Best Practice Guidelines


CMS (Center for Medicare and Medicaid Services) rates Medicare Advantage plans on combination of measures that are captured through member surveys, HEDIS data and administrative data.

CMS uses a method in which they score each measure category by “weight”. The higher the weight of the measure the more impact that measure will have on the overall star score. For example: Breast Cancer Screening is weighted a (1) and Diabetes Care is weighted a (3). So, Diabetes Care will have 3 times the impact of the overall star score.

These measures are related to senior members only.


P4P (Pay for Performance) is a means of attaching financial incentives to clinical care objectives. Using measurable metrics, a percentage of physician compensation can be tied to achieving specific clinical standards in the care they provide.

These measures are related to commercial/senior members