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Health Care Performance Measures

Center for Medicare & Medicaid Services (CMS) Five-Star Quality Rating System

The Center for Medicare & Medicaid Services (CMS) developed the Five-Star Quality Rating System to evaluate the quality and performance of Medicare Advantage (MA) plans and Prescription Drug Plans (PDPs). The Star Ratings measures change annually and include measures from Healthcare Effectiveness Data and Information Set (HEDIS®), Consumer Assessment of Healthcare Providers and Systems (CAHPS®), and Health Outcomes Survey (HOS). As health plans and providers collaborate to give our members the best quality care, we can all look to the plan’s Star Ratings to see how well we are achieving this goal. The annually-updated Quality Measures Tip Sheet can guide all of our efforts to improve.

Consumer Assessment of Healthcare Providers (CAHPS®)

CAHPS® is a member satisfaction survey in which the objective is to capture information about consumer-reported experiences with healthcare. The focus of the survey is to measure how well plans are meeting member expectations, determine which areas of service have the greatest effect on overall member satisfaction, and identify areas of opportunity for improvement. Topics included in the survey are Getting Needed Care, Getting Care Quickly, How Well Doctors Communicate, Customer Service, Coordination of Care, Getting Needed Prescription Drugs, and the Ratings of: Health Care, Personal Doctor, Specialist, and Health/Drug Plan. The survey is conducted annually according to CMS protocol by a CMS certified vendor.

Health Outcomes Survey (HOS)

HOS is a member survey that assesses the physical and mental health of a patient over a two-year period. Topics included in the survey are: improving or maintaining physical and mental health, reducing the risk of falling, and improving bladder control.

Health Literacy

There are many reasons health plan members, patients and caregivers may struggle to understand health information. Johns Hopkins HealthCare (JHHC) has structured its goals to meet their mission to provide quality health care, develop new methods to improve the health of its patient community and set standards of excellence in patient care. Doctor-patient communication, patient engagement, and health literacy are focus areas used to develop shared decision making so patients have a better understanding of their healthcare needs. Initiatives such as health coaching and health literacy are ways to encourage patients to ask questions and improve their understanding of their role in managing their behaviors and attitudes toward health maintenance. Providers should encourage their patients to ask questions and develop an open flow of communication. By having an engaged patient and developing a better means of communication through health literacy initiatives, healthcare providers can treat their patients and achieve optimal health outcomes and favorable HEDIS® and CAHPS® results. For more information on health literacy tools for improved communication, visit the Agency for Healthcare Research and Quality website.

Healthcare Effectiveness Data and Information Set (HEDIS®)

HEDIS® is a widely used set of health care performance measures that is developed and maintained by the National Committee for Quality Assurance (NCQA). Examples of HEDIS® measures are Comprehensive Diabetes Care, Breast Cancer Screening, Controlling Blood Pressure, and Colorectal Cancer Screening. For detailed information about HEDIS®, please go to the NCQA website or view our Quality Measures Tip Sheet.