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Consumer Reports Names Top-Ranked Health Plans

 |  By Margaret@example.com  
   September 25, 2012

Consumer Reports released on Monday its annual health plan rankings. For the third consecutive year an HMO operated by Massachusetts-based Harvard Pilgrim Health Care was the top-ranked private plan. Harvard Pilgrim has three plans in the top 10: its PPO ranked fifth and its New Hampshire HMO was ranked seventh.

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The rankings are compiled by the National Committee for Quality Assurance, a nonprofit health care accreditation and quality measurement group. The scores take into account customer satisfaction, prevention, and treatment, including Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) performance measures.

Each plan receives an overall score between 1 and 100. Prevention and treatment account for 60% of the score, consumer satisfaction for 25%, and NCQA accreditation for 15%.

This year's findings rank 978 health plans, including 474 private plans, 395 Medicare Advantage plans, and 115 Medicaid HMOs. NCQA accreditation is voluntary, although health plans pay for the process. Beginning in 2014, all health plans that participate in health insurance exchanges must be accredited.

In a press statement announcing its ranking, Harvard Pilgrim officials credited the health plan's clinical programs and customer service with its NCQA performance. "We are committed to encouraging exceptional patient/physician relationships and offering product innovations to address the many challenges faced by patients and providers today," Eric Schultz, president and CEO of Harvard Pilgrim, said in the statement.

Nonprofits once again claimed every spot on the top 10 list of private plans. NCQA officials attribute the nonprofit standing to their independence from investors. "Their nonprofit mission and member focus makes it easier for them to deliver care in ways that really benefit their members. They don't have to satisfy investors with growing profits," Sarah Thomas, vice president of public policy and communications for NCQA, told HealthLeaders Media during a telephone call.

CR's Top Health Plans
In addition to Harvard Pilgrim, the top 10 list includes HMO/POS products from Tufts Health Plan (Massachusetts), Kaiser Foundation Health Plans (Colorado), and Northern and Southern California, Capital Health Plan (Florida), and Group Health Cooperative (Wisconsin).

Five of the top plans are integrated health systems (IHS) that employ physicians and even own hospitals that care for their customers. The IHS makes it somewhat easier to control the delivery of care as well as cost and quality because the system has physicians, nurses, and others "who talk to each other and work together toward quality goals," explains Thomas. The IHSs are Capital Health Plan, Group Health Cooperative, and the Kaiser Foundation Health Plans.

Major Non-Profit Plans
Among the major for-profit health insurers, only Anthem cracked the top 30. The POS offered by Anthem Blue Cross and Blue Shield New Hampshire is ranked at number 26. A Cigna HMO in Massachusetts is ranked 39, an Aetna HMO/POS in Massachusetts is ranked 57, UnitedHealthcare's PPO in Rhode Island is ranked 62, and Humana's HMO/POS in Wisconsin is ranked 141.

Medicare Plans
NCQA also released rankings for Medicare Advantage plans and Medicaid HMOs. An HMO from Kaiser Foundation Health Plan of Southern California claimed the top Medicare spot while HMOs from Fallon Health Plan and Kaiser Foundation Health Plan of Hawaii shared the top Medicaid spot.

HMOs have been ranked for eight years, but this is only the second year for ranking PPOs. This year, private PPOs performed about the same as private HMOs overall, according to Nancy Metcalf, senior program editor for Consumer Reports.

Among the improvements: PPOs have caught up with HMOs in terms of appropriate use of medications for asthma and appropriate use of imaging for lower-back pain. Medicare HMOs perform only slightly better than PPOs, which actually outperform HMOs on some measures, such as managing antidepressant treatments and rheumatoid arthritis medications.

Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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