OAKLAND, Calif. — When she became eligible for Medicare, Linda Gummerson knew exactly what she wanted in a Medicare Advantage plan. As a member of the nation’s largest integrated health system for eight years prior, she knew she wanted to stay with Kaiser Permanente. “I love how everything is under ‘one roof’ — my doctor, pharmacy, labs and specialists. It just makes taking care of my health so much easier.”
Gummerson, a Kaiser Permanente Senior Advantage member in Santa Rosa, California, is one of nearly 1.4 million Medicare beneficiaries who rely on the health plan for high-quality health care with service that’s easy, convenient and personalized. Her experience represents one of the many reasons the organization’s Medicare health plans have once again achieved top scores for quality and service by the Centers for Medicare & Medicaid Services.
In today’s CMS announcement of the 2017 Medicare star quality ratings, Kaiser Permanente’s Northern and Southern California, Colorado, Northwest and Mid-Atlantic States regions received 5 out of 5 stars each, the highest overall rating. Kaiser Permanente’s Georgia and Hawaii regions earned 4.5 out of 5 stars.
According to the CMS, Kaiser Permanente represents four of 14 Medicare health plans (with Parts C and D) that earned 5 out of 5 stars — and of the more than 1.6 million beneficiaries enrolled in those 5-star plans nationwide, 81 percent are Kaiser Permanente Medicare members.
“Our high ratings year after year demonstrate our deeply-rooted commitment to safe, reliable, quality care and service for our members,” said Patrick Courneya, MD, executive vice president and chief medical officer for Kaiser Foundation Health Plan and Hospitals. “Our coordinated, patient-centered approach enables patients to partner with their physicians and care teams to detect, prevent and treat chronic conditions and diseases. The health decisions they make together reflect the patient’s needs and preferences, helping them live full, healthy, active lives.”
The Centers for Medicare & Medicaid Services created the Medicare star quality rating system to provide beneficiaries with a way to assess Medicare plans based on quality of care and service delivery. Kaiser Permanente Medicare plans have consistently received high ratings since CMS began the Medicare stars program, and have maintained high performance in all states in which the health plan operates. For CMS’ 2017 star ratings:
- Kaiser Permanente Colorado Region received the highest possible rating of 5 out of 5 stars for the seventh year in a row.
- Kaiser Permanente Northern and Southern California received the highest possible rating of 5 out of 5 stars for the sixth year in a row and is the highest rated plan in the state.
- Kaiser Permanente Northwest Region, which includes Oregon and Washington, received the highest possible rating of 5 out of 5 stars for the sixth year in a row and is the highest rated plan in both states.
- Kaiser Permanente Mid-Atlantic States Region received the highest possible rating of 5 out of 5 stars for the fifth year in a row.
- Kaiser Permanente Georgia and Hawaii regions received a 4.5 out of 5 star rating.
The Medicare star quality rating system provides beneficiaries a way to assess Medicare health plans so they can make an informed decision when selecting a plan. CMS uses the star ratings system to rank Medicare health plans on a scale of 1 to 5 stars, with 5 stars representing the highest quality. The overall scores are based on care and service quality measures (Parts C and D) across nine categories, including staying healthy, managing chronic conditions, member satisfaction, customer service and pharmacy services. The star ratings also measure health plans’ compliance performance.
The methodology CMS uses for the star ratings is dynamic and continues to change. This means that Medicare health plans must stay ahead of the curve on measures that may be included in the 5-star portfolio, and continually improve their performance to achieve 5 stars.
Kaiser Permanente Medicare health plans have consistently received high ratings since CMS began awarding them in 2009. One reason is Kaiser Permanente’s integrated care model, which enables care teams and staff to serve members and patients using a coordinated, seamless approach. This model also allows customer service agents, health plan representatives, call center operators and other administrative and pharmacy staff to better assist and support members.
“Our physicians and care teams are dedicated to the quality care and total health of our members,” said Michael Kanter, MD, executive vice president of quality and chief quality officer for The Permanente Federation, the national organization for nearly 18,000 physicians who provide care to Kaiser Permanente’s more than 10.6 million members. “Our integrated system, technology and digital tools allow our members to access care whenever and wherever they need it. These ratings reflect the compassionate, personalized and excellent care and service we’re honored to provide our patients and members every day.”
Kaiser Permanente’s online tools make it easy for members to manage their care from home — or from wherever they are.
“I use the kp.org website all the time — to make my appointments, and to view my current and past labs,” Gummerson said. “I also use it to order medication refills. I love that refills arrive by mail, and that I get a discount when ordering for several months’ supply. My doctor sends reminders for screening and check-up visits, so I feel like I’m in good hands and we’re proactive about my health.”
This year’s top scores by CMS add to the list of quality recognitions achieved by Kaiser Permanente Medicare plans this year. In the “NCQA Health Insurance Plan Ratings 2016-2017” report, the National Committee for Quality Assurance lists all seven Kaiser Permanente Medicare plans as highest-rated in the markets they serve — for the fifth year in a row. And according to the J.D. Power 2016 Medicare Advantage study, Kaiser Permanente was ranked “Highest in Member Satisfaction with Medicare Advantage Plans” by J.D. Power for two years in a row, 2015-2016.
Along with high-quality care and service, another benefit of 5-star plans is a longer enrollment opportunity. Medicare beneficiaries may change to a 5-star Kaiser Permanente individual Medicare plan through a CMS 5-star Special Enrollment Period from Dec. 8, 2016, to Nov. 30, 2017, without having to wait until the next annual enrollment period. All available Kaiser Permanente physicians welcome Kaiser Permanente Medicare health plan members.
Medicare beneficiaries can learn more about the star ratings and Kaiser Permanente’s Medicare health plans by visiting kp.org/medicarestars.
Medicare evaluates plans based on a 5-star rating system. Star ratings are calculated each year and may change from one year to the next.
About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 10.6 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/share.