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. The Star Ratings 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,
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 physicians and healthcare providers 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 is aligned with the Center for Medicare & Medicaid Services’ (CMS) National Quality Strategy (NQS) and with the Institute of Healthcare Improvement’s (IHI) Quintuple Aim of improving population health, enhancing the care experience, reducing costs, addressing clinical burnout, and advancing health equity.
By incorporating the NQS’ and IHI’s Quintuple Aim into the QI Program description, CarePlus becomes a trusted partner in shaping a resilient, high-value health plan that promotes high-quality, safe, equitable, and accessible care for all our members and the communities we serve.
Information about our QI program and the progress we’ve made toward our goal can be viewed in the
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
6101 Blue Lagoon Drive, Suite 195
Miami, FL 33126
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 savings. We created our Stars Rewards Program to encourage primary care physicians and Managed Services Organizations (MSO) 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 MSOs 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 Stars rewards earned under this bonus program. Any remaining dollars would be paid to your group/vendor once the balance due has been satisfied.
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.
Patient Experience Circle (PXCircle)
As part of the Perfect Experience Program (PXP), we launched the Patient Experience Circle (PXCircle) to help your CarePlus-covered patients play more of a role in their overall health and well-being. With this initiative, we aim to strengthen our relationship with you and your CarePlus-covered patients, while helping them become more involved in their healthcare decisions. Trained healthcare educators will present information relevant to patient experience through education sessions at your location, or members may join PXCircle sessions online through CarePlus Link.
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
