part c star
prt_c_star_rtgDefinition
ISO-11179 Definition
The CMS summary quality star rating assigned specifically to the medical benefit component of a Medicare Advantage plan, reflecting performance on clinical quality measures, member experience surveys, and health plan administrative metrics separate from the Part D prescription drug benefit rating. Part C stars are calculated from HEDIS clinical effectiveness measures covering preventive care and chronic disease management, CAHPS member experience surveys measuring satisfaction with care and the health plan, Health Outcomes Survey functional status measures, and CMS administrative measures tracking appeals and complaints. Plans earning four or more Part C stars qualify for quality bonus payments that increase capitation revenue.
Healthcare data teams build Part C star analytics that calculate measure-level performance rates across all applicable HEDIS and CAHPS measures, apply CMS weighting methodology, project summary Part C star ratings under current performance trajectories, and identify the specific measure improvements needed to achieve four-star or five-star ratings that unlock quality bonus payments.
Standard Abbreviation
prt_c_star_rtg
Category
Production DDL — FACT_QUALITY_MEASURE
CREATE OR REPLACE TABLE FACT_QUALITY_MEASURE (
qlty_key INTEGER NOT NULL -- surrogate key,
mbr_key INTEGER NOT NULL -- FK to DIM_MEMBER,
plan_key INTEGER NOT NULL -- FK to DIM_PLAN,
meas_yr SMALLINT -- measurement year,
hedis_meas_cd VARCHAR(20) -- HEDIS measure code,
denom_ind CHAR(1) -- denominator eligible,
numer_ind CHAR(1) -- numerator met,
excl_ind CHAR(1) -- exclusion indicator,
gap_open_ind CHAR(1) -- care gap open,
star_rtg_nbr DECIMAL(3,1) -- star rating,
qlty_scr DECIMAL(5,2) -- quality score,
perf_thrsh_pct DECIMAL(5,2) -- performance threshold,
raf_scr DECIMAL(10,3) -- risk adjustment factor,
outreach_cnt SMALLINT -- outreach attempts,
load_dt TIMESTAMP_NTZ NOT NULL -- load timestamp
);
Standard Snowflake DDL for the canonical quality table. Convert to BigQuery or Databricks →
Why This Term Matters
Quality measure data determines how payers and providers are rated and reimbursed under CMS Stars, HEDIS, and value-based care contracts. Data engineers who understand quality terminology build measure calculation pipelines that correctly attribute patients, apply denominator exclusions, and flag documentation gaps before submission deadlines. Incorrect quality data directly affects star ratings, pay-for-performance bonuses, and Medicare Advantage plan bids.
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