The National Committee for Quality Assurance rates health plans on a 1-5 scale (5 is highest) on these parameters:
- Consumer satisfaction
- Prevention
- Treatment
Some questions within each:
Consumer satisfaction
- Did members get appointments, preventive care, tests, and treatment easily?
- Did members get appointments, preventive care, tests, and treatments promptly?
- Did members rate their primary-care doctors high overall? Specialists? Overall care?
- Were members satisfied with how their primary provider coordinated care with other providers?
- Were members informed of health promotion and illness prevention activities?
- Were members satisfied with how their health plans handled their claims?
- Did members rate their health plan’s overall customer service high?
Prevention
Children and adolescents
- Did children age 15 months get up to six well-child visits since birth?
- Did children ages 3 to 6 have at least one well-child visit in the latest year reported?
- Did members ages 12 to 21 have at least one comprehensive well-care visit in the latest year reported?
- Did children receive recommended immunizations by age 2? By age 13?
- Did children receive recommended immunizations by age 13?
- Did members ages 3 to 17 have their BMI assessed?
Women’s reproductive health
- Did pregnant women have a prenatal visit in their first trimester or shortly after enrolling in a health insurance plan?
- Did women who gave birth have a postpartum visit three to eight weeks after delivery?
Cancer screening
- Did women ages 50 to 74 get mammograms every two years?
- Were members ages 50 to 75 screened for colorectal cancer?
- Did women ages 21 to 64 receive cervical cancer screening?
- Were adolescent females ages 16 to 20 screened unnecessarily for cervical cancer?
- Did 13-year-old girls receive the HPV vaccine?
Other preventive services
- Did adult members ages 18 to 74 have their BMI assessed?
- Did sexually active women ages 16 to 24 get tested for chlamydia?
- Were members ages 18 to 64 vaccinated against the flu?
Treatment
Asthma
- Did asthmatic members ages 5 to 85 take medication to control asthma as prescribed?
- Did people ages 5 to 85 with persistent asthma have their symptoms well controlled during the year? ?
Diabetes
Did diabetic members ages 18 to 75:
- Have their blood pressure below 140/90 at their last visit?
- Have a retinal or dilated eye exam?
- Maintain their blood sugar level below 8 percent?
- Have their kidney function checked or monitored?
Heart disease
- Did heart-attack patients 18 or older receive beta blockers for at least six months?
- Did hypertensive patients ages 18 to 85 have their blood pressure controlled (i.e., for patients 18 to 59 a BP <140/90 mm Hg, for patients 60 to 85 with a diagnosis of diabetes a BP <140/90 mm Hg or a BP <150/90 mm Hg without a diagnosis of diabetes)?
Other treatment measures
- Did adults at risk for cardiovascular disease take aspirin?
- Were adults ages 18 to 64 with acute bronchitis not prescribed antibiotics in the three days after their diagnosis, as recommended?
- Were children ages 3 to 18 with a sore throat given strep tests and appropriately prescribed antibiotics?
- Did members 40 and older who were hospitalized or had an ED visit for chronic obstructive pulmonary disease receive a bronchodilator within 30 days of their discharge?
- Were children ages 3 months to 18 years with colds not prescribed antibiotics up to three days after their diagnosis, as recommended?
- Were imaging tests appropriately not recommended for patients with a new episode of low back pain?
For more information on the NCQA health insurance plan ratings methodology, go to http://www.ncqa.org/Portals/0/Report%20Cards/Health%20Plan%20Ratings/HPR%202016%20Methodology%20Overview.pdf?ver=2016-08-02-150340-867