Contract
H3907

UPMC for Life · 2027 Star Ratings

UPMC HEALTH PLAN, INC. · Local CCP

Parent: UPMC Health System

Summary ratings

Overall
4.5
2026: 4.5±0
Part C · health plan
4.5
2026: 4.5±0
Part D · drug plan
4.0
2026: 5.0−1.0

2027 footprint

Members, Sep 2026
129K
2027 plans
18
Open to all ($0 premium)
18 (5)
Counties
65
Special needs plans
None
Drug coverage
Yes
OHPA

Domain stars

Domain20272026Change
HD1Staying Healthy: Screenings, Tests and Vaccines4.03.0+1.0
HD2Managing Chronic (Long Term) Conditions4.04.0±0
HD3Member Experience with Health Plan5.05.0±0
HD4Member Complaints and Changes in the Health Plan's Performance5.05.0±0
HD5Health Plan Customer Service4.04.0±0
DD1Drug Plan Customer Service3.04.0−1.0
DD2Member Complaints and Changes in the Drug Plan's Performance4.05.0−1.0
DD3Member Experience with the Drug Plan5.05.0±0
DD4Drug Safety and Accuracy of Drug Pricing4.04.0±0

Part C measures · health plan

Measure2027 result2027 starsvs 2026
C01Breast Cancer Screening79%4.0±0
C02Colorectal Cancer Screening78%4.0new spec
C03Annual Flu Vaccine67%4.0±0
C04Improving or Maintaining Physical Health70%2.0−1
C05Improving or Maintaining Mental Health87%5.0+3
C06Monitoring Physical Activity46%2.0±0
C07Special Needs Plan (SNP) Care ManagementPlan not required to report measure—
C08Care for Older Adults – Medication ReviewPlan not required to report measure—
C09Care for Older Adults - Functional Status AssessmentPlan not required to report measure—
C10Osteoporosis Management in Women who had a Fracture27%1.0−1
C11Diabetes Care – Eye Exam82%4.0+1
C12Diabetes Care – Blood Sugar Controlled95%5.0±0
C13Kidney Health Evaluation for Patients with Diabetes72%4.0±0
C14Controlling High Blood Pressure84%4.0+1
C15Reducing the Risk of Falling53%2.0±0
C16Improving Bladder Control45%3.0±0
C17Plan All-Cause Readmissions8%5.0+1
C18Statin Therapy for Patients with Cardiovascular Disease91%4.0+1
C19Transitions of Care83%5.0±0
C20Follow-up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions71%3.0−1
C21Getting Needed Care855.0±0
C22Getting Appointments and Care Quickly865.0±0
C23Customer Service945.0±0
C24Rating of Health Care Quality895.0±0
C25Rating of Health Plan915.0±0
C26Care Coordination873.0−1
C27Complaints about the Health Plan0.045.0±0
C28Members Choosing to Leave the Plan4%5.0±0
C29Health Plan Quality ImprovementMedicare shows only a Star Rating for this topic4.0±0
C30Plan Makes Timely Decisions about Appeals100%5.0+1
C31Reviewing Appeals Decisions99%4.0±0
C32Call Center – Foreign Language Interpreter and TTY Availability94%3.0−1

Part D measures · drug plan

Measure2027 result2027 starsvs 2026
D01Call Center – Foreign Language Interpreter and TTY Availability92%3.0−1
D02Complaints about the Drug Plan0.045.0±0
D03Members Choosing to Leave the Plan4%5.0±0
D04Drug Plan Quality ImprovementMedicare shows only a Star Rating for this topic2.0−3
D05Rating of Drug Plan884.0−1
D06Getting Needed Prescription Drugs925.0±0
D07MPF Price Accuracy994.0−1
D08Medication Adherence for Diabetes Medications92%4.0±0
D09Medication Adherence for Hypertension (RAS antagonists)92%4.0−1
D10Medication Adherence for Cholesterol (Statins)91%4.0−1
D11Statin Use in Persons with Diabetes (SUPD)89%3.0±0
D12Concurrent Use of Opioids and Benzodiazepines (COB)12%4.0—
D13Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH)7%4.0—

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