stars are based off of the mean of the distribution rather than top box responses
The mean are converted to the percentage of the best possible score each contract earned
The star ratings are determined by percentile rankings with statistical testing
40
2009 Part C Summary Score Distributions
0
10
20
30
40
50
60
70
80
1 1.5 2 2.5 3 3.5 4 4.5 5# of stars
# o
f c
on
tra
cts
41
Part C – Staying Healthy: Screenings, Tests and Vaccines
0
20
40
60
80
100
120
140
160
180
1 2 3 4 5# of stars
# o
f c
on
tra
cts
42
Part C - Getting Timely Care from Doctors and Specialists
0
20
40
60
80
100
120
140
160
180
200
1 2 3 4 5# of stars
# o
f c
on
tra
cts
43
Part C – Ratings of Health Plan Responsiveness and Care
0
20
40
60
80
100
120
140
160
180
1 2 3 4 5# of stars
# o
f co
ntr
acts
44
Part C – Managing Chronic (Long-Lasting) Conditions
0
20
40
60
80
100
120
140
160
180
1 2 3 4 5# of stars
# o
f c
on
tra
cts
45
Part C – How Well and Quickly Health Plans Handled Appeals
0
10
20
30
40
50
60
70
80
1 2 3 4 5# of stars
# o
f co
ntr
acts
46
Other Improvements for CY2009
Category and topic labels revised from continued consumer testing
New website functionalityPrint on demand of plan ratings available by state or
contractLinks to other information resources, e.g. Medicare
appeals
47
Alice Lee-Martin410-786-1103
Liz Goldstein410-786-6665
Contact Information