Your practice can earn an annual bonus when you achieve an Average Star Rating of 3.75 or higher.
| MA-PCPi Average Star Rating | Payment amount* |
|---|---|
| 4.75 and above | $120 per member per year (PMPY) |
| 4.50 - 4.74 | $65 PMPY |
| 4.00 - 4.49 | $50 PMPY |
| 3.75 - 3.99 | $30 PMPY |
| 3.74 and below | $0 |
| Measure thresholds | |||||||
|---|---|---|---|---|---|---|---|
| 2024 Star Rating ID |
Measure | MA-PCPi weight | 1-Star | 2-Star | 3-Star | 4-Star | 5-Star |
| C01 | Breast Cancer Screening (BCS-E) | 1 | <52% | 52% | 64% | 72% | 81% |
| C02 | Colorectal Cancer Screening (COL-E) | 1 | <56% | 56% | 66% | 74% | 82% |
| C09 | Eye Exam For Patients with Diabetes (EED) | 1 | <50% | 50% | 65% | 74% | 83% |
| C10 | Glycemic Status Assessment for Patients with Diabetes (GSD) | 3 | <56% | 56% | 71% | 81% | 89% |
| D08 | Medication Adherence for Diabetes Medications (MAD) | 3 | <81% | 81% | 85% | 88% | 92% |
| D09 | Medication Adherence for Hypertension (RAS Antagonists) (MAH) | 3 | <82% | 82% | 86% | 89% | 91% |
| D10 | Medication Adherence for Cholesterol (MAC) | 3 | <81% | 81% | 86% | 89% | 92% |
| D12 | Statin Use in Persons with Diabetes (SUPD) | 1 | <80% | 80% | 84% | 87% | 90% |
| C16 | Statin Therapy for Patients with Cardiovascular Disease (SPC) | 1 | <80% | 80% | 85% | 88% | 92% |
| Patient experience performance percentages | |||||||
| N/A | Getting needed care | 2 | N/A | <90% | 90% | 93% | 96% |
| N/A | Care coordination | 2 | N/A | <87% | 87% | 90% | 93% |
| 2024 Star Rating ID | Measure | Measure performance percentage | Quality rating | MA-PCPi weight | MA-PCPi weighted quality rating |
|---|---|---|---|---|---|
| C01 | Breast Cancer Screening (BCS-E) | 72% | 4 | 1 | 4 |
| C02 | Colorectal Cancer Screening (COL-E) | 84% | 5 | 1 | 5 |
| C09 | Eye Exam For Patients With Diabetes (EED) | 77% | 4 | 1 | 4 |
| C10 | Glycemic Status Assessment for Patients With Diabetes (GSD) | 75% | 3 | 3 | 9 |
| D08 | Medication Adherence for Diabetes Medications (MAD) | 91% | 4 | 3 | 12 |
| D09 | Medication Adherence for Hypertension (RAS Antagonists) (MAH) | 86% | 3 | 3 | 9 |
| D10 | Medication Adherence for Cholesterol (MAC) | 89% | 4 | 3 | 12 |
| D12 | Statin Use in Persons With Diabetes (SUPD) | 90% | 5 | 1 | 5 |
| C16 | Statin Therapy for Patients With Cardiovascular Disease (SPC) | 88% | 4 | 1 | 4 |
| NA | Getting needed care | 96% | 5 | 2 | 10 |
| NA | Care coordination | 90% | 4 | 2 | 8 |
| Total | 21 | 82 | |||
| In this example, the Average Star Rating for the 2024 program year would be 3.90. | |||||
The patient experience measures are UnitedHealthcare measures. The weight and Star performance thresholds for these measures are determined by UnitedHealthcare.