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NCQA Releases Health Plan Ratings for 2015-2016

By John Commins  
   September 18, 2015

Using new methodology, the National Committee for Quality Assurance compares the quality and services of more than 1,000 health plans that collectively cover nearly half of the nation's population.

Health insurance plans in New England and the Great Lakes region received the highest rankings for performance and customer satisfaction under a new nationwide ratings system released Thursday by the National Committee for Quality Assurance.

Using a new methodology, NCQA's Health Insurance Plan Ratings 20152016 compare the quality and services of more than 1,000 health plans that collectively cover 138 million people—more than 43% of the nation's population. NCQA ranked 1,358 health plans and rated 1,016: 491 private, 376 Medicare and 149 Medicaid.

The ratings replace the annual health plan rankingsthat NCQA published each fall for a decade, in partnership with U.S. News &World Report and Consumer Reports. The new ratings align with the CMS Star Ratings of Medicare Advantage plans, and stress health outcomes and consumer satisfaction.




Source: NCQA

Of the 1,016 rated plans, 116 (11%) received a top rating of 4.5 or 5.0 out of 5. Fifty-four (5%) earned the lowest ratings of 1.0 to 2.0. Most plans are in the middle, approximating a "bell curve" when all plans' performances are plotted on a graph.

States with the highest percentage of plans receiving a 4.5 or 5.0 out of 5 rating include Maine, Massachusetts, New Hampshire, New York, Pennsylvania, Rhode Island, Vermont, Michigan, Minnesota and Wisconsin.

NCQA rated three major performance categories:

  • Consumer Satisfaction: What patients say about their health plans in satisfaction surveys, including about claims processing and customer service.
  • Prevention: Checkups, tests and other care that keeps people—especially children—healthy.
  • Treatment: How consistently a plan provides scientifically recommended care for common, costly conditions such as diabetes, depression and heart disease.

In each category, patient outcomes count extra in the scoring; for example, whether blood pressure and diabetics' blood sugar are controlled to safe, recommended levels. The emphasis on results means that, together with consumer satisfaction, outcomes are the main driver of ratings results, NQCA said.

NCQA grouped plans into broad categories, which give consumers a practical guide to understanding their health plan choices. Consumers can "drill down" into any part of the ratings to learn how a health plan handles particular health issues or patient populations. 

For example, expectant parents may be interested in performance on two measures of prenatal and postpartum care. Families may be interested in quality results on 10 measures of pediatric preventive care and treatment, ranging from well-child care for infants, to monitoring ADHD treatment of 12-year-olds.

NCQA says it will continue its relationship with Consumer Reports.

John Commins is a senior editor at HealthLeaders.

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