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Provider updates

CareOregon Advantage (Medicare) Star Rating

Dec 17, 2020, 08:00 AM

By Viet Nguyen, Senior Pharmacy Clinical Coordinator, and Maria Berta, Medicare Stars Program Manager

For the past 13 years, the Centers for Medicare & Medicaid Services (CMS) has been using a 5-point star rating system to measure the quality of health plans and drug services. Health plans are rated on a scale of 1 to 5 stars, with 5 being the highest performance. Achieving 5 stars is an important achievement and only a few plans are awarded this rating every year. You can find out how CareOregon Advantage scored on our website. (

What are the benefits to our members, your patients?

Navigating the many different available plans can be very confusing for some Medicare beneficiaries, and making a choice can be difficult. A Plan’s star rating gives people a way to consider quality, as well as cost. when making enrollment decisions.
Also, CMS awards plans with quality bonus payments based on performance.  The higher the rating, the more funds a Plan receives to reinvest in their members. Quality bonus payments can help reduce costs for members and help fund supplemental benefits not traditionally covered by Medicare (like vision or dental care).

What are the measures?

The overall Star Rating is comprised of over 40 measures in six broad categories:

  1. Staying healthy, whether members are receiving recommended screenings, tests, and vaccines
  2. Managing chronic conditions
  3. Member experience
  4. Member complaints and changes in the Health Plan’s performance
  5. Customer service
  6. Drug safety and accuracy of drug pricing

We are striving to improve the following measures and need your help to do it.




Current Status

How you can help

Medication Adherence – Diabetes

Percent of members with a prescription for diabetes medication (excludes insulin) who fill their prescription often enough to cover 80% or more of the time.



  • Prescribe for 90-day fills to reduce copays and to reduce trips to the pharmacy.
  • Determine barriers to adherence.
  • Recommend solutions: dose optimization, medication synchronization, special packaging, pillboxes, home delivery.

Medication Adherence - Hypertension

Percent of members on RAS antagonists (ACE inhibitors, ARBs, or direct renin inhibitors) who fill their prescription often enough to cover 80% or more of the time.



Medication Adherence - Cholesterol

Percent of members on statins who fill their prescription often enough to cover 80% or more of the time.



Comprehensive Medication Review (CMR) Completion Rate

Percent of members enrolled in the MTMP program who received a CMR.



Encourage members to participate in our MTM program and to complete a medication review with a pharmacist.

Statin Use in Persons with Diabetes

Percent of members with diabetes who are on a statin.



Talk with your patients and help them “buy in” to statin therapy.

Statin Use in Persons with Cardiovascular Disease

Percent of members with ASCVD who are on a moderate to high intensity statin.



  • Talk with your patients and help them “buy in” to statin therapy.
  • Documenting statin related muscle pain in the medical record helps with this measure!

Rheumatoid Arthritis Management

Percent of members diagnosed with RA who are on a DMARD.



  • Do not code medical claims with a RA diagnosis unless the patient has been properly diagnosed.
  • Assess patients for DMARD therapy.

Annual Flu Vaccine


The percentage of sampled Medicare members who received an influenza vaccination.



Remind patients how important it is for their health to get a flu vaccine ever year.

Care for Older Adults – Medication Review

Percent of plan members whose doctor or clinical pharmacist reviewed a list of everything they take (prescription and non-prescription drugs, vitamins, herbal remedies, other supplements) at least once a year.



This measure can be satisfied using CPT/HCPCS codes or through medical record review during HEDIS review. Both the medication list and the review must be in the encounter to be compliant.

Osteoporosis Management in Women who had a Fracture

The percentage of woman MA enrollees 67 - 85 who suffered a fracture and who had either a bone mineral density (BMD) test or prescription for a drug to treat osteoporosis in the six months after the fracture.



Within 6 months of a fracture, have the member come in for a BMD test to test for osteoporosis or add drugs to treat osteoporosis.

Diabetes Care – Blood Sugar Controlled

The percentage of diabetic MA enrollees 18-75 whose most recent HbA1c level is greater than 9%, or who were not tested during the measurement year.



Educating patients about healthy lifestyle choices through motivational interviewing

Using an evidence-based diabetes care pathway for medication management and other care options.

Controlling Blood Pressure

All members age 18–85 years who had an essential hypertension diagnosis and at least one PCP visit in the measurement year.



Patient-reported blood pressure is now allowed if documented in the medical record.

Order a BP monitor for home use (covered under Medicaid).

Re-take blood pressure at the end of each visit if the initial reading is elevated and document repeat values in vital flow sheets.

Ensure the members whose blood pressure is above 140/90 mmHg have a scheduled follow-up visit with a care team member to work toward controlled blood pressure.

Improving Bladder Control

(Health Outcomes Survey (HOS) measure)

Adults aged 65 or older who had a problem with urine leakage in the past six months, who discussed it with their doctor or pharmacist and got treatment during the year



Discussing urinary incontinence with patients can help address and reduce symptoms with evidence-based treatment.

Medication Reconciliation Post-Discharge

Documentation of medication reconciliation on the date of discharge through 30 days after discharge (31 total days).



Documentation of the member’s current medications with a notation in the outpatient medical record that the discharge medications were reviewed.

How else can you help our members, your patients?

  • Bring the patient in for a visit or schedule a telehealth visit for annual wellness visit (AWV) or annual physical exam.
  • Help members earn incentives by getting a flu shot or completing certain preventative services such as AWV, mammograms, diabetes screenings and colorectal screenings.

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