Skip to main content
Back to The Full Scoop

HEDIS, star measures and nutrition

Get an overview of how most plans measure effectiveness and clinical quality.

August 22, 2019

HEDIS, star measures and nutrition

Most health plans measure effectiveness and clinical quality, in part, through the Healthcare Effectiveness Data and Information Set (HEDIS) and the Centers for Medicare & Medicaid Services (CMS) Five-Star Quality Rating System. Nutrition benefits design can improve both sets of scores.

HEDIS versus star ratings

Today, all Medicare Advantage (MA) plans are tied to HEDIS and star measures. HEDIS is a set of standardized performance measures intended to provide purchasers and consumers with the information they need to make reliable comparisons of health plan performance. The measures also tie to significant public health issues, such as cancer, heart disease, smoking, asthma and diabetes.

HEDIS reports have become a major component of quality rating systems that measure the clinical quality performance of health plans by CMS, states offering Medicaid and other entities.

Since 2007, CMS has used a 5-Star Quality Rating System to measure how well providers and MA plans provide service to members. The rating system is comprised of a variety of criteria, including performance measures from HEDIS and member satisfaction scores.

The CMS star rating system ranks plans on how successfully they perform in five categories:

  1. Staying healthy: screenings, tests and vaccines
  2. Managing chronic (long-term) conditions
  3. Plan responsiveness and care
  4. Member complaints, problems getting services and choosing to leave the plan
  5. Health plan customer service

There is a strong incentive for MA plans to perform at peak level — plans achieving a five-star rating may enroll new members all year long, versus only at enrollment periods. Plus, Medicare beneficiaries are allowed to switch between five-star rated MA plans at any time during the year, provided they meet the plan requirements.

How does nutrition fit in?

Quality nutrition is closely linked to several of the CMS star rating system categories because of nutrition’s ability to effectively prevent and manage chronic conditions, including heart disease, diabetes, renal disease and obesity. Treating chronic conditions is important as 85 percent of adults have at least one chronic condition and 90 percent of health care spending is due to chronic disease. Nutrition benefits — like medically tailored, home-delivered meals programs — can improve total cost of care for health plans and ultimately help boost a plan’s star ratings.

According to research, a chronic care meals program for members with chronic disease can lower total cost of care for members by up to 40 percent. Another study shows that members who receive meals have:

  • 50% fewer hospital readmissions
  • 37% shorter lengths of inpatient stay
  • 31% lower total cost of care

Further, with the additional flexibility allowed for Special Supplemental Benefits for the Chronically Ill (SSBCI) in the Medicare Advantage and Part D Call Letter, released by the CMS in April 2019, MA plans can now offer meal benefits to chronically ill enrollees if they have a “reasonable expectation of improving or maintaining the health or the overall function of an individual.”

In addition to helping members stay healthy and manage chronic conditions, health plans that offer meals also make a positive impression on their members. Data from a 2022 Mom’s Meals® survey shows that 97 percent of MA plan members who used their meal benefit were more likely to retain their plan and they were almost twice as likely to recommend their plan as well.

Without a doubt, MA plans face fierce competition when it comes to attracting and retaining members. As consumers shop for the health plan that best suits their needs and their pocketbook, they may just be looking to the stars for answers.

Improving Outcomes and Star Ratings Through Food and Nutrition Benefits Design

Mom's Meals can help

Discover how to improve your plan’s star ratings by incorporating medically tailored, home-delivered meals benefits with our Guide for Medicare Advantage Plan Product and Clinical Teams: Improving Outcomes and Star Ratings Through Food and Nutrition Benefits Design.