The Med Diva

An insider's guide to Medicare Part D and more

Archive for the category “Medicare Star Ratings”

A question for Medicare: Why must a major Part D program depend on little ol’ me to save it from termination?

Medicare Part D worldIn my last two posts, I talked about how difficult it can be to convince Medicare beneficiaries to take advantage of the Medicare Medication Therapy Management program. One of the problems is that the Centers for Medicare & Medicaid Services (CMS) puts the responsibility on Part D sponsors to get members to opt into the free program. That means prescription drug plan employee peons like me have to write letters or make phone calls to persuade (in other words, beg) eligible plan members to participate in the program.

This week I am faced with a similar situation that involves convincing people to follow their doctors’ orders.  I must write a compelling letter to entice members who are not taking their medications properly to speak with a pharmacist. These members may be skipping pills, forgetting to take their medication, delaying their refills, or doing something else that is causing a gap in therapy (also called nonadherence). If members ignore this letter and don’t take their medication as directed, their Part D plan could be terminated.

Honestly, it sort of feels like the world is on my shoulders.

It’s all in the Medicare stars

To make a long story short, it all has to do with the Medicare star ratings.

CMS uses a star rating system as a guide to help beneficiaries compare the quality of private health plans in the Medicare Part D and Medicare Advantage (Part C) programs. These ratings measure everything from customer service issues such as call wait times to clinical issues such as adherence rates for members taking diabetes and hypertension medications. Based on these measurements, a plan’s overall star rating can range from 1 (poor) to 5 (excellent) stars.

Starting in 2015, CMS can cancel the contracts of Part D and Part C sponsors that fail to receive at least a 3-star (average) rating for 3 years in a row. Potential termination is a great “incentive” for Part C and Part D plans to deliver better care and value. The problem is that not all ratings are created equal: In 2012, clinical measures, such as adherence rates, were weighted three times heavier than other measures.

Many Part D plans received low star ratings in 2012 – even the plan I work for, which got a 5-star rating in 2011, dropped to 4 stars in 2012.  Many of the lower ratings were not due to poor customer service or low member satisfaction, but due to poor medication adherence rates. In other words, because many people are not following doctors’ orders and taking their medication the right way, Part D plans are getting lower star ratings. If these low medication adherence rates do not improve over the next two years, these Part D plans could be shut down by CMS.

CMS: Why is the burden on Part D plan sponsors?

Once again, I ask CMS why all the responsibility is placed on the shoulders of the Part D plan.

Although some plans do have very effective medication management tools in place—such as pharmacist outreach calls—it can be difficult and expensive for plans to ensure their members are following doctor’s orders and taking their drugs as prescribed. Plus, how do strangers at a Part D plan convince people who are not following their doctors’ orders to listen to them? If a doctor can’t make their patients take their medications as prescribed, what chance do I have?

CMS, I really hope you can give me an answer. Because right now, if I can’t convince a few thousand people to get back on track with their medications within the next few months, a large Part D program with a major health plan may soon be getting the boot from you. How wrong is that?

Lower Medicare Star Ratings Can Be a Reflection of Poor Customer Service

I have just unofficially confirmed that when you enroll in a Medicare plan with less than four or five stars, you may also forgo receiving star treatment from the plan’s customer service department. That’s why I’m going to step away from my planned series on proposed changes to Medicare for 2013 and share this story that demonstrates the significance of the Medicare star rating system.

No straight answers after spending one-half hour on the phone

This afternoon I received an email from one of my readers regarding a confusing letter she had received from SilverScript Insurance, the company that sponsors the CVS Caremark prescription drug plans.  Having just spent a half hour on the phone with SilverScript customer service—and still not satisfied with the answers she received (or should I say didn’t receive)—“Joanne” contacted me to ask if I could help her.

 “I don’t know about you, but people need blood pressure pills trying to talk to these customer service people,” she told me. “The first person I talked to had no idea what I was talking about so she told me to call this other number. Then that person also gave me another number to call.  When I called that number I got a fax machine. I just want a straight answer!”

 According to Joanne, she received a letter from SilverScript advising her that as a SilverScript plan member, she was entitled to the CVS ExtraCare Health Card, which provides a 20 percent discount on health-related products at CVS stores. The problem, however, is that Joanne is not a member of a SilverScript prescription drug plan.

Joanne said she called the customer service number listed on the letter to find out why she had received the card and whether there is any charge to use the card for non-members. Joanne told me she was transferred from one representative to another, but no one was able to answer her questions or even find her name in the ExtraCare database. The representatives all seemed in a hurry to end the call, she said.  “Maybe tomorrow if I’m in a better mood I’ll try calling back again.”

My first thought was that perhaps Joanne had accidentally enrolled in a CVS Caremark plan during Open Enrollment. It was also possible that a former employer had enrolled her in a CVS Caremark plan as part of a group benefit program for its retirees. Although Joanne would have received correspondence from the former employer advising her of this enrollment, there is always that slim chance that she put the notices aside or even threw them away, thinking it was junk mail.

I wrote back to Joanne and asked her if any of the above scenarios were possible. I explained why it was important for her to confirm that she had not been enrolled in a CVS Caremark plan – and to also confirm that she was still a member of her Part D plan of choice. (Because you can never be enrolled in more than one Part D plan at a time, had she enrolled in a CVS plan, she would have been automatically disenrolled from her current plan.)

 Customer Service did not take “ExtraCare”

My questions prompted an “Aha!” moment for Joanne. Turns out she was automatically enrolled in a CVS Caremark plan two years ago when the company that sponsored her former plan went out of business. Apparently the marketing firm for the ExtraCare card still had her name and address on record even though she was no longer a plan member. So it appears to me that the three or four customer service reps Joanne spoke to at SilverScript failed to take “ExtraCare” to ask pertinent questions in order to resolve what turned out to be a fairly simple matter. 

 SilverScript’s Medicare Part D plans (CVS Caremark Value and CVS Caremark Plus) may have received an overall rating of 3 stars from Medicare this year, but today I give their customer service department only 2 stars (and that’s only because I was finally transferred to Hope, who was able to answer one of Joanne’s questions: No, there is no charge to use the ExtraCare Health Card for non-members, but non-members do not get the 20 percent discount, so there is no benefit to using the card.) Thank you, Hope, for giving us at least one straight answer.

 

28% of #Medicare #partD plans receive poor star ratings from CMS

You probably wouldn’t choose a 2-star restaurant or a resort hotel that has only earned 3 out of 5 stars. You shouldn’t choose a Medicare Part D or Medicare Advantage plan with low star ratings, either. And for pretty much the same reason: Low star ratings mean lower quality and poor customer service.

Each year, the Centers for Medicare & Medicaid Services (CMS) rates how well health plans and prescription drug plans perform in different categories, such as customer service, prescription drug safety, and member satisfaction. The Medicare star ratings are important because they help you compare the overall quality of plans. Star ratings range from 1 star (poor) to 5 stars (excellent), so look for a plan with high ratings (4 or 5) to ensure you get the level of service and safety you deserve.

Now here’s the catch (there’s always a catch with Medicare!). This year, 28 percent of rated prescription drug plans (PDPs) that will be available in 2012 scored poorly (fewer than 3 stars). No national PDPs received a perfect 5-star rating this year, and one only national PDP—Medco Medicare Prescription Plan—received 4 stars. Although a few smaller, regional plans did receive 5 stars, the chance that one of these plans is in your region and meets your needs is very slim. 

The good news for beneficiaries is that CMS is telling these poor-performing plans that unless they take steps to improve their performance over the next few years, they face losing their Medicare sponsor status.

One of the main reasons that many plans’ ratings fell from last year is a shift in the way CMS rates Medicare drug plans. This year, the criteria changed to focus more on clinical outcomes, such as whether patients with diabetes, hypertension and high cholesterol are taking their medications as directed by their doctors.  Although some plans do have very effective medication management tools in place—such as pharmacist outreach calls—it’s not an easy or inexpensive task for plans to ensure their members are following doctor’s orders and taking their drugs as prescribed.

Like last year, the ratings also consider member experience, such as how long a patient is kept on hold when calling the plan, the number of complaints lodged against plans, and the number of people who choose to leave plans.

How does your state rate?

On a national level, 24 percent of the 557 rated drug plans get the top ratings of four or five stars, and about half fall in the middle with three stars. Another 28 percent score below three stars. From Kaiser Health News, here is the percentage of rated Part D plans in each state that get fewer than 3 stars on a scale of 1-5.:

Alabama 50%
Alaska 40%
American Samoa 0%
Arizona 48%
Arkansas 47%
California 42%
Colorado 46%
Connecticut 43%
Delaware 42%
Florida 42%
Georgia 47%
Guam 0%
Hawaii 40%
Idaho 40%
Illinois 44%
Indiana 48%
Iowa 42%
Kansas 39%
Kentucky 48%
Louisiana 50%
Maine 46%
Maryland 42%
Massachusetts 43%
Michigan 44%
Minnesota 42%
Mississippi 47%
Missouri 50%
Montana 42%
Nebraska 42%
Nevada 48%
New Hampshire 46%
New Jersey 43%
New Mexico 43%
New York 31%
North Carolina 43%
North Dakota 42%
Northern Mariana Islands 0%
Ohio 48%
Oklahoma 43%
Oregon 40%
Pennsylvania 39%
Puerto Rico 81%
Rhode Island 43%
South Carolina 53%
South Dakota 42%
Tennessee 50%
Texas 42%
Utah 39%
Vermont 43%
Virgin Islands 0%
Virginia 50%
Washington 40%
Washington D.C. 42%
West Virginia 39%
Wisconsin 45%
Wyoming 42%

Countdown to Medicare Part D Open Enrollment: Day 14

Open Enrollment for 2012 begins on Saturday, October 15, and ends on Wednesday, December 7, 2011.

 Day 14: Why Medicare star ratings are important to you

Chances are, you’re not going to choose a 2-star hotel or a restaurant that has only earned 3 out of 5 stars. You shouldn’t choose a Medicare Part D or Medicare Advantage plan with low star ratings, either. And for pretty much the same reason: Low star ratings mean lower quality.

Each year, the Centers for Medicare & Medicaid Services (CMS) rates how well health plans and prescription drug plans perform in different categories, such as customer service, prescription drug safety, and member satisfaction. The Medicare star ratings are important because they help you compare the overall quality of plans. Star ratings range from 1 star (poor) to 5 stars (excellent), so look for a plan with high ratings (4 or 5) to ensure you get the level of service and safety you deserve.

A plan can get ratings between one to five stars

★ ★ ★ ★ ★  is excellent

★ ★ ★ ★  is very good

★ ★ ★  is good

★ ★  is fair

★  is poor

The ratings for prescription drug plans are based on information from various sources, including:  

  • Results from Medicare’s regular plan-monitoring activities
  • Reviews of billing and other information that plans must submit to Medicare
  • Member surveys conducted by Medicare

 Starting December 8, 2011, you can switch to a 5-star Medicare Advantage or Part D Plan at any time during the year.

Although very few plans have earned a 5-star rating from CMS, if you’re fortunate enough to find one that serves your area, you can enroll in a 5-star plan any one time during the year, starting as early as December 8, 2011.

Why is this special enrollment period important for you? Let’s say you join a new plan during the 2012 Open Enrollment period, only to find out in January or February that the plan has lousy customer service. In past years, you were stuck with this plan until the following year. But now you can disenroll from the plan you’re not satisfied with and join a plan that has earned 5 stars.

The Special Enrollment Period for joining a 5-star plan runs from December 8, 2011, through November 30, 2012.

 Use the following resources to get plan ratings:

  • The overall plan star ratings are available at the Medicare Plan Finder.  Plan ratings will be available starting October 12.
  • You can call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
  • You can call your plan’s customer service number and ask for the plan’s Medicare star rating.
  • You can download the Medicare fact sheet, which has additional information about star ratings.

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