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Quality Resources

The Centers for Medicare & Medicaid Services (CMS) uses a five-star quality rating system to measure Medicare beneficiaries’ experiences with health plans and the healthcare system. This star rating system applies to the Medicare Advantage (MA) line of business and is a key component in financing healthcare benefits for MA plan enrollees. Star ratings are posted on the CMS consumer website, www.medicare.gov (link opens in new window), to help beneficiaries choose from the MA plans offered in their areas.

In a healthcare industry increasingly driven by quality, it is imperative that physicians and other clinicians understand how to navigate the ever-changing landscape. CarePlus is here to support healthcare practitioners through the development of educational resources and quality initiatives. We aspire to increase your knowledge of and engagement with the regulatory and accreditation guidelines that drive our quality initiatives and programs.

CarePlus Quality Improvement Program Overview

CarePlus’ Quality Improvement (QI) Program encompasses clinical care, preventive care and member services. Information about our QI program and the progress we’ve made toward our goal can be viewed in the CarePlus Quality Improvement Program Description Overview (PDF opens in new window).

Healthcare providers also can obtain the report by calling CarePlus’ Quality Operations Compliance and Accreditation Department at 1-305-626-5195, Monday – Friday, 8:30 a.m. – 5 p.m., Eastern time.

We welcome your input regarding our QI program. Please send any comments you might have to the following address:

CarePlus Health Plans Quality Operations Compliance & Accreditation Department 3501 SW 160th Ave. Building B First Floor Miramar, FL 33027

Stars Rewards Program

CarePlus’ support of value-based reimbursement is the foundation on which we developed our quality rewards program. We offer financial rewards for improvements in quality, outcomes and cost. We created our Stars Rewards Program to encourage primary care physicians and managed services organizations in their development of population health management capability and focus.

The Stars Rewards Program is a pay-for-value program focused on achieving specific National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS®), Pharmacy Quality Alliance, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Health Outcomes Survey (HOS) measure goals. The Stars Rewards Program provides incentives to physicians and managed services organizations that meet score-weighted average thresholds. Practices and MSOs that achieve these weighted average thresholds receive reward payments.*

*This program is subject to change or termination upon prior notice from CarePlus. The plan reserves the right to offset any amounts owed by your group/vendor with Star rewards earned under this bonus program. Any remaining dollars would be paid to your group/vendor once the balance due has been satisfied.

Stars/Quality Improvement Support

For answers to questions about HEDIS clinical education and reports, Star scores, clinical opportunities and the Stars Rewards Program, contact your Clinical Stars Improvement adviser or email CPHP.STARSDEPT@CarePlus-hp.com.

Provider Services Account Support

For answers to provider/vendor questions or to discuss concerns about payment, membership (including transfers) and status information, contact your provider services executive or call CarePlus’ Provider Operations inquiry line at 1-866-220-5448, Monday – Friday, 8 a.m. – 5 p.m., Eastern Time.

Perfect Experience Program (PXP)

CarePlus’ PXP was designed to enhance the provider and vendor patient experience and improve health outcomes metrics and comprehension. PXP educational consultants support providers and their staff through educational and best-practices presentations, as well as leave-behind educational and informational materials. For more information, email CPHP.STARSDEPT@CarePlus-hp.com.

Care Management Member Satisfaction Surveys

CarePlus’ Care Management Department conducts annual member satisfaction surveys to ensure that we are delivering the perfect care management experience to our members. We use the results to enhance programs that help patients manage their care and improve their health. To receive a copy of these survey results, contact the CarePlus Care Management Department at 1-866-657-5625, Monday – Friday, 8 a.m. – 5 p.m., Eastern Time, or by email at CPHP_HSD_Care_Management_Referrals@humana.com.