Quality & 5 Star Programs

Quality & 5 Star Programs

Five Star Quality


Background/History

In early 2008, the Centers for Medicare & Medicaid Services (CMS) contracted with the National Committee for Quality Assurance (NCQA) to develop a strategy to evaluate the quality of care provided by SNPs. This strategy relies on a phased approach, beginning with defining and assessing desirable structural characteristics and followed by assessing processes and, eventually, outcomes. The evaluation approach includes several types of assessment.

  • HEDIS® measures
  • CAHPS measures
  • HOS measures
  • CMS specific measures
  • Measures that evaluate structure and process requirements through submission of documentation

Objectives of CMS’s SNP Assessment Program

  • Evaluate the quality of care SNPs provide
  • Evaluate how SNPs address the special needs of their beneficiaries
  • Provide data to CMS to allow plan-plan and year-year comparisons

Focus of Quality Measures

  • Preventive care
  • Up-to-date treatments for acute episodes of illness
  • Chronic disease care
  • Appropriate medication treatment

Five Star Quality Measures for 2016

The documents below show the current quality measures for CMS Five Star Quality Program for Medicare Advantage Plans.

Independent Care Health Plan : Quality Results

See this link for quality results:
Prescription Drug Coverage - General Information (CMS)

Data Reporting

HEDIS 2017 data is reported in June 2017. Data reflects events that occurred January to December 2016 (per specs) HEDIS 2017 = 2016 data

Independent Care Health Plan’s Annual Diagnoses Collection and Confirmation Project

As part of Independent Care Health Plan ’s contract with The Centers for Medicare & Medicaid Services (CMS), it is required to compile and report diagnostic profiles annually. This information must be obtained via a medical record review of individual member diagnoses that were treated or impacted within a claim (calendar) year.

Independent Care Health Plan has partnered with Cognisight to perform the annual collection of data and confirmation project. Cognisight’s goal is to obtain a “complete diagnostic member profile”, while attempting to minimize disruptions to your office workflow and staff.

CMS will only accept submission of diagnoses when they are listed on an encounter note rather than on an active problem list, signed lab result or consult. This does not imply that a provider’s documentation for the purposes of patient care is not sufficient, only that CMS has specific requirements to recognize existing diagnoses for a patient.

This information is time sensitive and a response is needed as soon as possible.

If you have additional questions, please contact Paul Kesselring, Account Manager, at Cognisight at 877-271-1657 ext. 8087 or Provider Network Development at

More Information

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Modified: 6/30/2017
 

 
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