MY 2014 Medicare Five-Star and Medicare Stars Most Improved Winners to be Announced
Excellence in Healthcare Award
“Excellence in Healthcare” award winners are physician organizations that have been
successful at achieving strong quality results while effectively managing costs. To earn this
recognition, physician organizations must have performance that ranks in the top 50% for
clinical quality and patient experience and cost performance. Cost performance is based on
the Total Cost of Care, including adjustments to account for members’ risk and geography. See here for a description of the methodology.
Most Improved Award
“Most Improved” award winners are determined by calculating the relative improvement for
each physician organization on the overall achievement score for this year compared to the
overall achievement score for last year. The physician organization in each of the eight P4P
regions that has the highest relative improvement score for overall quality performance—
and does not decrease performance in any quality measurement domain—is recognized as
the most improved group in that region.
Medicare Five-Star Award
“Medicare Five-Star” award winners are five-star rated physician organizations, identified by
comparing performance on individual Medicare Stars measures against national benchmarks
provided by the Centers for Medicare & Medicaid Services (CMS) which were then combined
into a weighted overall Stars rating across a set of 14 Part C (Medicare Advantage) and Part
D (Prescription Drug Plan) measures.
Medicare Stars Most Improved Award
“Medicare Stars Most Improved” award winners are determined by calculating the relative
improvement for each physician organization on the overall Medicare Stars score for this
year compared to the overall score for last year. The physician organizations that improved
by at least ½ Star overall are recognized as the most improved groups in California.
Quality Performer Award (Discontinued)
In keeping with the national imperative to reduce the cost of the healthcare system while delivering high quality care to consumers, the “Quality Performer” award was discontinued in 2015 after eleven years of awards based on quality and patient experience.
"To drive major improvements, performance-based payments must exceed 10% of total provider income. Incentives of this magnitude can only be mobilized if they originate in payer savings.”