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Carrier Updates

Based on the 5-Star Quality Rating System, Centers for Medicare and Medicaid Services (CMS) rate carriers on the performance of MA/MAPD plans. The scores range from (1) Poor to (5) Excellent.

WellCare manages these measures within five chapters.

  • Admin/Ops (Administrative Operations)
    • Measures how well WellCare is providing hassle-free care and services to their members and providers.
  • CAHPS (Consumer Assessment of Healthcare Providers and Systems)
    • Measures if members are happy with their experience.
  • HEDIS (Healthcare Effectiveness Data and Information Set)
    • Measures if WellCare is effectively getting members to care.
  • HOS (Health Outcomes Survey)
    • Measures if members think they are feeling better.
  • Pharmacy
    • Measures if members are getting and taking the medications as prescribed.

How did WellCare Perform?

They are pleased to share that their resource investments and one-team focused efforts are moving them in the right direction. Their PY 2019 Star rating improved to 3.57 from 3.43 last year overall. Thsi is their best performance to date, with improvement above the industry improvement average two years in a row. Importantly, this success provides access to enhanced quality bonuses that they will reinvest in additional benefits and programs for their members.

They want to thank you, their partners, for helping continue to improve their star ratings by providing quality support to their members.

Please download the 2019 star raing insert applicable to your market for use during the presentation of star scores to beneficiaries.

In addition, download WellCare's 2019 Star Score FAQ and 2019 Marketing Guidelines for details on presenting star scores to beneficiaries during the marketing process.