This article is for all providers caring for our members
The CMS Star rating system helps Medicare members compare health plans so they can make informed decisions. CMS rates Medicare plans on how well they perform in specific categories, including:
- Member Experience
- Customer Service
- Plan Performance
- Chronic Condition Management
- Helping Members Stay Healthy
The Centers for Medicare & Medicaid Services has awarded our Medicare Advantage HMO and PPO plans a 4.5 out of 5 Stars for calendar year 20261. Only 17% of rated health plans nationwide earned 4.5 Stars or greater. Achieving a high rating is a testament of our commitment to patient care and quality service.
Thank you! Your dedication and hard work have been pivotal in our success. We encourage you to continue to explore new ways to improve quality. Striving for a 5-Star rating ensures the highest level of patient care and satisfaction, and can result in a higher payout for provider organizations participating in our incentive program. Achieving the top rating can lead to increased patient trust and better health outcomes.
-Blue Cross Senior Vice President of Government Programs, Krista Bowers.
What’s next: While we celebrate, ongoing efforts are crucial to sustain and exceed these standards. Blue Cross is continuing our rigorous test-and-learn approach to improving performance of our Stars initiatives. We are offering several in-home screening options for colorectal cancer, diabetes, and osteoporosis to ensure convenience and proactive health care management. We are also offering retinal eye screenings for our members with diabetes on November 10th through our partnership with 20/20. See our member postcard.
We’re asking our provider partners to help us continue improving patient care and satisfaction by:
- Scheduling members for annual wellness visits before the end of the year. If you do not have openings available, consider referring your patients to Signify Health, our in-home wellness assessment partner. Learn more here.
- Reviewing information that Blue Cross shares about your patients’ open gaps. PCPs can log into Provider Central and select Quality & Performance > Reports & Data > PCP Reports to view.
- Encouraging patients to use the blood pressure monitors that Blue Cross provided last year. Read more: Encourage patients to use their blood pressure monitors
- Attending our Patient Experience Champions League to hear about best practices for enhancing patient experience.
Continuous improvement and expanding the scope of our test-and-learn approach to performance improvement, remains a priority to maintain our competitive edge and improve member experience. Together, we can set a new benchmark in healthcare excellence.
1. Every year, Medicare evaluates plans based on a 5-Star rating system. 2026 ratings are based on calendar year 2024 performance.
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