Star Ratings for CMS Centers for Medicare and Medicaid Services

Star Ratings for Centers for Medicare and Medicaid Services (CMS) Discuss your findings; identify the implications for healthcare and for pharmaceutical companies, and offer conclusions or suggestions. In the last several years, the CMS has been focused on reducing the costs associated with Medicare and Medicaid related services. At the same time, there is an emphasis on improving quality. A rating system is designed to provide better insights about how pharmaceutical and healthcare providers are achieving these objectives. There is a focus on five different areas during this process.

The most notable include: healthcare effectiveness data / information, consumer assessments, CMS, health outcomes survey and the independent review. These variables are designed to provide better information about quality, safety, costs and the delivery of services. ("Choosing Higher Quality," 2013) The findings are showing how the five star system, is providing more clarity about the kinds of healthcare solutions and pharmaceutical products / services. According to CMS, this is an invaluable tool which is enabling consumers to rate providers who are doing the best job.

This takes place once a year and it offers more clarity about how these services are delivered. Evidence of this can be seen with the CMS saying, "Higher quality means better care and value. Each fall, everyone should review their current Medicare plan and compare with other options to make sure they are the best value for their needs. The Medicare Plan Finder at Medicare.gov/find-a-plan has tools to helps them compare Medicare health and prescription drug plans in their area.

When comparing plans, they should consider the plan's quality in addition to looking at the plan's costs and coverage. Looking at the plan's quality tells you how well it performs overall and in different categories. Medicare measures how well health and prescription drug plans perform on more than 50 items." ("Choosing Higher Quality," 2013) This is showing how these solutions are embracing more transparency, simplicity and openness to the process. In the future, this helps consumers to make more informed decisions.

The implications this is having on the industry, is transforming everyone's thinking about how to improve quality and maintain favorable levels. This means that providers and drug companies need to carefully focus on how their products and services are being received. In the future, this makes them aware of possible challenges and it encourages them to respond / quickly to resolve these issues. This is because they receive bonuses from maintaining these levels.

Evidence of this can be seen with observations from Hewitt (2012) who said, "To encourage Medicare Advantage plans to provide quality care, health reform law authorized Medicare to pay plans bonuses beginning in 2012 if they receive 4 or 5 stars on the program's 5-star quality rating system. Building on that provision, the Centers for Medicare and Medicaid Services subsequently launched a demonstration that allowed more plans to receive bonuses and increased the size of the bonuses to encourage plans to maintain or improve their ratings.

Health plans, of course, desire the highest possible rating to be more attractive to consumers and there are incentives to the star ratings. Additionally, health plans receiving 5 stars in 2012 will be able to enroll and market to Medicare beneficiaries throughout 2012. About one third of the bonus payments will be made to plans with 4 or more stars with the other.