The Centers for Medicare and Medicaid Services (CMS) use a five-stars quality control system to measure the experience of Medicare beneficiaries with their health plans and health care system. This rating system applies to all Medicare Advantage (MA) plans: Health Maintenance Organization (HMO), Preferred Providers Organization (PPO), Private Fee for Service (PFFS) co-payment plan, and Prescription Drug Plan (PDP).
The program is a key component in the financing of health services rendered to MA members. Additionally, ratings are published in the CMS website, www.Medicare.gov, to help members select among the different MA plans offered in their area.
Medicare
Each year, Medicare rates all health and prescription drug plans based on a Five–Star Quality Rating System. CMS Star Ratings can help you compare plans based on quality and performance. Humana Puerto Rico HMO plans has the highest rates in Rating of Health Care Quality, Rating of Health Plan and Rating of Drug Plan. The plans rated 5 out of five (5) on these measures and rated 4.0 overall Stars Ratings. The highest rates for Medicare PPO plans are in Getting Needed Care and Rating of Drug Plan.
Commercial
Humana contracted DSS, a certified vendor by NCQA, to conduct the 2016 CAHPS 5.0 survey. The main objective is to accurately capture customer response and expands the scope of information gathered relative to quality of care The highest rates obtained for HMO/PPO Commercial plans are Personal doctor and Health care ratings All of those, with an estimated rating of 5 out of 5 when compare with 2015 Quality Compass data.
Click here to find out more about the Five-Stars rating program.
Note about coordinated care
The coordinated health care service that we currently offer is a key strategy to get the best health results for our patients. The term we use to describe the health services system that delivers orderly attention and added value to our patients is “coordinated care”. Medicare Advantage plans are coordinated care plans.
Click here to find more notes on Coordinated Care.
Is a program created by Humana for Medicare members that use certain drugs for chronic conditions such as diabetes, cholesterol and hypertension, to help them get the most from their medications. The objective of the program is to offer:
Click here to get more information about the My Medications program.
Click here to see the list of medications that the elderly should avoid.
Hypertension is one of the most common conditions seen in the practice of primary care and, if it is not detected early, results in the patient suffering from cardiovascular complications. The new guidelines for hypertension prevention and management have been published using the best scientific evidence. It is not meant to preclude clinical judgment. Treatment decisions should always be based on clinical judgment.
Click here to get more information about the new hypertension guidelines.
Click here for recommendations on how to prevent and detect osteoporosis.