And Maintains the Position of the Only Health Plan in Massachusetts to be Rated as 5-Star

A 5‑star rating is Medicare’s highest rating and reflects a plan’s overall performance. Medicare determines a plan’s overall performance rating based on information from member satisfaction surveys, HEDIS (quality effectiveness data) results, and CMS monitoring data. A plan can get a rating between one and five stars. These ratings help prospective members compare plans based on quality and performance.

The overall score for quality covers both medical and pharmacy, and includes 53 different topics in 9 categories:

1. Staying healthy: screenings, tests, and vaccines
2. Managing chronic (long-term) conditions
3. Ratings of health plan responsiveness and care
4. Health plan member complaints and appeal
5. Health plan telephone customer service
6. Drug plan customer service
7. Drug plan member complaints and Medicare audit findings
8. Member experience with drug plan
9. Drug pricing and patient safety

Prospective members have the opportunity to switch to a 5-star plan at any time during the year by using a Special Enrollment Period (SEP), not just during the Annual Enrollment Period (AEP), which runs from October 15^th through December 7^th.  HNE will actively market year-round to reach Medicare beneficiaries who would like to make a change after the AEP.

“We are extremely proud to achieve a second-year 5-star designation. HNE’s quality program is comprehensive. It is focused on ensuring that high-quality, cost-effective care and services are provided to all HNE members, regardless of the type of coverage they have with us. In addition to Medicare Advantage Plans, HNE offers Employer Group and Individual Health Plan options, and is a provider for MassHealth. With leadership from Pat Scheer, Director of Quality Operations, HNE has an annual quality improvement plan, a Quality Management Committee that guides our quality program, and several internal committees that manage the clinical and service quality improvement initiatives. This rating is a testament to all the hard work we do with our members and providers. I congratulate the entire organization for focusing on quality and achieving the best results possible,” said Peter Straley, HNE president and CEO.