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

4

www.medicare.gov

www.medicare.gov

5

www.medicare.gov

www.medicare.gov

Drug Plan AH1234

Drug Plan BH0123

6

www.medicare.gov

www.medicare.gov

Drug Plan AH1234

Drug Plan BH0123

Drug Plan CH0000

7

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

8

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.

9

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

10

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.

11

Plan Ratings for Part D

12

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

15

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

25

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

Questions?PartDMetrics@cms.hhs.gov

Alice Lee-Martin410-786-1103

Alice.leemartin@cms.hhs.gov

Liz Goldstein410-786-6665

Elizabeth.goldstein@cms.hhs.gov

Contact Information