Providence Health Plans reaches for stars with CMS

Providence Health & Services strives to provide individuals with the highest quality care while emphasizing compassion for the most vulnerable among those we serve.

Toward that end, Providence Health Plans – part of Providence's integrated health care system – is committed to working closely with our providers to maintain or improve on our four-star rating, according to the star rating system issued by the Centers for Medicare and Medicaid Services (CMS) for 2012.

You can help by working with Providence to improve the 36 measures associated with Medicare Part C. General areas of focus include quality of care; access to care; plan responsiveness; and beneficiary satisfaction with the plan.

In particular, you can positively affect our rating when following the CMS-issued guidelines during annual wellness exams with Medicare members.

Providence Health Plans is rated on a total of 53 performance measures across Medicare parts C and D. Plan star ratings are culled from several sources that measure various aspects of care, including CMS administrative data on plan quality and member satisfaction (secret shoppers and member complaints); the Consumer Assessment of Healthcare Providers and Systems (CAHPS); the Healthcare Effectiveness Data and Information Set (HEDIS); and the Health Outcomes Survey (HOS), conducted for Providence by an outside vendor with our Medicare members.

Unlike previous years, CMS is actively engaging health plans to use these measurements as a guide to quality of care. Individual plan star ratings are now highly publicized in CMS' bid to encourage health plans to become more accountable. Each Medicare Advantage Plan receives an annual star rating from CMS, which uses this system to rank the performance of Medicare Advantage Plans nationwide.