MCS receives Five-Star distinction for the second year in a row
- The San Juan Daily Star
- 5 days ago
- 4 min read
For the second consecutive year, among the 521 medical insurance plans available nationwide and the nine locally, only MCS earned the prestigious five-star distinction from the Centers for Medicare and Medicaid Services (CMS).
“This achievement of reaching five stars is not just for MCS; it is a victory for Puerto Rico,” said Lydelisse Ortiz, Vice President of Sales at MCS.
To award this classification, CMS, the federal regulatory agency, applies a series of metrics, audits, analyzes all the data, and then reaches its conclusions. “That’s when they grant us the five stars. Last year, for us, it was a huge achievement because we were the first plan to receive the rating. But achieving it for the second consecutive year is an even greater accomplishment,” Ortiz explained.
One of these metrics is the satisfaction survey conducted with members. The average score in Puerto Rico is 92%, while in the United States, it is 87.4%. In MCS’s case, they achieved 94%, surpassing the average. “Our commitment has always been to be innovative in making a difference in the industry by offering health benefits within our Medicare Advantage plans.”
Achieving this accomplishment does not happen in a vacuum; it is the result of teamwork forged by MCS staff and the 20,000 service providers, including clinical laboratories, pharmacies, therapy centers, and doctors, among others.
“Certainly, we can see the commitment from the providers, business partners, and employees, who put in their efforts to ensure that each patient received not only quality service but also that they are adhering to their health, keeping their conditions optimal,” Ortiz commented.
To achieve this, it is important to note that MCS’s model is integrated, aiming to address and monitor the patient’s conditions, as well as meet their needs that could affect their health and optimal management.
“It’s a coordinated effort. In the office, we identify everything about the patient’s conditions; we see them physically, see who brings them in. Essentially, when we receive that information, we are giving the medical plan tools to identify certain areas. MCS is very effective in reaching out to patients for case management or coordinated treatments and identifying their immediate needs, such as transportation or if they need a wheelchair at home,” explained Dr. Francisco Berio, a general practitioner.
This process begins when the insured person enrolls in the medical plan. A profile is created for them in an internal platform, which doctors have access to, allowing them to view basic patient information even before their appointment, as well as to inform the plan of the diagnosis, treatments, and possible needs the patient may have. This way, MCS can follow up with the member, ensuring they reach their doctor and fulfill their annual evaluations, among other healthcare needs.
“We ensure that we have a communication system in place so that we can meet and comply with all the metrics,” added Ortiz.
As part of patient monitoring, there is the Individualized Care Plan, which is aimed at patients with chronic conditions like hypertension, cancer, or diabetes, who may develop cardiovascular problems, neuropathy, obesity, and others.
The plan consists of supporting both the doctor and the member. Part of this is ensuring the patient complies with their treatments, has up-to-date medications, as well as preventive tests and the correct nutritional and physical activity routines.
“If I have a patient with multiple conditions, I monitor them and get extra support from a nutritionist and nursing staff, who call and guide them. It’s a way to provide direct support, outside of the office,” Berio pointed out.
In addition to the support framework for the doctor and the member, MCS has an educational program in which they coordinate with doctors to bring various patient orientation activities to their offices, instructing them on the risks of not properly managing their conditions, among other relevant topics. Additionally, there is the “Club Te Paga” program, which reinforces the member’s well-being with cooking workshops, exercises, Zumba classes, aerobics, and other activities.
“One of the nice things about that is that patients are often very lonely and need companionship, and there, they establish friendships. In an activity center, they can leave their worries behind and be entertained while making new friends,” Ortiz emphasized.
Another initiative this year is the MCS Wellness Challenge, which promotes prevention, physical activity, and well-being as key elements for good health. This encourages people to challenge themselves to engage in physical activity or dietary changes that will improve their health, such as walking, taking the stairs instead of the elevator, or reducing their daily coffee intake.
The challenge goes beyond, as on May 4th, the MCS Wellness Challenge event will take place at the Teodoro Moscoso Bridge. “It’s a 2k, 5k, and 10k event, with whichever distance participants feel suits their condition. This is to encourage every citizen to realize that their health is important and that they need to make some adjustments to stay healthy,” Ortiz commented.
“It’s a way to motivate the population to do something for their well-being, to feel good, to be creative with their exercises, diet, and move a little,” concluded Berio.
For more information, you can visit the MCS website at www.mcs.com.pr or check out their social media profiles.
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