How many more gaps in care do you need to resolve to get a 4 Star Rating?

In 2013 and 2014, plans that did not score at least 3 stars did not receive a QBP. In 2015 and beyond, the threshold is a 4 star minimum to get a 5% QBP. 65% of the total Part C rating is based on HEDIS metrics which reflect the work of primary care providers to address preventative care and chronic conditions. Plans must have a way to engage these providers to ensure that there are no gaps in care that would reduce the Star rating.


This calculator applies population health data from the US Census and the CDC to the HEDIS metrics in Domains 1 and 2 (including their Star weighting).  This establishes an average baseline of care metrics which must be done for your members every year.  Input your Star Rating for each domain (you can use your overall rating in both fields if necessary), number of members and number of primary care providers and we'll show you how many care metrics must be resolved to get to a 4 star rating.

 

Using reimbursement data from CMS, we can calculate the value of the 5% QBP for your contract.

About Your MA Contract

How many MA members are in this contract?

How many Primary Care Providers do you have?

What state does this contract cover?

What is your Star rating?

What is your Domain 1 Star rating?

What is your Domain 2 Star rating?