Do you want to know how the health plans in your territory stack up? Your customers sure do. So do their patients.
National Committee for Quality Assurance Health Insurance Plan Ratings are designed to provide consumers with a picture of how health insurance plans perform in the areas of consumer satisfaction, prevention and treatment. Last fall, NCQA published its 2016 ratings, which compare the quality and services of more than 1,000 health plans in the United States.
Under a new agreement, NCQA and WebMD have teamed up to publish the ratings. WebMD has published them on its website – WebMD.com.
Health plans are rated in three categories:
- Private plans that people enroll in through work or on their own
- Plans that serve Medicare beneficiaries in the Medicare Advantage program (not Supplemental plans)
- Health maintenance organizations (HMO) for Medicaid beneficiaries
The 2016 ratings do not include marketplace plans because they have not yet developed sufficient data for analysis.
NCQA ratings are based on three types of quality measures:
- Measures of clinical quality from NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®)
- Measures of consumer satisfaction using Consumer Assessment of Healthcare Providers and Systems (CAHPS®)
- Results from NCQA’s review of a health plan’s health quality processes (i.e., performance on NCQA accreditation standards). NCQA rates health plans that report quality information publicly.
In each category, the results – outcomes – of a patient’s care count extra in the scoring; for example, whether blood pressure and diabetics’ blood sugar are controlled to safe, recommended levels. This emphasis on results means that, together with consumer satisfaction, outcomes are the main driver of ratings results.
Takeaways
Here are some takeaways from the 2016 health insurance plan ratings.
- New England and Great Lakes plans perform best. States with the highest percentage of plans receiving a 4.5 or 5.0 out of 5 rating include Massachusetts, Rhode Island, Wisconsin, Maine, New Hampshire, Minnesota, Vermont and New York. Hawaii and Iowa round up the top ten.
- High and low performers are rare. Of the 1,012 rated plans, 105 (10 percent) received a top rating of 4.5 or 5.0 out of 5. Twenty-seven (3 percent) earned the ratings of 1.5 to 2.0. Most plans are in the middle, approximating a “bell curve” when all plans’ performances are plotted on a graph.
- Commonalities among plans. The percent of top-rated plans are relatively the same between private (commercial), Medicare and Medicaid plans.
To view the ratings, go to http://doctor.webmd.com/find-health-insurance