star rating
star_rtg_nbrDefinition
ISO-11179 Definition
The CMS summary quality rating assigned to Medicare Advantage and Part D prescription drug plans on a scale of one to five stars reflecting plan performance on clinical quality measures, member experience surveys, and administrative efficiency metrics. Star ratings are calculated annually from HEDIS clinical measures, CAHPS member experience surveys, Health Outcomes Survey functional status measures, and CMS administrative measures covering appeals, complaints, and call center performance. Plans earning four or more stars qualify for quality bonus payments that significantly increase capitation revenue and enable enhanced benefits for members.
Five-star plans receive the highest bonus and can market year-round outside normal enrollment periods. Healthcare data teams build star ratings analytics pipelines that calculate measure-level performance rates, apply CMS cut points to determine star levels for each measure, weight measures according to CMS methodology to calculate domain and overall star ratings, and project final star ratings throughout the measurement year to guide quality improvement prioritization.
Standard Abbreviation
star_rtg_nbr
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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