AmeriHealth Caritas’ Two Dual Eligible Special Needs Plans Earn Overall Four Star Rating from the Centers for Medicare & Medicaid Services

The Plans are Nationally Recognized for Exceptional Commitment to Quality

AmeriHealth Caritas, a national leader in Medicaid managed care and other health care solutions for those most in need, announced today that its two dual eligible special needs (HMO D-SNP) plans in Pennsylvania received an overall four-star rating (out of a possible five stars) from the Centers for Medicare & Medicaid Services (CMS) for 2020. The Pennsylvania plans earned this achievement through their commitment to providing quality benefits and services and because of their focus on social determinants of health.

“Keeping our members well can’t happen without maintaining a robust provider network whose health care professionals care deeply for our members and stress the importance of regular exams,” said Robert J. Smith, president of Medicare of AmeriHealth Caritas. “Having our care managers and providers focus on the socioeconomic factors affecting our members has yielded very positive results. Our exemplary patient satisfaction survey results demonstrate that our associates, providers, and community partners are working well together so that our members may maintain their best health.”

“Star ratings tell us about the quality of service we are providing and our plan responsiveness” said Tonya Moody, vice president for AmeriHealth Caritas’ Pennsylvania VIP plans. “Earning this score means we are excelling at helping our members get care and stay well, and that we are building healthy communities. Our integrated care model, and the relationships we have built in the communities in which we serve, all contributed to our high ratings.”

CMS’ nationally recognized quality-rating system looks at Medicare Part C (health plan services) and Part D (drug plan services). CMS uses information from member satisfaction surveys, health plans, and health care providers to give overall performance Star Ratings to plans. The Star Ratings program emphasizes areas such as preventive medicine, early disease detection, customer service and benefits supporting chronic condition management. The program’s goal is to raise the quality of care and strengthen protections for Medicare beneficiaries.

AmeriHealth Caritas’ two Pennsylvania D-SNP plans scored a four or five out of five stars in 32 of 48 categories. Highlights include:

• The Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores were a particular area of strength for the AmeriHealth Caritas Pennsylvania D-SNPs, as all 2020 Part C measures improved over 2019 and both Customer Service and Rating of the Health Plan achieved five out of five stars.
• A look at the plans’ management of chronic conditions for older adults revealed that 99% of members completed an annual medication review, 91% an annual pain assessment, and 81% an annual Functional Status Assessment. These assessments ask members to answer questions related to areas such as pain management, physical function, emotional well-being, health-related quality of life, and symptom acuity.
• Finally, the plans achieved four out of five stars in diabetes prevention categories and improved scores in retinal eye exams (up 13% from 2019), statin therapy for those with cardiovascular disease (up 11%), and HbA1c control (up 7%).

AmeriHealth Caritas has offered the D-SNP plans since 2013. They will begin offering services in the entire state of Pennsylvania beginning Jan. 1, 2020, adding the northwest and northeast areas of the commonwealth. “We are pleased that just as we are expanding into the rest of the state that even more Pennsylvanians will be able to benefit from our four-star rated quality services,” said Robert Smith.

Note: Every year, Medicare evaluates plans based on a 5-star rating system. Information in this press release is based on 2018 Star Ratings data published by CMS on October 9, 2019. Star ratings are calculated each year and may change from one year to the next.