OAKLAND, Calif. — “They really did surround me with care,” said Pauline Willems of her Kaiser Permanente care team, after a routine appointment for a sore wrist unexpectedly turned into a treatment plan for cancer. The 79-year-old Kaiser Permanente Senior Advantage member from Long Beach, California, went in for what she thought was tendinitis from quilting. Thanks to the proactive care of her physician and care team, however, she was diagnosed with and successfully treated for early-stage tumors in her breast and lung that may have otherwise gone undetected. “I was so grateful to Kaiser,” she said, “they insisted on so much preventive care for me … They saved my life.”
Kaiser Permanente’s commitment to providing coordinated and patient-centered care that takes into account the treatment preferences of members, including Pauline, is one of the many reasons that more than 1.3 million Medicare beneficiaries rely on the health plan for high-quality, affordable health care. The care and services provided by Kaiser Permanente’s staff and physicians have once again received top marks by the Centers for Medicare & Medicaid Services. In today’s CMS announcement of the 2016 Medicare star quality ratings, Kaiser Permanente’s California, Colorado, Hawaii, Northwest and Mid-Atlantic States Regions received 5 stars each, the highest overall rating for quality and service. Kaiser Permanente’s Georgia Region earned 4.5 overall stars.
According to the CMS “2016 Star Ratings Fact Sheet,” Kaiser Permanente represents five of 12 Medicare health plans (with Parts C and D) that earned 5 stars — and of the 1.6 million beneficiaries enrolled in those 5-star plans nationwide, 81 percent are Kaiser Permanente Medicare members.
“Kaiser Permanente’s consistently high star ratings reflect how our commitment to quality and service translates into real, everyday results of people living healthier, fuller lives,” said Patrick Courneya, MD, executive vice president and chief medical officer for Kaiser Foundation Hospitals and Health Plan. “Our coordinated approach to care allows our physicians, nurses and care teams to partner with patients to make treatment decisions that best reflect their needs and desires. This approach, combined with evidence-based practices, prevention measures and personalized service, helps us achieve the best health outcomes for our members.”
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 tracking them in 2009, maintaining high performance in all states in which the health plan operates:
- Kaiser Permanente Colorado Region received the highest possible rating of 5 stars for the sixth year in a row.
- Kaiser Permanente Northern and Southern California received the highest possible rating of 5 stars for the fifth year in a row and is the highest rated plan in the state.
- Kaiser Permanente Hawaii Region received the highest possible rating of 5 stars for the fifth 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 stars for the fifth 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 stars for the fourth year in a row.
- Kaiser Permanente Georgia Region received a 4.5 star rating.
CMS created the Medicare star quality rating system to provide beneficiaries a way to assess Medicare plans’ quality of care and service delivery so they can make an informed decision when choosing a plan. CMS uses the star ratings to rank Medicare 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 number of measures used varies by the health plan, and from year to year, but for 2016, CMS based overall scores for each plan on up to 44 unique quality and performance measures. Besides care and service quality, the star ratings also reflect health plans’ compliance performance. CMS’ methodological changes and improvements among all Medicare plans continue to raise the bar on the level of performance required to achieve 5 stars.
Kaiser Permanente Medicare plans have consistently received high ratings since CMS began tracking them in 2009. One reason is Kaiser Permanente’s integrated care model, which enables its staff and care teams to serve members and patients using a coordinated, seamless system that promotes a total health approach. A core feature of this model is Kaiser Permanente’s electronic health records system that its physicians, nurses and other providers use to safely and efficiently provide high-quality care, connecting with patients and members wherever they are. This technology also enables customer service agents, health plan representatives, call center operators and other administrative and pharmacy staff to better assist and support members, leading to the superior service and satisfaction ratings from CMS.
“At Kaiser Permanente, we use our technology, our integrated system and our talented care teams to provide proactive and coordinated care for chronic conditions, as well as preventive measures like bone health screening, exercise as a vital sign and good nutrition. We also use the latest digital technologies to provide personalized care to reach our members when and where they need us,” said Scott Young, MD, associate executive director for The Permanente Federation, the national organization for nearly 18,000 physicians who provide care to Kaiser Permanente’s more than 10 million members. “These ratings show that we’re helping our members achieve total health in mind, body and spirit.”
In addition to recognition by CMS, Kaiser Permanente Medicare plans’ quality excellence was recently highlighted by the National Committee for Quality Assurance report, “NCQA’s Health Insurance Plan Rankings 2015-16.” For the fourth year in a row, all seven Kaiser Permanente Medicare plans are the highest-rated in the markets they serve. And out of nearly 400 Medicare plans in the nation, only nine received the highest possible rating – and five of those are Kaiser Permanente plans.
Kaiser Permanente Medicare plans also recently received top scores in the “Best Medicare Advantage Plans 2016” list released by U.S. News & World Report. The list features companies with consistently highly-rated Medicare Advantage plans on a state-by-state basis, and Kaiser Permanente achieved the highest rating possible in each state where it offers Advantage plans.
For Medicare beneficiaries, the advantages of a 5-star plan go beyond high-quality care and service – they also include a longer enrollment opportunity. Medicare beneficiaries may switch to a 5-star Kaiser Permanente individual Medicare plan through a CMS Special Enrollment Period from Dec. 8, 2015 to Nov. 30, 2016, 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 plans by calling Kaiser Permanente at 1-877-425-7892.
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, Kaiser Permanente has a mission 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 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.