Medicare Advantage Stars
The Centers for Medicare and Medicaid Services (CMS) rates Medicare Advantage plans and prescription drug plans separately on a scale of one to five stars, with five representing the highest quality. The Star Rating for Medicare Advantage plans is an overall measure of the plan's quality, and is a cumulative indicator of: Quality of care, Access to care, Beneficiary satisfaction, Customer Service, and Responsiveness to member needs. The intent of the program is to tie quality of care to financial reimbursements, whereby rewarding high performing plans and forcing low performing plans to exit the market.
Medicare Advantage Member and Provider Programs
Highmark partners with our members and their physicians to help members maintain their best health possible. Highmark conducts various programs designed to encourage preventive care and management of chronic conditions. This section offers information on the Medicare Advantage primary care incentive program, other provider programs, member programs and general references and resources.
Inter-Plan Medicare Advantage Care Management and Provider Engagement Program
Highmark is committed to working with you to improve and maintain our members' health and will participate in the Inter-Plan Medicare Advantage Care Management and Provider Engagement Program for out of area (OOA) Blue Cross Blue Shield plan members hosted by Highmark. The program aims to improve care management and data sharing strategies for the OOA Medicare Advantage (MA) Member population. Inter-plan data sharing will include Care Gap Closure for defined CMS quality metrics, Risk Adjustment programs, and the Retrospective Chart Retrieval Program.
Provider Quality Scores
A key factor that our members consider when choosing physicians is how they perform according to nationally recognized quality ratings. We gather information on physician practice performance through many channels.
Unique to the Medicare Advantage network, The Medicare Advantage Incentive program shows how physician practices perform against national quality measures. We will publish the results of the 2015 Medicare Advantage incentive program at both the overall performance rating level and measure-specific level on our online provider directory.
Last updated on 3/15/2021