A: The Centers for Medicare & Medicaid Services (CMS) developed its Star Quality Rating System to give people with Medicare an objective measure of a plan’s performance and quality. CMS evaluates plans every year and scores them on a scale of 1 to 5 Stars, with 5 Stars indicating the highest performance. The Star Rating System measures beneficiaries’ experience with health plans, providers, and the health care system.
A: Star ratings are released annually in October.
A: The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey is sent to a random sample of at least 800 beneficiaries enrolled for at least six months per contract. The survey rates the patient experience by focusing questions on quality of care.
A: CAHPS survey results are publicly reported. CMS has decided to increase the weighting of the CAHPS Star rating measures so that the survey will represent about 25 percent of a plan’s overall 2026 Star rating.
A: The first CAHPS survey is sent in mid-March. A second CAHPS survey is sent to non-respondents in mid-April. Telephone outreach to non-respondents occurs in April through May. The survey ends on or near June 1 of every year.
A: Survey results are part of the CMS Stars Rating System that affect payment to Medicare Advantage health plans. Ultimately, the results can encourage improvements in the quality of care patients receive.
A: You and your office staff can affect 62 percent of CAHPS survey questions that affect Star Quality Rating measures. These measures are Care Coordination, Getting Needed Care, Getting Appointments and Care Quickly, and Annual Vaccinations.
A: The Health Outcomes Survey (HOS) is sent by CMS to a random sampling of customers with Cigna Healthcare Medicare Advantage plans. It is related to patient-provider relationships and asks questions related to physical and mental health, incontinence, physical activity, fall risk and prevention, and other topics
A: HOS data helps CMS monitor health plan performance based on patient health outcomes. It also affects Star Quality Ratings that help Medicare beneficiaries choose a health plan.
A: A baseline HOS is sent in July by a company called Press Ganey. Respondents who are still in the Medicare Advantage Organization (MAO) two years later get a follow-up HOS.
A: The results report on MAOs with 500 or more enrollees as of January 1 of the prior year. Ultimately, HOS results affect providers and patients in the MAO network.
A: You can positively affect HOS results by starting important conversations during office visits. Ask questions, create recall, and encourage actions that align with key HOS measures. You can also encourage office staff to help patients fill out the HOS.
A: The Healthcare Effectiveness Data and Information Set (HEDIS® ) is a group of performance metrics that rate provider compliance related to preventive screenings and clinical activities. Based on claims, medical records, and laboratory data, HEDIS results are calculated by health plans and reported to the National Committee for Quality Assurance (NCQA).
A: Data is collected for HEDIS, Pharmacy Part D (PDE), and administrative measures during a given calendar year for care received and experiences surrounding that care. HOS is designed to measure health outcomes during the same calendar year, while CAHPS is administered later to gauge past experiences that fall in the same measurement year as other domains. The image below displays the data collection period for each Star rating domain for a given measurement year.