UPMC Health Plan
Pittsburgh (Oct. 12, 2022) – UPMC Health Plan announced today that UPMC for Life has AGAIN earned an excellent 5 out of 5 overall star rating from the Centers for Medicare & Medicaid Services (CMS) for 2023 and Accreditation from the National Committee for Quality Assurance (NCQA) for both our HMO and PPO plans. This makes UPMC for Life the BEST quality Medicare plan in Pennsylvania and better than 96% of Medicare Advantage plans nationally.
With these great accomplishments and our new and improved benefits for 2023, UPMC for Life now has the lowest priced, highest quality 5-star Medicare Advantage plans in Pennsylvania.
Plus, UPMC for Life's Special Needs Plan (SNP) in Western and Central Pennsylvania earned an Above Average star rating of 4.5, the highest in Pennsylvania. That means all UPMC for Life HMO, PPO, and Western and Central PA SNP members will be enrolled in plans with a high overall star quality rating.
"By recognizing our Medicare plans, CMS confirms what our members already know: UPMC Health Plan is committed to providing access to the best care, the best coverage, and the best customer service each and every time," said Diane Holder, president, and CEO, UPMC Health Plan. "From our clinical and quality leadership to our award-winning Member Services teams, we work exceptionally hard to deliver the best member experience possible, as indicated by these top Medicare ratings."
Additionally, UPMC Health Plan's Medicaid managed care plan, UPMC for You, earned Health Equity Accreditation and Health Equity Plus Accreditation status from the National Committee for Quality Assurance (NCQA), which recognized the UPMC for You's commitment to results related to diversity, equity, and inclusion for both its employees and members.
NCQA's Health Equity Accreditation evaluates how well an organization has established a standardized framework for turning health equity into a culture of continuous improvement. The organization builds an internal culture that supports diversity, equity, and inclusion; collects data to understand population demographics; offers language services and provider networks that consider individuals' cultural and linguistic needs; and identifies opportunities to reduce health inequities and improve care. The Health Equity Accreditations are just one more demonstration of the mission-driven commitment to quality, along with leading community-driven initiatives that mitigate health disparities in the communities UPMC Health Plan serves.
"These accomplishments reflect our commitment to continuous improvement, mitigating disparities in health care, and providing our vulnerable members and patients the very best in clinical care and service," said Carrie Whitcher, Chief Quality Officer and Vice President of Quality Performance, UPMC Insurance Services. "Our network of high-quality physicians and dedicated employees maintain an unwavering promise to keep people healthy."
How Plans Are Rated
The CMS Medicare Star Ratings Program focuses on measures related to person-centered care, equity, safety, affordability and efficiency, treatment of chronic conditions, wellness and prevention, seamless care coordination, and behavioral health. These measures follow five broad categories that emphasize and promote patient perspectives of care including: Outcomes, Intermediate Outcomes, Patient Experience, Access, and Process.
Plans are rated on a one to five scale, with one star representing a poor performance and five stars representing excellent performance. Star Ratings are released annually and reflect the experiences of individuals enrolled in Medicare Advantage and Part D prescription drug plans. The Star Ratings system supports CMS’ efforts to empower Medicare beneficiaries to make health care decisions that are best for them. The document describing the methodology for creating the Part C & D Star Ratings is displayed on the Medicare Plan Finder (MPF) at medicare.gov and on CMS's website.
Every year, Medicare evaluates plans based on a 5-star rating system. For more information on UPMC Health Plan’s awards visit upmchealthplan.com/best. UPMC for Life is the lowest priced, 5-star plan in Pennsylvania based on premium and maximum out-of-pocket costs. UPMC for Life is a product of and operated by UPMC Health Plan Inc., UPMC Health Network Inc., UPMC Health Benefits Inc., and UPMC Health Coverage Inc.
About UPMC Insurance Services
The UPMC Insurance Services Division serves 4 million members and is owned and operated by UPMC, a world-renowned health care provider and insurer in Pittsburgh, Pennsylvania. The UPMC Insurance Services Division provides commercial products through UPMC Health Plan for both groups and individuals. Its commercial products also include workers’ compensation and employee assistance from nationally known Workpartners®. Government products include Medicare Advantage plans (UPMC for Life); Special Needs Plans for those who are eligible for Medicare and Medical Assistance (UPMC for Life Complete Care and UPMC Community HealthChoices); a Medical Assistance plan (UPMC for You); and Children’s Health Insurance Program plans (UPMC for Kids). Community Care Behavioral Health Organization—one of the nation’s largest nonprofit managed care behavioral health organizations—is also part of the Insurance Services Division. Community Care offers a full range of services to commercial and Medical Assistance members. For more information, visit upmchealthplan.com.
UPMC for Life has a contract with Medicare to provide HMO, HMO SNP, and PPO plans. The HMO SNP plans have a contract with the PA State Medical Assistance program. Enrollment in UPMC for Life depends on contract renewal. UPMC for Life is a product of and operated by UPMC Health Plan Inc., UPMC Health Network Inc., UPMC Health Benefits Inc., and UPMC Health Coverage Inc.