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December 2019

Blue Cross, BCN receive 4-star ratings from CMS

Blue Cross Blue Shield of Michigan and Blue Care Network both received 4-star ratings from the Centers for Medicare & Medicaid Services for 2020 for their Medicare Advantage health plans.

Together, these results mean that 100% of our members across the country are covered by four-star plans, making us one of an elite few that can make that claim.

The Medicare Star Rating System is a nationally recognized measurement program that provides an overall rating of a health plan’s quality and performance for the types of services each plan offers. It also measures a member’s experience with a plan. Measurement ranges from 1 star (lowest) to 5 stars (highest).

Attaining a 4-star rating is a moving target because the bar is set higher each year and it’s harder for health plans to hit it year after year.

“Our health care providers take Medicare star ratings very seriously,” Dr. Duane DiFranco, Blue Cross Blue Shield of Michigan’s vice president of Medicare star ratings and clinical performance, said in a recent column in Hospital and Physician Update. “They try hard to meet the Medicare star measures because they understand the key role these measures play in improving care outcomes for our Medicare population.”

Star Measure Tips
We post a series of tip sheets on web-DENIS to help providers meet key measures. We’re currently in the process of updating the tip sheets for 2020 and expect the new ones to be posted early in January.

Our 2019 tip sheets range from such topics as adult BMI assessment to statin use in persons with diabetes. You can access the series of 15 tip sheets from the Clinical Quality Corner section of BCBSM Newsletters and Resources or from the Clinical Quality Corner section of BCN Provider Publications and Resources. Our HEDIS Measure Tip Sheets are also posted there.

As a reminder, web-DENIS is a secure website so you’ll need to log in as a provider to access these tip sheets.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2018 American Medical Association. All rights reserved.