Physicians Health Plan (PHP) announced today it’s earned a Medicare quality rating of 4.5 Stars (out of 5) from the Centers for Medicare & Medicaid Services (CMS). The rating means members enrolled in PHP Medicare Advantage plans — PHP Advantage, Sparrow Advantage, Covenant Advantage, and University of Michigan Health Advantage — have access to high quality Medicare Advantage plans offered by a locally-owned, community-based health plan.
The CMS Star Rating system is designed to help consumers research and compare Medicare health and drug plans, with Star Ratings ranging from a low of 1 to a high of 5. The Star Ratings focus on person centered care, safety, affordability, wellness, and other meaningful care measures. In addition, The Star Ratings measure outcomes, patient experience, and access to care.
Each year, Star Ratings are released to help Medicare beneficiaries make informed healthcare decisions while researching options during the Medicare open enrollment period, which begins on Oct. 15 and ends on Dec. 7. All Medicare beneficiaries can view and compare CMS Star Rating information at Medicare.gov.
CMS made several changes between the 2022 and the 2023 Star Ratings. One of the more significant changes is in member experience. CMS now places a higher value on the member experience in the Star Ratings. A member’s evaluation of their plan now has twice the weight in the overall Star Rating than it did in previous years. Member experience with PHP Medicare was awarded 4 stars. PHP Medicare was awarded 5 stars for customer service for both health plan and drug plan customer service. In fact, of those who enroll in a PHP Medicare plan, 93% stay with the plan (CMS 2021 disenrollment data, August 2021).
In addition to member experience, CMS evaluates the quality of care provided by the health plan. This is evaluated through clinical outcomes. Of the 36 clinical measures reviewed, PHP achieved 4 or 5 stars in 26 of the measures. Of note, PHP Medicare earned 5 stars for both breast cancer screening and diabetes care for blood sugar control. An excellent Star Rating of 5 stars reflects the support PHP Medicare provides its member to access important health screenings like mammography and care of chronic diseases like diabetes.
While PHP Medicare is entering its fourth plan year in 2023, it has been eligible to receive a CMS Star Rating for the last two years, achieving 4.5 stars each time. “PHP Medicare is set apart from other Medicare Advantage plans through our strong focus on physician engagement throughout our clinically integrated networks,” said PHP Chief Medical Officer Peter Graham, M.D. “Our comprehensive approach with our physician and health system partners allows us to directly address what’s most important to, and will have the biggest benefit for, our members’ health.
“Physicians Health Plan launched PHP Medicare to provide a trusted local choice in Medicare Advantage plans,” said Dennis Reese, President and Chief Executive Officer for PHP. “As a local plan, we are closer to our members and can more quickly respond to their needs. The attention we provide, and the quality of our care, is why we have earned a CMS Star Rating of 4.5 for the 2023 plan year.”
Medicare-eligible seniors can enroll in PHP Medicare plans during the Medicare annual enrollment period Oct. 15 to Dec. 7, 2022. Coverage for beneficiaries begins Jan. 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 health systems, PHP’s Medicare Advantage plans are known in local communities as PHP Advantage, Sparrow Advantage, Covenant Advantage, and University of Michigan Health Advantage.