Just in time for consumers to assess their coverage opportunities in the soon-to-be-unveiled health insurance exchanges, the National Committee for Quality Assurance has released its annual ranking of health insurance plans.
Just in time for consumers to assess their coverage opportunities in the soon-to-be-unveiled health insurance exchanges, the National Committee for Quality Assurance has released its annual ranking of health insurance plans.
This is the ninth year the NCQA has ranked health plans. For four consecutive years an HMO operated by Wellesley, Mass.–based Harvard Pilgrim Health Care has topped the list of commercial health plans. Harvard Pilgrim has four plans in the 2013 top 10: two PPOs and two HMOs. The health plan serves about 1.2 million members in Massachusetts, Maine, and New Hampshire.
The rankings are compiled by the NCQA, a nonprofit healthcare accreditation and quality measurement group. They are based on the 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 the NCQA ranked 1,020 health plans, including 484 commercial plans, 405 Medicare Advantage plans, and 131 Medicaid HMOs. NCQA accreditation is voluntary and health plans pay for the process.
So how does Harvard Pilgrim manage to fare so well year after year?
I had the opportunity a while back to interview Michael Sherman, MD, MBA, Harvard Pilgrim's senior vice president and the chief medical officer. He spoke then about the importance of partnering with provider systems to be "part of the solution" and talked about the innovations such as pay-for-performance, bundled payments, and patient-centered medical homes that the company has supported for several years.
Sherman stressed the importance of shifting physician relationships from a win-lose model, where most payer-provider discussions are about fee schedules, to a win-win model, where payers and providers work together to improve the delivery of healthcare.
That means spending more time talking to physicians about things like their infrastructure needs and developing payment systems that support improved healthcare delivery. Harvard Pilgrim also provides capabilities in analytics and care management programs to support physicians.
The health plan invests not only in outcome-based programs but also provides grants to help physician practices get the tools, develop the infrastructure, and hire the personnel needed to improve care delivery and reduce costs. Over 13 years Harvard Pilgrim has funded more than 190 initiatives totaling more than $14 million in its three-state service area.
The organization has also moved aggressively into healthcare cost transparency. Earlier this year it announced a partnership with Castlight Health to develop member access to cost and quality information about healthcare providers and common procedures, including out-of-pocket pricing and quality measures for all in-network healthcare providers.
Recently Harvard Pilgrim also announced that it is partnering with two New Hampshire provider organizations, Dartmouth-Hitchcock Medical Center and Elliot Health System, to offer a defined-network product focused on care coordination. The network includes more than 400 primary care doctors and 2,600 specialists, with an insurance premium that's about 10% less than Harvard Pilgrim's similar full-network plans.
Here's the NCQA top 10 results for 2013:
Top 10 Commercial Health Plans
- Harvard Pilgrim Health Care (HMO, Maine and Massachusetts)
- Kaiser Foundation Health Plan of the Northwest (HMO, Oregon and Washington)
- Blue Cross and Blue Shield of Massachusetts (HMO, Massachusetts)
- Harvard Pilgrim Health Care (PPO, Massachusetts)
- Harvard Pilgrim Insurance (PPO, Massachusetts)
- Tufts Associated HMO (HMO, Massachusetts)
- Kaiser Foundation Health Plan of Northern California (HMO, California)
- Tufts Benefit Administrators (PPO, Massachusetts and Rhode Island)
- Harvard Pilgrim Health Care of New England (HMO, New Hampshire)
- Kaiser Foundation Health Plan of Ohio (HMO, Ohio)
This is only the third year that PPOs have been included in the rankings, and they are making their mark. This year 274 commercial PPOs are ranked versus 204 HMOs. In 2012, two of the top 10 plans were PPOs; this year, three PPOs are among the top 10. There are 11 PPOs in the top 50 this year versus seven last year.
The three Kaiser Foundation Health Plans are the only health plans in the top 10 that are also part of an integrated health system. Kaiser employs its physicians and owns its hospitals, which gives the organization an advantage in delivering coordinated care as well as meeting cost and quality benchmarks.
For-Profit Health Plans
Among the major for-profit health insurers, only Anthem managed to crack the top 25. The HMO offered by Anthem Blue Cross and Blue Shield Maine is ranked at number 23. A Cigna PPO in Massachusetts is ranked 50, an Aetna PPO in Connecticut is ranked 59, UnitedHealthcare's PPO in Rhode Island is ranked 67, and Humana's PPO in Ohio is ranked 132.
Medicare Advantage Health Plans
An HMO from Kaiser Foundation Health Plan of Southern California claimed the top spot among Medicare Advantage health plans. In fact, Kaiser dominates that ranking, with six of its Medicare Advantage plans in the top 10.
Medicaid Health Plans
Fallon Community Health Plan of Massachusetts topped the Medicaid health plan rankings.
Andy Reynolds, assistant vice president for marketing and communications at NCQA, says the health plan participation in the NCQA rankings indicates that more and more insurers are committed to measuring their performance and accept that transparency—providing public access to their performance results—is a critical step in the process of improving healthcare.
He notes that the health plans at the top of the rankings have been committed to transparency for a long time.
Of course, the more plans that are transparent with their performance results, the better it is for consumers and employers, who are increasingly considering the value proposition in their healthcare insurance purchases.
Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
