“Our members are
what we’re here for.

MENASHA, WI (October 24, 2017) – Network Health, a Wisconsin-based health plan, has received a 4.5 overall Star rating for its Medicare Advantage PPO plans from the Centers for Medicare and Medicaid Services (CMS), outperforming national averages in several measures, which make up overall Star Ratings. This information is timely as consumers start evaluating available Medicare health plans during open enrollment for 2018 insurance coverage. The Medicare annual enrollment period runs October 15, 2017 through December 7, 2017.

The Medicare Advantage Five-Star Quality Rating System was implemented to drive improvements in quality of care and to help consumers make plan comparisons. Plans are given a score on a scale of one to five Stars, with five Stars being the highest rating. The Star ratings are based on clinical data, customer survey responses and plan performance scores spanning the previous two years. CMS evaluates plans based on a 5-Star rating system. Star ratings are calculated each year and may change from one year to the next.

For the fifth consecutive year, Network Health has been recognized as a 4.5 Star plan for offering high-quality coverage and achieving high customer satisfaction scores. With this rating, Network Health, currently the largest provider-owned Medicare Advantage plan in Wisconsin, outranks the national average of 4 Stars.

 “This rating is recognition of the satisfaction of our Network Health Medicare members,” said Coreen Dicus-Johnson, Network Health president and CEO. “Providing access to quality care and taking care of our members is always our goal. One of the things that sets Network Health apart, is that we’re community-based. We know how to serve our members, because we live and work in the same communities.”

Several key factors contributed to Network Health’s success in achieving a 4.5 Star Rating including high performance in customer service measures, focused interventions on measures such as all-cause readmissions, implementation of robust improvements to their Medication Therapy Management (MTM) program in 2016 and 2017, and high performance in other pharmacy measures.

Network Health received a 5 Star Rating in customer service, while the national average is just 3.4 Stars. The rating for customer service comes from measures such as members choosing to leave the health plan and management of customer complaints. Network Health received a 5 Star rating for management of customer complaints, higher than the national average of 4.3 Stars.

In addition to customer service, Network Health focused on making overall improvements in customer care and care management costs through the all-cause readmission program. This program works to provide better transitions of care following hospital discharges to help lower readmission rates. Network Health received a 4 Star rating, while the national average Star rating for this area is 3.3 Stars.

Improvements in Network Health’s MTM program resulted in the increase of the Star rating for this measure from 2 Stars in 2017 to 5 Stars in 2018. At Network Health, a new hybrid MTM program was developed to integrate medical and pharmacy data to help qualified Medicare members save money, as well as prevent medication therapy problems, such as harmful drug interactions. 

Additionally, Network Health received a 5 Star rating in a measure evaluating health plan members’ ability to get needed prescription drugs, whereas the national average for this measure is 3.4 Stars.

Earning high Star Ratings continues to become more challenging for health insurance providers, as the health care industry strives to make improvements in services, quality of care and close gaps in member health care. Thresholds for many measures continue to change yearly, making a high Star Rating more difficult to achieve. Last year, health plan performance scores indicate about 19 percent of national health plans earned a rating of 4.5 Stars. Only about 15 percent achieved 4.5 Stars this year. Out of 384 plans, which received a 2018 Star Rating, just 15 were awarded 5 Star ratings, 57 plans, including Network Health, achieved a 4.5 Star rating. 4 Star ratings were awarded to 98 plans; and the largest percentage of plans, 139, achieved only 3.5 Stars.