Contract
H3204
Presbyterian Health Plan · 2027 Star Ratings
PRESBYTERIAN HEALTH PLAN · Local CCP · offers special needs plans
Parent: Presbyterian Healthcare Services
Summary ratings
Overall
3.0
2026: 3.0±0
Part C · health plan
3.0
2026: 3.0±0
Part D · drug plan
3.5
2026: 2.5+1.0
2027 footprint
- Members, Sep 2026
- 53K
- 2027 plans
- 3
- Open to all ($0 premium)
- 0 (0)
- Counties
- 33
- Special needs plans
- Dual-Eligible
- Drug coverage
- Yes
NM
Domain stars
| Domain | 2027 | 2026 | Change |
|---|---|---|---|
| HD1Staying Healthy: Screenings, Tests and Vaccines | 3.0 | 4.0 | −1.0 |
| HD2Managing Chronic (Long Term) Conditions | 3.0 | 3.0 | ±0 |
| HD3Member Experience with Health Plan | 3.0 | 2.0 | +1.0 |
| HD4Member Complaints and Changes in the Health Plan's Performance | 5.0 | 5.0 | ±0 |
| HD5Health Plan Customer Service | 4.0 | 3.0 | +1.0 |
| DD1Drug Plan Customer Service | 4.0 | 3.0 | +1.0 |
| DD2Member Complaints and Changes in the Drug Plan's Performance | 5.0 | 4.0 | +1.0 |
| DD3Member Experience with the Drug Plan | 2.0 | 3.0 | −1.0 |
| DD4Drug Safety and Accuracy of Drug Pricing | 3.0 | 3.0 | ±0 |
Part C measures · health plan
| Measure | 2027 result | 2027 stars | vs 2026 |
|---|---|---|---|
| C01Breast Cancer Screening | 75% | 3.0 | ±0 |
| C02Colorectal Cancer Screening | 73% | 3.0 | new spec |
| C03Annual Flu Vaccine | 74% | 5.0 | +1 |
| C04Improving or Maintaining Physical Health | 67% | 2.0 | −1 |
| C05Improving or Maintaining Mental Health | 82% | 2.0 | −1 |
| C06Monitoring Physical Activity | 47% | 2.0 | −2 |
| C07Special Needs Plan (SNP) Care Management | 54% | 2.0 | −1 |
| C08Care for Older Adults – Medication Review | 91% | 3.0 | ±0 |
| C09Care for Older Adults - Functional Status Assessment | 82% | 3.0 | — |
| C10Osteoporosis Management in Women who had a Fracture | 66% | 4.0 | ±0 |
| C11Diabetes Care – Eye Exam | 77% | 3.0 | ±0 |
| C12Diabetes Care – Blood Sugar Controlled | 88% | 3.0 | ±0 |
| C13Kidney Health Evaluation for Patients with Diabetes | 72% | 4.0 | ±0 |
| C14Controlling High Blood Pressure | 75% | 2.0 | ±0 |
| C15Reducing the Risk of Falling | 58% | 3.0 | ±0 |
| C16Improving Bladder Control | 49% | 4.0 | +1 |
| C17Plan All-Cause Readmissions | 9% | 4.0 | +1 |
| C18Statin Therapy for Patients with Cardiovascular Disease | 80% | 1.0 | −1 |
| C19Transitions of Care | 71% | 4.0 | +1 |
| C20Follow-up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions | 55% | 2.0 | ±0 |
| C21Getting Needed Care | 74 | 1.0 | ±0 |
| C22Getting Appointments and Care Quickly | 80 | 2.0 | +1 |
| C23Customer Service | 90 | 3.0 | ±0 |
| C24Rating of Health Care Quality | 85 | 2.0 | −1 |
| C25Rating of Health Plan | 87 | 4.0 | ±0 |
| C26Care Coordination | 86 | 3.0 | +1 |
| C27Complaints about the Health Plan | 0.1 | 5.0 | ±0 |
| C28Members Choosing to Leave the Plan | 5% | 5.0 | ±0 |
| C29Health Plan Quality Improvement | Medicare shows only a Star Rating for this topic | 4.0 | ±0 |
| C30Plan Makes Timely Decisions about Appeals | 100% | 5.0 | ±0 |
| C31Reviewing Appeals Decisions | 96% | 3.0 | +1 |
| C32Call Center – Foreign Language Interpreter and TTY Availability | 98% | 4.0 | +1 |
Part D measures · drug plan
| Measure | 2027 result | 2027 stars | vs 2026 |
|---|---|---|---|
| D01Call Center – Foreign Language Interpreter and TTY Availability | 97% | 4.0 | +1 |
| D02Complaints about the Drug Plan | 0.1 | 5.0 | ±0 |
| D03Members Choosing to Leave the Plan | 5% | 5.0 | ±0 |
| D04Drug Plan Quality Improvement | Medicare shows only a Star Rating for this topic | 5.0 | +4 |
| D05Rating of Drug Plan | 86 | 3.0 | ±0 |
| D06Getting Needed Prescription Drugs | 87 | 1.0 | −1 |
| D07MPF Price Accuracy | 100 | 5.0 | ±0 |
| D08Medication Adherence for Diabetes Medications | 87% | 2.0 | +1 |
| D09Medication Adherence for Hypertension (RAS antagonists) | 89% | 3.0 | +1 |
| D10Medication Adherence for Cholesterol (Statins) | 89% | 3.0 | +1 |
| D11Statin Use in Persons with Diabetes (SUPD) | 84% | 2.0 | ±0 |
| D12Concurrent Use of Opioids and Benzodiazepines (COB) | 6% | 5.0 | — |
| D13Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH) | 7% | 4.0 | — |