Stars and HEDIS Overview
(Healthcare Effectiveness Data and Information Set)

What are Medicare Star Ratings?
The Centers for Medicare & Medicaid (CMS) use a 5-Star quality rating system to measure how well providers and Medicare Advantage (MA) health plans are delivering care to members. Successful collaboration with our providers and quality patient care for our members is very important to us. Ratings range from five as the highest and one being the lowest.

The Star measures are made up of performance measures from HEDIS, CAHPS, HOS (measures comparison of members health plan assessment over 2 years), Prescription Drug Program and CMS administrative data.

You can see more details on MediGold's Plan Rating at this link: MediGold.com/Why-MediGold/Star-Ratings   

HEDIS
HEDIS consists of standardized performance measures. The purpose is to provide members with a means to assess the value they receive for their health care dollar and to hold health plans accountable for their performance. As a network provider, at times you may be required to assist in providing medical record data to allow measurement of our performance. You can read more about the collection of these medical records in our
HEDIS Medical Record section.

 

 

Updated 03/2018