Finally, CMS (Centers for Medicare and Medicaid Services) moves to require Insurers (Carriers) to display a ‘STAR RATING’ for any of their products offered on Health insurance exchanges (Federal, State or private).
The CMS STAR RATINGS will be in effect for the OPEN ENROLLMENT (NOVEMBER 1st -DECEMBER 15th) for your health insurance coverage in 2020.
This requirement is intended to help consumers to make informed healthcare decisions for themselves and their dependents.
When announcing this initiative Senior CMS Administrator, Seema Verma made the point that “for the first time, consumers will have access to meaningful, simple to use information with which to compare the quality and price of plans on exchange websites”.
Ms. Verma went on to say “increasing transparency and competition drive better quality and cost, with the consumer benefitting most”.
Although MEDICARE ADVANTAGE PLANS have been required to use and display a 5 QUALITY RATING for some years OPEN ENROLLMENT (2020) is your first opportunity to compare all MEDICARE and MEDICAID plans (there are some exceptions) on a LIKE FOR LIKE BASIS.
How will it work?
Like most five-star Quality Rating Systems the overall CMS star rating (5 stars is best) reflects the performance in key areas.
In this case
- Medical care
- Member experience
- Plan Administration
We all make judgments and decisions based on our past experience, friends and colleague’s advice, expert opinions. Taking the family out for a meal for example – not so important as a health plan but the thought process is the same
- How good is the cooking?
- Has anyone I know been there?
- How good is the service?
Is it value for money?
The CMS Quality Rating System will provide consumers with easily understood information to compare quality, price, and performance of health care plans available on exchange websites including Healthcare.com
- The medical care assessment is based on how well the health care providers within the plan’s network manage member’s healthcare. This includes providing regular screenings, vaccines, and other basic health services
- The Member Experience star rating is based on the results of member satisfaction surveys focusing on their healthcare providers, doctors and the ease of access, e.g. appointments and services.
- This is a measure of how effectively a plan is run. The rating takes account of
- Customer Service
- Availability of necessary information appropriately presented
- Network providers facilitating appropriate tests and treatment in a timely fashion
The QRS (Quality Rating System) is a determined step in the direction of providing enrollees with an independent tool for assessing the appropriateness and quality of the health plans on offer through the Health Insurance exchanges.
The CMS star rating system may seem simplistic, but it is based on over 35 measurements of Medical Care, User satisfaction and administrative excellence.
HAS THE QRS BEEN TESTED?
Short answer YES
CMS piloted the use of this approach in Virginia and Wisconsin during open enrollment in 2017 and 2018 and last year included Michigan, Montana and New Hampshire.
The QRS will be operational in all States for the 2020 open enrollment.
For the upcoming Open Enrollment CMS will be publishing star ratings and the data on which they are based in a Public Use File (PUF). BUT remember, these are based on the 2019 plan data. Not all plans now available were eligible for the QRS assessment last year. The absence of a rating is not necessarily an indicator of quality.
This is your opportunity to review your health insurance needs for 2020 against a set of independent criteria.
You may change your plan as a result of this program. You may stay with your existing insurer with more confidence!
In either case, QRS will be doing the job for which it was designed. To help you, the consumer to make the RIGHT CHOICE, the INFORMED choice for YOU.