Focus Measure Analysis
This section is dedicated to analyzing specific measure sets and their respective measures and how they contribute to the performance of the plan relative to their targets.
Understanding what's on this page using example data:
HEDIS (Healthcare Effectiveness Data and Information Set):
It shows a negative variance of -0.07, meaning these clinical quality measures are performing below the goal.
Specific measures under HEDIS that are driving this negative variance are listed, like Planned All Cause Readmissions, Diabetes Care - Eye Exam, and others.
Pharmacy:
Indicates a positive variance of 0.02, suggesting better performance in pharmacy-related measures like Statin Use with Diabetes and Med Adh for Hypertension.
Operations:
A negative variance of -0.11 points, with several operational measures listed that affect this score, such as Plan Makes Timely Decs - Appeals, Reviewing Appeals Decisions, and Complaints about the Health Plan.
CAHPS (Consumer Assessment of Healthcare Providers and Systems):
No variance indicated (0.00), suggesting that performance on these measures matches the goals. CAHPS are survey measures, so it's not uncommon to see a 0.00 delta from target indicated for this measure set.
HOS (Health Outcomes Survey):
A small negative variance of -0.02, with Monitoring Physical Activity being a specific measure mentioned. HOS
QI Measures (Part C & D):
Shows a negative variance of -0.05, indicating areas like Monitoring Physical Activity and Diabetes Care - Eye Exam need improvement.
Reward Factor:
Displays a negative variance of -0.20, which is quite significant. Measures like Med Adh for Cholesterol and Statin Therapy-Patients with CVD (Cardiovascular Disease) are contributing to this variance.
Overall Stars 2025 Score Details:
Reiterates the projected overall score of 4.08, the goal of 4.55, and the variance from the goal of -0.47.
The current month for data consideration is November.
Bottom Navigation:
This section provides quick navigation buttons to go to specific areas like HEDIS, Pharmacy, Operations, CAHPS, and HOS for more detailed analysis.
This screen is valuable for identifying specific areas where the Medicare Advantage plan is underperforming or overperforming compared to its goals. It can help in targeting improvement initiatives to areas that will have the most significant impact on the overall Star Rating.
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