Optima Health Medicare Ranks Among Top National Plans

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Receiving 4.5 out of 5 Stars, Optima Medicare HMO ranks among the top 2017 CMS-rated plans in U.S. Optima Medicare listed in U.S. News Best Medicare Advantage Plans 2017.

We improve health every day.

We improve health every day.

A first time Star Rating of 4.5 is very rare, and a very significant result.

Ranking among the top Medicare Advantage Prescription Drug plans in the United States, Virginia-based Optima Health received an overall Star Rating of 4.5 out of 5 from the Centers for Medicare & Medicaid Services (CMS) for its 2017 plan, Optima Medicare. Optima Medicare was also listed in the U.S. News Best Medicare Advantage Plans 2017, which is based on the government’s Star Ratings, as well as an independent rating methodology. 2017 is the first year Optima Medicare has been eligible to be awarded an overall CMS quality rating, due to its being new in the market.

“A first time Star Rating of 4.5 is very rare, and a very significant result,” said Michael Dudley, CEO of Optima Health. “We see this incredible success as a result of the integrated clinical and pharmacy partnerships we are forging to help us exceed the quality measures set forth by CMS, and to achieve the healthiest outcomes for our members.”

The current CMS Star Rating strategy is designed to support three all-encompassing goals: better care, healthier people and communities, and lower-cost care. Particularly, the ratings provide a measurement of quality across nine domains of member outcomes and experience with a Medicare plan’s Parts C and D.

In the Part C domain “Staying Healthy: Screening, Tests and Vaccines,” Optima Medicare achieved 5 Stars, the highest possible rating, for all quality measures that contribute to its overall Star Rating. These measures encompass whether members received an annual flu vaccine and appropriate screenings for certain cancers, monitored their physical activity and assessed adult BMI. Five-Star Ratings were also achieved for measures within “Managing Chronic Conditions,” including control of blood sugar and blood pressure, and lowered hospital readmission rates.

To help achieve good outcomes and consistent good health for members, Optima Health has established clinical and pharmacy partnerships. "We have worked closely with Optima Health and our providers at Sentara Medical Group and Eastern Virginia Medical School Medical Group to create a remarkably successful model of care for our patients, and the Star Ratings demonstrate that,” said Dr. Daniel Dickinson, Medical Director for Clinical Integration, and Clinical Chief Internal Medicine for Sentara Medical Group. “We are proud of our success, and we are continuously striving to achieve even better results.”

One tool used by CMS to capture Star Ratings is the Consumer Assessment of Healthcare Providers and Systems (CAHPS). Optima Medicare CAHPS scores for “Member Experience with Health Plan” also contributed to 5-Star Ratings for members’ opinions of how easy it is to get needed care and how quickly they could get it; as well as their rating of health care quality, and how well the plan coordinates care.

For the Part D domain “Member Experience with the Drug Plan,” Optima Medicare achieved 5 Stars for members’ rating of the drug plan. The company also achieved 5 Stars for measures within “Drug Safety and Accuracy of Drug Pricing,” for providing accurate prescription drug pricing information and ensuring members with hypertension regularly fill their blood pressure medication.

CMS Star Ratings provide information for Medicare beneficiaries on the quality of plans to assist them in choosing their health and drug services during the annual fall open enrollment period. The ratings also have the effect of improving the quality of care and health status for Medicare beneficiaries.

Optima Medicare is an HMO with a Medicare contract. Enrollment in Optima Medicare HMO is dependent upon contract renewal.

Medicare evaluates plans based on a 5-Star Rating system. Star Ratings are calculated each year and may change from one year to the next.

About Optima Health Optima Health, based in Virginia, provides health insurance coverage to approximately 450,000 members. With 30 years of experience in the health insurance arena, Optima Health offers a suite of commercial products including consumer-directed, employee-owned and employer-sponsored plans, individual health plans, employee assistance programs and plans serving Medicare and Medicaid enrollees. Our provider network features 26,000 providers including specialists, primary care physicians and hospitals across Virginia. Optima Health offers programs to support members with chronic illnesses, customized wellness programs and integrated clinical and behavioral health services, as well as pharmacy management – all to help our members improve their health. Our goal is to provide better health, to be easy to use and offer services that are a great value. To learn more about Optima Health, visit http://www.optimahealth.com. (1)

(1) The membership figure includes total membership in all group and individual insured products, Medicare Managed Care Plans, Medicaid and Famis Plans, and self-funded health plans issued or administered by Optima Health. Total Medical Membership based on Membership History Report, June 2016. Includes members from all Optima Health Licenses, products, Medicare and Medicaid products. Optima Health is the trade name of Optima Health Plan, Optima Health Insurance Company, and Sentara Health Plans, Inc. Optima PPO plans, and Medicare Managed Care Plans are underwritten or administered by Optima Health Insurance Company. Optima Vantage HMO plans, Medicaid, and Famis products are underwritten or administered by Optima Health Plan. Sentara Health Plans provides administrative services to self-funded plans but does not underwrite benefits. Employee Assistance Programs (EAP) are administered by Optima Behavioral Health Services, Inc. Wellness programs are administered by Sentara Health Plans. Source for provider network is Optima Health, Provider Status Report, February 2016.

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Pamela Walters
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