"The ratings are a way for consumers to hold the industry accountable and for families to choose plans based on their individual needs," said NCQA's Andy Reynolds.
The National Committee for Quality Assurance (NCQA) has published its 2022 Health Plan Ratings, which evaluate "commercial, Medicare and Medicaid health plans based on the quality of patient care, how happy patients are with their care and health plans' efforts to keep improving."
Eligible plans—those that report Healthcare Effectiveness Data and Information Set (HEDIS) results to NCQA—receive a 0–5-star rating. For calendar year 2021, this included 1,048 health plans.
"With open enrollment for health plans beginning in November, the NCQA 2022 Health Plan Ratings provide timely insight to help consumers and businesses make informed decisions about their health care," said NCQA President Margaret E. O'Kane in the agency's ratings press release.
In interview with HealthLeaders, Andy Reynolds, the organization's assistant VP of external relations, added: "The health plan ratings are a culmination of NCQA values, including measurement and transparency. They are a way for consumers to hold the industry accountable and for families to choose plans based on their individual needs."
Sarah Shih, NCQA's assistant VP of research and analysis, also detailed plan rating methodology, which includes:
- Patient Experience – Self reported by patients, measured by eight questions from the Consumer Assessment of Healthcare Providers and Systems (CAHPS).
- Clinical – The proportion of eligible members receiving preventive services (prevention measures) and recommended care for select conditions (treatment measures).
- Accreditation – Plans that are NCQA accredited (including full or provisional status receive an added 0.5 bonus points as part of their rating.
The NCQA website details complete results, measures, and methodology. Key findings from the 2022 Health Plan Ratings include:
- Six plans achieved five-star ratings, including Kaiser Foundation Health Plan (KFHP) which achieved a top rating across all three lines of business.
Specifically, KFHP of the Mid-Atlantic States, Inc. received five stars in its commercial, Medicaid, and MA plans (counted as three distinct plans). The payer's MA plan in Colorado also earned five stars, with other top-rated Medicare Advantage plans including: Medical Associates Clinic Health Plan of Wisconsin; and Medical Associates Health Plan, Inc.
- The NCQA ratings represent a significant proportion of U.S. health plans.
Up to 203 million Americans are represented by NCQA-accredited plans, a number that "has never been higher," said NCQA's Reynolds. More than 70% of the people enrolled in a commercial, Medicaid, or MA plan are members of an NCQA-accredited plan. Note: NCQA does not rate ACA Marketplace plans.
- Patient experience is paramount, despite a decline in adult care satisfaction.
"The clear signal we all want to put forward is that patient experience matters," said NCQA's Shih. "Roughly 22-27% of overall rating weight is patient experience, which is close to CMS MA Star Ratings." The ratings did reflect, however, that adult patients' overall healthcare ratings of their plans dropped year over year for both commercial (4.2%) and Medicaid (2.2%) plans.
Patient experience will only become more important. Shin noted that there is an intent to develop additional experience measures, which could be added to CAHPS, represent entirely new types of metrics, or both.
- Quality improved for Heart Disease and Diabetes Care.
Controlling high blood pressure improved the most: 6.9% for commercial plans, 7.6% for MA, and 2.7% for Medicaid. Plans improved on two diabetes-related measures: Controlling blood pressure (with an average increase of 5.5%, 2.5%, and 2.1%, respectively for commercial, MA, and Medicaid Plans) and Controlling Hemoglobin A1c (performance improved on average 4.1%, 3.2%, and 3.3% for those same categories).
Both Heart Disease and Diabetes Care had declined the prior measurement year (2019–2020).
- Immunization rates show children on Medicaid more at risk.
While immunization rates were up 2.2% for commercially insured children, they declined 3% for those enrolled in Medicaid plans. In its ratings press release, the NCQA noted: "This >5-point divergence suggests a growing gap in preventive care that puts America's most vulnerable children at disproportionate risk for disease."
- The immunization disparity highlights the continued importance of health equity.
Speaking on the healthcare disparities that the pandemic laid bare, Reynolds stated: "Everyone gets it: we have a problem. From there, there are a variety of responses and readiness to respond." Reynolds added that while some states are out front and others are just getting started, "there stepwise ways to get better" no matter where a state or plan currently sits.
- One surprise: The number of plans not meeting reporting benchmarks.
As part of NCQA's methodology, 40% of plans must be able to report a measure for it to be used in the ratings. The organization reports that two Medicaid measures (Rating of Specialist, Care Coordination) and one Commercial measure (Claims Processing) failed to meet the threshold and were excluded from the 2022 ratings. All three are CAHPS patient experience measures.
"We're trying to understand the why of this," said Shih. "It could be continued impacts from the pandemic, that the public is just feeling over surveyed, or other reasons."
The development represented what Reynolds termed "a tale of two cities" in this year's ratings: "the reduction of plans not meeting reporting thresholds but at the same time, an unprecedented expansion" of U.S. health plan members represented.
“The health plan ratings are a culmination of NCQA values, including measurement and transparency. They are a way for consumers to hold the industry accountable and for families to choose plans based on their individual needs.”
Andy Reynolds, assistant VP of external relations, NCQA
Laura Beerman is a contributing writer for HealthLeaders.
The NCQA has released its 2022 Health Plan Ratings.
The annual ratings emphasize both clinical and patient experience performance.
This year's results include six five-star-rated plans, rebounds in heart and diabetes care, and a few divergent outcomes that one agency executive terms "a tale of two cities."