Higher Star Ratings Research Articles

The Roles of Cost and Quality Information in Medicare Advantage Plan Enrollment Decisions: an Observational Study.

To facilitate informed decision-making in the Medicare Advantage marketplace, the Centers for Medicare & Medicaid Services publishes plan information on the Medicare Plan Finder website, including costs, benefits, and star ratings reflecting quality. Little is known about how beneficiaries weigh costs versus quality in enrollment decisions. We aimed to assess associations between publicly reported Medicare Advantage plan attributes (i.e., costs, quality, and benefits) and brand market share and beneficiaries' enrollment decisions. We performed a nationwide, beneficiary-level cross-sectional analysis of 847,069 beneficiaries enrolling in Medicare Advantage for the first time in 2011. Matching beneficiaries with their plan choice sets, we used conditional logistic regression to estimate associations between plan attributes and enrollment to assess the proportion of enrollment variation explained by plan attributes and willingness to pay for quality. Relative to the total variation explained by the model, the variation in plan choice explained by premiums (25.7%) and out-of-pocket costs (11.6%) together explained nearly three times as much as quality ratings (13.6%), but brand market share explained the most variation (35.3%). Further, while beneficiaries were willing to pay more in total annual combined premiums and out-of-pocket costs for higher-rated plans (from$4,154.93 for 2.5-star plans to $5,698.66 for 5-star plans), increases in willingness to pay diminished at higher ratings, from $549.27 (95%CI: $541.10, $557.44) for a rating increase from 2.5 to 3 stars to $68.22 (95%CI: $61.44, $75.01) for an increase from 4.5 to 5 stars. Willingness to pay varied among subgroups: beneficiaries aged 64-65years were more willing to pay for higher-rated plans, while black and rural beneficiaries were less willing to pay for higher-rated plans. While beneficiaries prefer higher-quality and lower-cost Medicare Advantage plans, marginal utility for quality diminishes at higher star ratings, and their decisions are strongly associated with plans' brand market share.

How Smart are Smartphone Apps for Smoking Cessation? A Content Analysis

Smartphone technology is ideally suited to provide tailored smoking cessation support, yet it is unclear to what extent currently existing smartphone "apps" use tailoring, and if tailoring is related to app popularity and user-rated quality. We conducted a content analysis of Android smoking cessation apps (n = 225), downloaded between October 1, 2013 to May 31, 2014. We recorded app popularity (>10,000 downloads) and user-rated quality (number of stars) from Google Play, and coded the existence of tailoring features in the apps within the context of using the 5As ("ask," "advise," "assess," "assist," and "arrange follow-up"), as recommended by national clinical practice guidelines. Apps largely provided simplistic tools (eg, calculators, trackers), and used tailoring sparingly: on average, apps addressed 2.1 ± 0.9 of the 5As and used tailoring for 0.7 ± 0.9 of the 5As. Tailoring was positively related to app popularity and user-rated quality: apps that used two-way interactions (odds ratio [OR] = 5.56 [2.45-12.62]), proactive alerts (OR = 3.80 [1.54-9.38]), responsiveness to quit status (OR = 5.28 [2.18-12.79]), addressed more of the 5As (OR = 1.53 [1.10-2.14]), used tailoring for more As (OR = 1.67 [1.21-2.30]), and/or used more ways of tailoring 5As content (OR = 1.35 [1.13-1.62]) were more likely to be frequently downloaded. Higher star ratings were associated with a higher number of 5As addressed (b = 0.16 [0.03-0.30]), a higher number of 5As with any level of tailoring (b = 0.14 [0.01-0.27]), and a higher number of ways of tailoring 5As content (b = 0.08 [0.002-0.15]). Publically available smartphone smoking cessation apps are not particularly "smart": they commonly fall short of providing tailored feedback, despite users' preference for these features.

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Does advertising spending improve sales performance?

Hotel managers and investors commonly analyze the impact of advertising spending on firm performance. This paper investigates such an impact using a comprehensive framework incorporating the moderating effects of hotel size and star ratings. We estimated sales performance via dynamic, stochastic frontier modelling. Using longitudinal data from a sample of Slovenian and Croatian hotels, we demonstrate that advertising spending has a positive impact on hotel sales performance, and that the relationship strengthens for larger hotels and hotels with higher star ratings. Theoretical and managerial implications along with directions for future research are also discussed.

Is there an association between the high-risk medication star ratings and member experience CMS star ratings measures?

Methods to achieve high star ratings for the High-Risk Medication (HRM) measure are thought to result in unintended consequences and to compromise several member experience measures that ultimately put at risk the plan sponsor's Medicare Part D Centers for Medicare Medicaid (CMS) star rating. To determine if HRM scores are associated with relevant member experience measure scores. This is a cross-sectional analysis utilizing CMS 2013 and 2014 plan star ratings reports (2011 and 2012 benefit year data) for Medicare Advantage prescription drug (MA-PD) plans and prescription drug plans (PDPs). Medicare contracts with complete data for all measures of interest in 2013 and 2014 star ratings reports were included (N = 443). Bivariate linear regressions were performed for each of 2 independent variables: (1) 2014 HRM score and (2) 2013 to 2014 change in HRM score. Dependent variables were the 2014 scores for "Getting Needed Prescription Drugs," "Complaints about Drug Plan," "Rating of Drug Plan," and "Members Choosing to Leave the Plan." The bivariate linear regressions demonstrated weak positive associations between the 2014 HRM score and each of the 2014 member experience measures that explained 0.5% to 4% (R2) of variance of these measures. The bivariate regressions for the 2013 to 2014 change in the HRM score and 2014 member experience measures of interest demonstrated associations accounting for 1% to 8% of variance (R2). The greatest associations were observed between each independent variable and the 2014 "Getting Needed Prescription Drugs" score with correlation coefficients of 0.21 and 0.29. HRM star ratings and change in HRM star ratings are weakly correlated with member experience measures in concurrent measurement periods. Plan sponsors may be more aggressive in HRM utilization management, since it is unlikely to negatively impact CMS summary star ratings.

Providing quality services to improve patient outcomes

This past winter I presented to community pharmacists across the country about the impact CMS star ratings are having on pharmacy practice. It is a real possibility that as Medicare prescription drug plans and Medicare Advantage plans with a prescription drug benefit develop their preferred pharmacy networks, pharmacies that are not performing at a certain level may not be part of the plan network and may lose access to some of their patients.

What’s new in Medicare Part D for 2014?

During Medicare’s annual Fall Open Enrollment Period that begins October 15 and ends December 7 (not to be confused with the October 1 start of open enrollment in the health insurance marketplaces established by the Affordable Care Act), people with Medicare can change their Medicare health and drug coverage options such as their Part D plan.Tabled 1Standard benefit20132014Deductible$325$310Initial coverage limit$2,970$2,850Out-of-pocket threshold$4,750$4,550Minimum cost sharing in the catastrophic phaseGeneric/preferred multisource medications$2.65$2.55Other drugs$6.60$6.35Source: CMS ensures greater value for people in Medicare drug and health plans. http://cms.gov/newsroom/ MediaReleaseDatabase/Press-Releases/2013-Press-Releases-Items/2013-04-01.html Open table in a new tab Source: CMS ensures greater value for people in Medicare drug and health plans. http://cms.gov/newsroom/ MediaReleaseDatabase/Press-Releases/2013-Press-Releases-Items/2013-04-01.html These weeks present an opportunity for pharmacists to continue to build relationships with their patients. Pharmacists can remind patients of the dates, talk to patients about what services pharmacists provide, make sure Medicare patients receive medication therapy management (MTM) and “star” ratings information from Part D plans, and explain MTM to patients.■Pharmacists can encourage Medicare patients to ask questions about the benefits included in their Part D plan.■Part D plans with high star ratings often use MTM to boost their score. ■Pharmacists can encourage Medicare patients to ask questions about the benefits included in their Part D plan.■Part D plans with high star ratings often use MTM to boost their score. “Encourage patients to ask questions about the benefits included in their plan,” said Stacie Maass, BSPharm, JD, APhA Senior Vice President of Pharmacy Practice and Government Affairs. “Many patients are eligible for MTM but are unaware of the benefit or do not take advantage of it. Patients who take advantage of their MTM benefit are overwhelmingly happy with the service.” The growing importance of MTM was emphasized in CMS’s advance notice and call letter for 2014—an annual guidance document for Medicare Advantage and Part D prescription drug plans that was released April 1. In the guidance, CMS also outlined a policy for avoiding fraud, waste, and abuse in mail-order services. In addition, the Part D “donut hole” will continue to close gradually in 2014. Medicare health and prescription drug plans are rated on their performance on a scale of one star (“Poor”) to five stars (“Excellent”). The overall star ratings are available at Medicare.gov/find-a- plan. These star ratings can be used to compare plans to find the best plan for the patient. “Star ratings should be highlighted in the discussion with the patient,” said Jillanne Schulte, JD, APhA Director of Regulatory Affairs. In the guidance for 2014, CMS reported that it is aware of high-performing plans using MTM services to improve their Part D star ratings. Of note, Medicare patients can switch to a Medicare prescription drug plan rated five stars during a 5-Star Special Enrollment Period from December 8,2013, to November 30,2014, according to the 2014 Medicare & You handbook. Patients can only switch to a five-star plan if one is available in their area, and can only use the Special Enrollment Period once during these dates. CMS will continue to promote beneficiaries’ awareness of MTM services through the 2014 Medicare & You hand book, on Medicare.gov, through the new MTM tab on the plan finder, and the requirement that plans have a dedicated “Medication Therapy Management Program” page linked from the Medicare drug plan website. In the guidance for 2014, CMS encouraged Part D plans to require mailservice and community pharmacies to obtain patient consent to deliver a new or refill prescription, before each delivery, including refills or new prescriptions received directly from the physician. The new policy doesn’t apply when the patient actively requests the new prescription or refill, according to Schulte. While the idea is to avoid fraud, waste, and abuse from unnecessary refills, APhA recommended in March 1 comments on the draft guidance that CMS consider additional steps in which a patient or caregiver could select their own preferences for use of an auto-refill or ship program to avoid generating too many phone calls to the patient. The Part D donut hole will continue to close gradually under the Medicare Coverage Gap Discount Program in the Affordable Care Act. In 2014, Medicare patients in the donut hole (who don’t qualify for the low-income Extra Help program) will pay 47.5% of the cost for brand-name drugs and 72% of the cost for generic drugs.

Evaluating the energy and carbon reductions resulting from resource-efficient household stock

The nexus of water and energy and greenhouse gas emissions is now well recognised, however, quantifying the energy savings from (hot) water-efficient technologies has been largely based on modelled or assumed consumption data from water use appliances and fixtures. The aim of this paper is to determine water, energy and greenhouse gas emission savings from resource-efficient household stock using empirical water end-use data and detailed stock specifications for homes in Queensland, Australia. Hot water system type is considered with comparisons made between intervention scenarios with and without inclusion of a low energy heating system. The results confirm the significant impact that coal-fired electricity water heating has on total household energy consumption. Further, it appears that substantial savings can be achieved by substituting water (e.g. high star rating appliances) and energy (e.g. solar hot water system) efficient appliances in the home. The findings also suggest that retrofitting cheaper resource-efficient technologies are still an effective means of reducing both water and energy consumption, regardless of hot water system type. Future work in this area is needed to expand the current research outcomes, such as the consideration of all thermal losses from heating systems and the use of empirical energy end-use data.

Hotel Characteristics and Seasonality in Prices: An Analysis Using Spanish Tour Operators' Brochures

Seasonality in the tourism sector has been a major concern for policy makers, managers and other stakeholders. Many studies have analysed seasonality from the point of view of the number of visitors. However, there appear to be no studies focusing on seasonality in prices and on how to smooth out seasonal patterns. This paper analyses how hotel characteristics affect seasonality in prices using brochure data on 1,776 hotels in 32 sun-and-beach destinations in 11 countries. The authors find that, after controlling for destination-specific variables that may cause variations in prices through demand shifts (such as climatic conditions, exchange rates or marketing expenditures), more hotel services and higher star ratings are associated with fewer seasonal variations in hotel prices.

Design methodology to reduce the chest deflection in US NCAP and EURO NCAP tests

There have not been many studies on the factors that affect chest deflection, although the US NCAP thoracic injury criterion was recently shifted from the 3-msec clip to chest deflection. This study explored these factors and proposed a design methodology for the factors to minimize chest deflection. Because injuries can become severe if the driver crashes against the vehicle interior, this study also sought a solution using a penalty function to prevent crashes with the interior and minimize injuries. First, a MADYMO model was made to simulate US NCAP and EURO NCAP tests by one-to-one and stochastic verifications. Second, a sensitivity analysis was conducted to find the major factors that affect chest deflection. Lastly, the factors identified via the sensitivity analysis were optimized to propose design guidelines that helped vehicles receive high star ratings in US NCAP and EURO NCAP tests and helped minimize the possibility of hard contact between the driver and the vehicle interior by utilizing a penalty function and the Taguchi method.

Representation of Destination Cultural Factors on Hotel Websites: Content Analysis of Beijing Hotel Websites

The extant tourism literature contains virtually no studies examining the issue of destination culture in the context of hotel website evaluations. The research presented herein examined 168 Beijing hotel websites. Content analysis of these websites was carried out using 12 destination cultural factors identified by the researchers. The aim was to examine whether the performance of the hotel websites under investigation differed in terms of these factors by hotel category. The results indicate that the majority of Beijing hotels do not include destination cultural factors on their websites. Although the websites of privately owned, chain, and international hotels, as well as those with higher star ratings were found to feature more of these factors, the differences were not statistically significant. Among the 12 destination cultural factors identified, Forbidden City was the most commonly included on the hotel websites, and Temple Fair and Pet Birds were completely absent.

Assessment of climate change impact on residential building heating and cooling energy requirement in Australia

This study investigated the potential impact of climate change on the heating and cooling (H/C) energy requirements of residential houses in five regional climates varying from cold to hot humid in Australia. Nine General Circulation Models (GCMs) under three carbon emission scenarios were applied to project the local climate. It was found that significant climate change impact on H/C energy requirements may occur within the lifespan of existing housing stock. The total H/C energy requirement of newly constructed 5 star houses is projected to vary significantly in the range of −26% to 101% by 2050 and −48% to 350% by 2100 given the A1B, A1FI and 550 ppm stabilisation emission scenarios, dependent on the existing regional climate. In terms of percentage change, houses in an H/C balanced temperate climate such as Sydney is found to be the most sensitive to climate change, potentially posing more pressures on the capacity of local energy supply. It was also found that energy efficient or high star rating houses may experience less absolute changes in energy requirement. However, they appear to experience higher percentage changes in the total H/C energy requirement. Especially in the regions with an H/C balanced temperate climate such as Sydney, the increase in the total H/C energy requirement is projected up to 120% and 530% for a 7 star house when the global temperature increases 2 °C and 5 °C respectively. The high sensitivity to global warming may need to be considered in the planning of future energy requirement for energy efficient buildings.

Training and Service Quality—A Case Study Analysis of Regional Australian Restaurants

The incorporation of training procedures, both formal and informal, within hospitality firms is recognised as a vital element in achieving sustainable perceived service quality. Yet, despite this importance, relatively little is known about the extent, nature and determinants of training in hospitality firms in regional Australia. Restaurants in particular have proven hard to analyse because many are what the Australian Bureau of Statistics calls micro-businesses who employ less than five staff, or are small businesses with five to twenty employees, and have little in the way of training resources and expertise in the area. An examination of six restaurants in Northern New South Wales identified that medium sized boutique operations owned and managed by operators with a passion for fine food and service had training policies that were more extensive than larger organisations such as resorts even though the latter often had a higher star rating. It was apparent that organisational size and resources had more of an effect on the adoption of formal training strategies such as induction and the establishment and provision of a formal training manual.

Setting vehicle side impact safety design targets using a regression-based approach

This paper presents a methodology for setting design variable targets for vehicle side impact safety using a statistical data-based approach. It is assumed that vehicles are to be designed for a high star rating in the Lateral Impact New Car Assessment Programme (LINCAP) conducted by the National Highway Traffic Safety Administration (NHTSA). Accordingly, the Thoracic Trauma Index (TTI) is the relevant injury parameter, which is expressed as a function of design variables in the form of a multilinear regression relation. The expression for TTI (front), which has been derived in an earlier work, has been complemented here with a new regression-based relationship for TTI (rear) through extensive statistical analysis of publicdomain LINCAP test data posted by NHTSA. Using 'best subset' regression analysis, significant variables affecting TTI (rear) have been identified and the latter has been expressed as a function of these variables yielding a high degree of correlation with test data. Using a simple computer-based tool, it is shown how numerical targets for design variables can be arrived at within predefined ranges for a given value of TTI (front or rear).

Revenue models in haute cuisine: an exploratory analysis

PurposeThe aim of this paper to shed light on the strategies adopted by chefs and to identify the most successful in terms of Michelin rating and profitability.Design/methodology/approachIn‐depth exploratory interviews with 20 great chefs located in France, Belgium, the UK and Switzerland having gained two or three Michelin stars over the last ten years.FindingsChefs use three different strategies for revenue‐generation: core business, full diversification and partial diversification. The reasoning behind the choice of strategy varies between two‐ and three‐star restaurants. The first strategy seems to lead to higher Michelin star ratings, and strategy, the second seems superior in terms of profitability. The third strategy yields inferior results, but is less risky.Research limitations/implicationsThe observations are constrained to “recently successful” restaurants, and hence may not be applicable to longer‐standing restaurants.Practical implicationsConcentrating on the core business leads to higher star rating, but lower profitability. Full diversification increases profitability but can jeopardize Michelin rating. The middle‐of‐the‐road approach seems inferior in any case.Originality/valueTo this day, little research has been conducted on the way in which great chefs having two or three stars in the famed Michelin Red Guide run their businesses. In particular, very little is known about their revenue‐generating strategies: what options are available and which revenue models are the “best”. This paper is exploratory in nature and aims to inform further research about luxury restaurants.

Performance comparisons of hotels in China

China's hotel industry has only really existed since 1978. In that time, it has grown in size and complexity of ownership. Quality has been improved by the introduction of foreign management techniques and quality standards, for example the star-rating system of hotel classification. This paper compares performance of hotels using various hotel groupings according to ownership, size and star rating. The comparisons indicate that better performance occurs in hotels that have foreign ownership connections (especially those linked to Hong Kong, Macau and Taiwan partners), those that are bigger and those which have a higher star rating. According to the World Tourism Organization, China is forecast to become the world's number one tourist destination by 2020. This paper also identifies the major issues facing the Chinese hotel industry and the government as they face this astounding prediction.