When you shop online for a new pair of shoes, you scroll past dozens of options. What’s the most important resource for helping you decide? For a lot of people, it’s the ratings. You trust the reviews, the feedback, and the overall score to guide your purchase.

Now imagine choosing a health plan for your family. The stakes are higher; the options are more complex, but the same principle applies. Health plan star ratings are your guide. 

Health plan star ratings, issued by organizations like the Centers for Medicare & Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA), offer a clear view into how well a health plan performs – how well a plan delivers care, how satisfied members are, and how committed the organization is to improving outcomes. The ratings factor in metrics and data from preventive care and chronic condition management to member satisfaction and medication safety.

Blue Cross NC’s ratings reflect our ongoing commitment to delivering high-quality, member-centered care. Here’s how that translates into real results for you.

Star ratings aren’t just scorecards. They’re a reflection of how well a health plan supports its members. They measure performance across three key areas.

You might have heard of HEDIS, the Health Care Effectiveness Data and Information Set. These scores evaluate how well your doctor delivers overall care like cancer screenings, diabetes management, and vaccinations.

High scores signal better preventive services and chronic care management, which can lead to improved health outcomes and lower long-term health care costs. Choosing a plan with strong HEDIS performance means you're more likely to receive timely, evidence-based care.

That’s important because when preventive services and chronic care management are done well, they help catch health issues early and make it easier to manage conditions like diabetes or hypertension before they become emergencies. This reduces costly hospital visits, ER usage, and complications, ultimately lowering overall health care spending for both consumers and insurers. In short, better-quality care upfront means fewer expensive problems later.

We send surveys to a sample of members every year to assess our performance through member feedback. That information has an influence on stars ratings, too. Consumer Assessment of Health Care Providers and Systems (CAHPS) surveys ask individuals to rate their experiences with health care providers, pharmacies, and plans, including communication, access to care, and customer service. 

That feedback is essential because it highlights real-world experiences that data alone can’t reveal – such as how well providers communicate or how easy it is to get needed care. This information drives improvements in service quality, helps health plans better meet patient needs, and ultimately leads to more personalized, effective, and satisfying care.

We’re extraordinarily proud that Blue Cross NC’s Medicare Advantage PPO plans continue to earn near perfect scores on CAHPS surveys. This reflects our commitment to continually improve, so our members enjoy the best possible experience.

The Pharmacy Quality Alliance (PQA) helps Medicare evaluate how well health plans manage medications, especially for chronic conditions like diabetes, high blood pressure, and high cholesterol. PQA measures look at things like whether members take their medications as prescribed and whether plans offer safe, effective pharmacy services.

These scores directly impact your plan’s Medicare Star Rating, which can affect your benefits, costs, and access to high-quality care.

Bottom line: Choosing a plan with a strong emphasis on medication, safety, and adherence means better health outcomes and fewer complications.

Choosing a health plan is one of the most important decisions you’ll make for yourself and your family. Star ratings offer a transparent, data-driven way to compare quality plans and ensure you’re getting the best possible care.

At Blue Cross NC, we view star ratings as more than a benchmark of where we stand – they’re a roadmap for where we need to go. We’re proud that these ratings reflect our long-standing commitment to quality and to raising the bar every year.