MARSHFIELD, Wis.--(BUSINESS WIRE)-- Security Health Plan of Wisconsin, Inc., a health maintenance organization sponsored by Marshfield Clinic, was one of only two health plans in the nation to be recognized for the second year in a row with the highest rating of 5 stars from the Centers for Medicare and Medicaid Services (CMS) for its Advocare Medicare Advantage plans for 2012.
Along with Security Health Plan, only eight other plans across the nation this year received a 5-star rating from CMS. Last year, only three plans received the highest rating, including Security Health Plan.
The ratings, now available at www.medicare.gov, are the result of an annual assessment by CMS of Medicare health plans’ clinical quality, consumer satisfaction and other beneficiary experience areas.
CMS began using the star-rating system in 2007 to give Medicare beneficiaries an easy way to verify the quality of health plans with which they were considering enrolling. Star ratings are assessed each year and may change from year to year. The star rating system uses quality measurements that are widely recognized within the health care and health insurance industry to provide an objective method for evaluating health plan quality.
Security Health Plan achieved its 5-star rating by working with providers and members to make sure members received appropriate and timely care, that chronic conditions are well managed, that members are pleased with the level of service from their health plan and care providers, and that health plans follow CMS operational and marketing requirements, according to Steve Youso, chief administrative officer. The plan uses mailings and personal phone calls to remind members about needed care and to help maintain optimal health. In addition, the plan’s affiliated home health nurses visit members at their homes and in the hospital to answer questions they have about their medications or ongoing care, and to ensure that they have the resources they need to recuperate.
“All of us at Security Health Plan are extremely proud that our Advocare plans are among just a few in the nation to achieve this ranking. In fact, we are one of only two health plans to maintain a 5-star rating for two consecutive years,” said Youso. “This rating is a recognition of the excellent care our members receive from their network providers, as well as the service they receive from Security Health Plan. Being recognized with this ranking for a second year is a sign that we are on the right path for improving the health and well-being of our members. We will continue to focus on providing high quality service, not for the recognition, but because it is the right thing to do for our members.”
About the CMS Five-Star Rating
The overall plan rating combines scores for the types of services each plan offers. For plans covering health services, the overall score for quality of services looks at such measures as:
- How the plan helps members stay healthy— Screenings, tests and vaccines, including how often members received various screening tests, vaccines, and other check-ups to help them stay healthy.
- How the plan helps members manage chronic (long-term) conditions—How often members with different conditions received certain tests and treatments that help them manage their condition.
- Ratings of health plan responsiveness and care— Scores of member satisfaction with the plan.
- Health plan member complaints and appeals—How often members filed a complaint against the plan.
- Health plan telephone customer service—How well the plan handles calls from members.
For plans covering drug services (Part D), the overall score for the quality of services covers such categories as:
- Drug plan customer service—How well the drug plan handles calls and makes decisions about member appeals.
- Drug plan member complaints and Medicare audit findings—How often members filed a complaint about the drug and findings from Medicare’s audit of the plan.
- Member experience with drug plan—Member satisfaction information.
- Drug pricing and patient safety—How well the drug plan prices prescriptions and provides updated information on the Medicare website, including information on how often members with certain medical conditions get prescription drugs that are considered safer and clinically recommended for their condition.
For quality of health services, the information comes from sources that include:
- Member surveys administered by Medicare
- Information from doctors
- Information submitted by the plans
- Results from Medicare's regular monitoring activities
For quality of drug services, the information comes from sources that include:
- Results from Medicare's regular monitoring activities
- Reviews of billing and other information that plans submit to Medicare
- Member surveys done by Medicare
About Security Health Plan’s Advocare plans
Security Health Plan offers six different Advocare plans to meet the health needs and budgets of people who are eligible for Medicare. Medicare beneficiaries can enroll in a Medicare Advantage plan or make Medicare Advantage coverage changes from October 15 through December 7. As a 5-star rated plan for 2012, Security Health Plan will be able to offer an additional opportunity to enroll in an Advocare plan through a 5-star Special Election Period, December 8, 2011, through 2012. Security Health Plan is holding seminars in many communities throughout its service area where Medicare beneficiaries and people who will soon be eligible can learn more about Security Health Plan’s Advocare plans. At seminars, a sales person will be present with applications to enroll. For a schedule of area seminars, visit www.securityhealth.org/advocare. For accommodations of people with disabilities, call 877-998-0998 or TTY 877-727-2232.
About Security Health Plan
Security Health Plan — celebrating its 25th anniversary — is a medically driven health maintenance organization sponsored by Marshfield Clinic. Founded 40 years ago as the Greater Marshfield Community Health Plan, the Plan became Security Health Plan in 1986 and now serves more than 200,000 residents in 32 counties of northern, western and central Wisconsin. Security Health Plan is one of only nine plans across the nation to hold a 5-star rating, the highest possible, from the Centers for Medicare and Medicaid Services (CMS) for its Advocare Medicare Advantage plans. Accredited by the National Committee for Quality Assurance (NCQA), Security Health Plan insures employees of large and small businesses, individuals and families, and administers self-funded employer health plans.
An electronic copy of this release can be found at: http://www.marshfieldclinic.org/mc/releases/
KEYWORDS: United States North America Wisconsin
INDUSTRY KEYWORDS: Practice Management Health Other Health Professional Services Insurance General Health Managed Care