Published: October 17, 2022
LANSING, MI— Health plan for doctors (PHP) announced today that it has received a Medicare quality rating of 4.5 stars (out of 5). Centers for Medicare & Medicaid Services (CMS). Rating means members are enrolled in PHP Medicare Advantage plans – PHP Advantage, Sparrow Advantage, Covenant Advantage, and University of Michigan Health Advantage – Have access to quality Medicare Advantage plans offered by a locally operated, community-based health insurance plan.
The CMS star rating system is designed to help consumers research and compare Medicare health and drug plans. Star ratings range from 1 to 5. Star ratings focus on person-centered care, safety, affordability, well-being, and other meaningful care interventions. In addition, the Star Ratings measure outcomes, patient experience and access to healthcare.
Star ratings are published each year to help Medicare beneficiaries make informed health decisions while researching options during the Medicare open enrollment period, which begins October 15 and ends December 7. All Medicare beneficiaries can view and compare CMS star rating information at Medicare.gov.
CMS made several changes between the 2022 and 2023 star ratings. One of the more significant changes relates to member experience. CMS now puts more emphasis on the member experience when it comes to star ratings. A member’s rating of their plan now has twice the weight in the overall star rating than in previous years. PHP Medicare member experience has been rated 4 stars. PHP Medicare received 5 stars for customer service for both healthcare plan and drug plan customer service. In fact, 93% of those who enroll in a PHP Medicare plan remain with that plan (CMS opt-out dates 2021, August 2021).
In addition to member experience, CMS evaluates the quality of care provided by the health insurance plan. This will be evaluated based on clinical results. Of the 36 clinical measures reviewed, PHP achieved 4 or 5 stars in 26 measures. Notably, PHP Medicare received 5 stars for both breast cancer screening and diabetes care for glycemic control. An excellent 5-star star rating reflects the support PHP Medicare offers its members in accessing essential health screenings such as mammography and the management of chronic diseases such as diabetes.
As PHP Medicare enters its fourth plan year in 2023, it has been eligible for a CMS star rating for the past two years, achieving 4.5 stars each time.
“PHP Medicare differentiates itself from other Medicare Advantage plans with our strong focus on engaging physicians in our clinically integrated networks,” said PHP Chief Medical Officer Peter GrahamMD “Our holistic approach with our physicians and healthcare systems partners allows us to directly address what is most important to our members’ health and brings the greatest benefit to them.
“Physicians Health Plan launched PHP Medicare to provide a trusted local choice for Medicare Advantage plans,” he said Dennis Reese, President and Chief Executive Officer of PHP. “As a local plan, we are closer to our members and can respond more quickly to their needs. The attention we provide and the quality of our care is why we have received a 4.5 CMS star rating for the 2023 plan year.”
Medicare-eligible seniors may enroll in PHP Medicare plans during the annual Medicare enrollment period of October 15 through December 7, 2022. Beneficiary coverage begins January 1, 2023.
PHP Medicare Advantage plans are offered in 17 Michigan counties: Bay, Calhoun, Clinton, Eaton, Gratiot, Huron, Ingham, Ionia, Jackson, Kalamazoo, Livingston, Montcalm, Sanilac, Saginaw, Shiawassee, Tuscola and Washtenaw. Through its partnerships with healthcare systems, PHP’s Medicare Advantage plans are known in the local community as PHP Advantage, Sparrow Advantage, Covenant Advantage and University of Michigan Health Advantage.
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