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Only 10% of Health Plans Nab Top NCQA Quality Ratings

News  |  By HealthLeaders Media News  
   September 26, 2016

The top-rated plans were almost evenly split among commercial, Medicare, and Medicaid plans. Health plans were evaluated on customer satisfaction, prevention, and treatment.

Only 105 of the 1,012 private/commercial, Medicare and Medicaid plans assessed by the National Committee for Quality Assurance (NCQA) achieved the highest quality scores.

The NCQA Health Insurance Plan Ratings 2016-2017 report indicates that 10% received a top rating of 4.5 or 5.0 out of 5. Of those 105 plans, 23 received the highest score of 5.0. The stop scorers include 13 commercial plans, eight Medicare plans, and two Medicaid plans.

On the other end of the scale, 27 plans (3%), earned the lowest ratings of 1.0 to 2.0.

The top-rated plans were almost evenly split among commercial, Medicare, and Medicaid plans.

The lowest-rated plan was Hawaii Medical Service Association with 1.5. The PPO received a 3 in customer satisfaction, 1 for prevention, and 0.5 for treatment. An NCQA statement noted, however, that the low score might be partially attributable to a lack of data.

NCQA has scored health plans for quality annually since 2005. Some of the top finishers this year were The Kaiser Foundation, University of Pittsburgh Medical Center, Capital District Physicians, Tufts, and Blue Cross Blue Shield of Massachusetts, each has at least two plans that received a 5.0 rating.

NCQA did not rate plans offered in the Affordable Care Act marketplace because the government will release ratings on those separately. NCQA derives the quality scores from three broad categories:

  1. Customer satisfaction
  2. Prevention
  3. Treatment

10 States with Highest-Scoring Plans
The percentage of plans receiving a good or very good rating was slightly smaller this year than last, 10.4% vs. 11.4%. There were similarities among the 23 top-rated plans, with all but one being HMOs or offering HMO plans. Many of the top-rated plans were in New England and in the Great Lakes region.

The 10 states with the highest percentage of plans receiving a 4.5 or 5.0 out of 5 rating were

  1. Massachusetts
  2. Rhode Island
  3. Wisconsin
  4. Maine
  5. New Hampshire
  6. Minnesota
  7. Vermont
  8. New York
  9. Hawaii
  10. Iowa

Like all quality ratings, the NCQA scores must be interpreted carefully so as to avoid reading more into them than intended.

A person seeking care under a plan that is highly scored is not guaranteed to see a provider who would be similarly scored on an individual level, because the scores reflect quality at the plan level, not the patient's interaction with a particular doctor or other clinician, the NCQA notes in its report.

Part of the overall plan score is an average of the individual performance ratings, so that one bad doctor wouldn't bring down the plan's score. But if a plan has a very low score, it is more likely that the score is an accurate reflection of most of the individuals because there weren't enough highly related clinicians to raise the score.


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