12:22 PM / Thursday June 30, 2022

26 Nov 2020

For second consecutive year AmeriHealth Caritas’ two dual eligible special needs plans earn overall four star rating from the Centers for Medicare & Medicaid Services

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November 26, 2020 Category: Health Posted by:

PA plans nationally recognized for exceptional commitment to quality

For the second consecutive year, 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 received an overall four-star rating (out of a possible five stars) from the Centers for Medicare & Medicaid Services (CMS) for 2021.

The Pennsylvania plans earned this achievement through their commitment to providing quality benefits and services and because of their focus 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 very positive results. The fact that fewer Medicare Advantage plans scored high quality ratings for their plans than last year 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, vice president for AmeriHealth Caritas’ two Medicare Advantage dual eligible special needs (HMO D-SNP) plans in Pennsylvania. “Earning this score for the second consecutive year means we are excelling at helping our members get care and stay well, and that we are building healthy communities. Our integrated care model, and the relationships we have built in the communities in which we serve, all contributed to our high 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 28 of 46 categories. Highlights include:

•  The Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores were a particular area of strength for the two Medicare Advantage dual eligible special needs (HMO D-SNP) plans in Pennsylvania in the areas of both Customer Service and Rating of the Health Plan.

•   The plans’ integrated model of care helped them manage chronic conditions for older adults. Members completed annual medication reviews, an annual pain assessment, and annual Functional Status Assessment. These assessments ask members to answer questions related to areas such as pain management, physical function, emotional well-being, health-related quality of life, and symptom acuity.

•   Two medication measures improved from last year, including medication adherence for those with hypertension and statin use for people with diabetes.

AmeriHealth Caritas has offered the HMO D-SNP plans since 2013. They began offering services in the entire state of 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 2021 Star Ratings data published by CMS on October 8, 2020. Star ratings are calculated each year and may change from one year to the next.

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