March 2, 2023
Star ratings include specific clinical, member perception, and operational measures. There are approximately 40 measures in the star rating framework.
To best capture a range of quality metrics, star ratings are determined using different data sets including, but not limited to, the following:
- Health Effectiveness Data and Information Set (HEDIS®) collects primarily clinical outcomes and data. This HEDIS® data best reflects care delivered by the provider and staff.
- Prescription Drug Event data is collected by health plans and provides insight for prescription drug-related measures.
- The Consumer Assessment of Healthcare Providers and Systems (CAHPS) is an annual survey sent to a random sample of members every spring to measure their experience with care delivered and the health plan. This data focuses on the member’s accessibility to quality care.
- The Health Outcomes Survey (HOS) is sent every summer to a random sample of members to measure self-reported health status and the quality of their healthcare. A follow-up survey is sent to these same members two years later to measure changes in health perception.
- Operations data from health plans is used to assess the quality of customer service and other services health plans are providing to their members.
This article is second in a series about the Centers for Medicare & Medicaid Services star ratings program. Read more.
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more information, contact ProviderClinicalConsulting@Premera.com.