Medicare members’ experience affects CMS Star Ratings
Every year, a random sample of Medicare members are surveyed about their experience with their doctors, services, and health plan. It is an important component of ensuring that members are satisfied, not only with their health outcomes but also with their healthcare experience.
The Centers for Medicare & Medicaid Services (CMS) Health Outcomes Survey (HOS) allow patients to evaluate the aspects of care delivery that matter the most to them. Providers have a direct impact on HOS because members’ perceptions of their health outcomes are primarily driven by how well the providers communicate with members. These survey results impact CMS Star Ratings.
Wellcare developed a guide that offers tips and recommendations to help guide discussions with your patients about their health. Providers may access the Medicare Health Outcomes Survey Tip Guide, available online at www.wellcare.com > California > Providers > Medicare > Quality > HEDIS Measures & Billing Codes > under CAHPS/Additional Resources or click on https://bit.ly/WellcareHEDISMeasuresBillingCodes.
What is the Health Outcomes Survey?
- An annual survey administered from late July to November to a random sample of Medicare Advantage patients. The same patients are surveyed again two years later to assess changes in physical and mental health status.
- A measurement of patients’ perception of their physical and mental health and overall quality of life.
- Survey results impact CMS Star Ratings.
Each CMS Star Rating/HOS measure addresses a different aspect of patient care and patient-provider interaction. You can directly impact each of these five measures.
|
Measure |
Description |
|
Fall risk management (FRM) |
Assesses the percentage of patients with problems walking or balancing who discussed it with their doctor and received treatment during the past year. |
|
Physical activity in older adults (PAO) |
Assesses the percentage of patients who discussed exercise with their doctor and were advised to start, increase, or maintain their physical activity during the year. |
|
Improving or maintaining physical health (IMPH) |
Assesses the percentage of patients whose physical health was the same or better after two years.
|
|
Management of urinary incontinence in older adults (MUI) |
Assesses the percentage of patients with a urine leakage problem who discussed the problem with their doctor and received treatment within six months. *A lower rate indicates better performance.
|
|
Improving maintaining mental health (IMMH) |
Assesses the percentage of patients whose mental health was the same or better than expected after two years. |
Additional information
Relevant sections of the Wellcare Provider Manual have been revised to reflect the information contained in this update as applicable. The manual is available online at www.wellcare.com/California/Providers/Medicare.
If you have questions regarding the information contained in this update, contact 866‑999‑3945.
