What is Medicare?

Medicare is a federal health insurance program for people who are 65 or older as well certain younger people with disabilities. To ensure that beneficiaries receive high quality care, the Centers for Medicare & Medicaid Services (CMS) established quality measures to evaluate healthcare systems and insurance providers. In this article, we cover what quality measures include, their goals, and how language support for limited English proficiency (LEP) beneficiaries impacts these metrics.

What Are Medicare Quality Measures?

Quality Measures are tools that help the CMS measure or quantify:

• Healthcare processes
• Outcomes
• Patient perceptions
• Organizational structure and/or systems that provide healthcare and/or relate to one or more quality goals for health care

These measures are used to evaluate whether a healthcare organization’s processes meet the following goals:

• Effective
• Safe
• Efficient
• Patient-centered
• Equitable
• Timely care

The CMS collects this data in a variety of ways including:

• Insurance claims
• Assessment registries
• Chart abstraction registries

Medicare Advantage, Prescription Drug Plans, and Quality Scores

Although Medicare covers a major portion of healthcare costs, it doesn’t cover everything. Because of this, people who are eligible for Medicare may decide to enroll in a Medicare Advantage plan or purchase a prescription drug plan.

Medicare Advantage (Medicare Part C) plans provide all the same benefits as Medicare, but are managed through a private health insurer. They often include additional coverage for vision, hearing, prescriptions, and other services for a monthly premium.

Medicare prescription drug plans (Medicare Part D) help cover the costs of medications that Medicare doesn’t cover. These plans can be paired with Original Medicare, but not with a Medicare Advantage plan.

To ensure these privately managed plans meet quality standards, the CMS developed a star rating system. Plans are rated from 1 to 5 stars, with 1 indicating poor performance and 5 indicating excellent performance. The organization publishes these quality ratings for Medicare Part C and D plans every year. Plans that earn 4 or 5 stars earn Quality Bonus Payments (QBPs), which can amount to an extra 5% per member annually.

How Language Services Impact Quality Scores for Health Plans

The CMS bases star ratings on a formula that examines a series of indicators, including the Accuracy and Accessibility Study. To ensure that Medicare Advantage (Part C) and Medicare Prescription Drug Benefit Plans (Part D) are providing language access, CMS conducts the study between February and June by placing calls to insurance call centers to evaluate their performance in assisting LEP callers. The study measures the availability of over-the-phone (OPI) interpreters as well as the accuracy of the information representatives provide.

Language Support Through Remote Interpreting  

By ensuring that LEP beneficiaries have access to interpreters, health plans not only improve heath outcomes but receive better ratings and more funding.

However, consistently providing that language support can be difficult without an interpretation platform such as Boostlingo. With Boostlingo, you connect with interpreters who speak over 300 languages within minutes –either over the phone or via video remote. With our open API, Boostlingo can route directly into your call centers routing system to help you connect to qualified interpreters.

How are you meeting Medicare’s language requirements? Let us know in the comments!