Healthcare & Health Cloud

STAR Ratings

CMS quality ratings for Medicare Advantage and Part D prescription drug plans.

Complete Definition

STAR Ratings are CMS's (Centers for Medicare & Medicaid Services) quality rating system for Medicare Advantage (MA) and Part D prescription drug plans, ranging from 1 to 5 stars. STAR Ratings are calculated annually based on up to 50 quality and performance measures including HEDIS measures, patient experience (CAHPS surveys), and plan administration. Plans with 4+ stars receive quality bonus payments from CMS, while low-rated plans face enrollment restrictions. Health Cloud helps health plans improve STAR ratings through automated HEDIS tracking, member engagement campaigns, and care gap closure workflows.

Key Points

1CMS quality ratings (1-5 stars)
2For Medicare Advantage and Part D plans
3Based on 50+ quality and performance measures
44+ stars receive CMS bonus payments
5Drives member enrollment and revenue

Common Questions

How can Health Cloud help improve STAR ratings?

Health Cloud automates HEDIS measure tracking, identifies member-level care gaps, triggers targeted outreach campaigns, and provides real-time performance dashboards to help health plans close gaps and improve quality measures that drive STAR ratings.

A comprehensive set of standardized healthcare quality measures used by health plans.

Population Health Management

Strategies to improve health outcomes for a defined group of individuals through data analytics and care interventions.

Salesforce Health Cloud

A healthcare-specific CRM platform built on Salesforce for patient engagement, care coordination, and population health management.