part d star
prt_d_star_rtgDefinition
ISO-11179 Definition
The CMS summary quality star rating assigned specifically to the prescription drug benefit component of a Medicare Advantage Prescription Drug plan or standalone Part D plan, reflecting performance on medication adherence measures, drug safety indicators, member experience with pharmacy services, and Part D administrative metrics. Part D stars are calculated from medication adherence measures for diabetes medications, hypertension medications, and cholesterol medications, drug safety measures including high-risk medication use in elderly members, member ratings of drug plan performance from CAHPS surveys, and CMS administrative measures tracking formulary accuracy and appeals. Medication adherence measures carry triple weight in Part D star calculations making them the single highest-priority area for quality improvement investment.
Healthcare data teams build Part D star analytics that calculate medication adherence rates using pharmacy claims data, identify members with low adherence who are candidates for medication therapy management outreach, project Part D star ratings under current pharmacy performance trajectories, and model the revenue impact of improving medication adherence rates on Part D star bonus payments.
Standard Abbreviation
prt_d_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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