AmeriHealth Caritas’ Two Dual Eligible Special Needs Plans Improve Star Rating to an Overall 4.5 out of 5 from the Centers for Medicare & Medicaid Services

PA Plans 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 that its two Medicare Advantage dual eligible special needs (HMO D-SNP) plans in Pennsylvania earned an overall 4.5-star rating (out of a possible five stars) from the Centers for Medicare & Medicaid Services (CMS) for 2022. The Pennsylvania plans earned this achievement through their commitment to providing quality benefits and services while focusing 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 for AmeriHealth Caritas. “Having our care managers and providers focus on the socioeconomic factors affecting our members has yielded exemplary results. The fact that our Star rating increased even in the midst of a pandemic makes this accomplishment stand out even more.”

“Star ratings tell us about the quality of service we are providing and our plan responsiveness,” said Tonya Moody, AmeriHealth Caritas’ vice president for Pennsylvania Medicare. “While the pandemic has been challenging for all of us, 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, quality management initiatives, and the relationships we have built in the communities we serve all contributed to our increased 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 Medicare Advantage dual eligible special needs (HMO D-SNP) plans in Pennsylvania scored four or five out of five stars in 33 of 39 categories. Highlights include:

• The Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores were a particular area of strength for the two D-SNP plans in Pennsylvania in the areas of both Customer Service and Rating of the Health Plan, each earning five stars.
• Significant improvement was noted in the following additional areas:
• Members’ medication adherence for hypertension, cholesterol and diabetes
• Call Center performance
• The plans helped members stay healthy through increased colorectal screenings and flu vaccinations
• Members’ chronic conditions for rheumatoid arthritis and statin therapy for cardiovascular disease were better managed
• Members got better quality care more quickly.

AmeriHealth Caritas has offered the HMO D-SNP plans since 2013. They began operating statewide in Pennsylvania on Jan. 1, 2020, through service area expansion into the northwest and northeast regions of the state.

Note: Every year, Medicare evaluates plans based on a 5-star rating system. Information in this press release is based on 2022 Star Ratings data published by CMS on October 8, 2021. Star ratings are calculated each year and may change from one year to the next.