Medicare Advantage Plan Becomes the First in the State to Incentivize Physician Groups Using the CMS Star Rating System
LONG BEACH, Calif.--(BUSINESS WIRE)-- SCAN Health Plan has become the first health plan in California to incentivize physician groups to improve quality by enhancing their performance in areas consistent with the Centers for Medicare and Medicaid Services (CMS) star rating system.
The Five Star Quality Rating System was put in place by CMS as part of an effort to help educate consumers on quality and make quality data more transparent and comparable between plans. Under the system, CMS ranks health plans on a one- to five-star basis, weighing such factors as clinical outcomes, access to preventive services such as screenings and vaccines, managing chronic conditions, preventive care and consumer satisfaction.
Pursuant to healthcare reform legislation taking effect this year, payment to Medicare Advantage plans such as SCAN will be directly linked to health plans’ star ratings. Plans that earn a CMS-established threshold star ranking will receive cash bonuses from the federal government. In this way, and for the first time, higher-performing plans will be paid more than lower-performing plans. This changes the terms of market competition and turns incentives in Medicare Advantage toward improving quality.
Piggybacking on this national program, SCAN will assign participating physician groups a "star rating" of their own, using some of the same criteria CMS uses when rating health plans. In 2011, SCAN is offering investment funds to those physician groups who commit to building infrastructure and initiatives to optimize their performance under the Five Star Quality Rating System. In 2012 those physician groups that show quantifiable improvement over the coming year in an agreed-upon rated area will receive additional compensation from SCAN for their achievement.
“This is really all about improving patient care and making healthcare more responsive and accessible for our members,” said Timothy Schwab, M.D., FACP, chief medical/informatics officer at SCAN Health Plan. “Working hand in hand with our physician partners, our goal is to incentivize and demonstrate the kind of improvements that will have a positive effect on the lives of seniors throughout California.”
SCAN presently contracts with approximately 50 medical groups statewide. SCAN has allocated $2.5 million for 2011 and an additional $2.5 million for 2012 to support the program.
For more than 30 years, SCAN Health Plan has been focusing on the unique needs of seniors and is now the country’s fourth largest not-for-profit Medicare Advantage plan. The company currently has nearly 130,000 members in California and Arizona. Further information may be obtained at scanhealthplan.com.
SCAN Health Plan
KEYWORDS: United States North America California
INDUSTRY KEYWORDS: Practice Management Health Professional Services Insurance Managed Care