Few health insurance plans rank highest or lowest in NCQA's plan ratings
NCQA uses HEDIS scores to rate plans, a performance measure used by more than 90 percent of health insurers.
NCQA insurance plan ratings. Credit: NCQA
The New England States again did well in the 2018 health insurance plan ratings by the National Committee for Quality Assurance.
The 2018 ratings show
Massachusetts at the top of the list, followed by Rhode Island and
Maine. New Hampshire and Vermont are in the top ten, as are Wisconsin,
Minnesota, Hawaii, New York and Iowa.
The top ten states with the highest-rated health plans received a
4.5 or 5 out of a 5 rating based on consumer satisfaction from surveys
that include questions on claims processing and customer service.
Ratings are also based on prevention and treatment.
In each category, the outcome of a patient's care counts extra in
the scoring. One example is whether blood pressure and diabetes 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," NCQA
said.
The NCQA ratings are similar to star ratings for Medicare
Advantage plans. The non-profit and private NCQA uses the Healthcare
Effectiveness Data and Information Set, or HEDIS scores, a performance measure used by more than 90 percent of health plans.
Only 8 percent of the plans received a top rating of 4.5 or 5.
But low performers were also rare, with only 2 percent earning ratings of 1 to 2.
NCQA rated 1,040 health plans. Of these, 445 were commercial plans, 418 were Medicare and 177 were Medicaid.
Key takeaways show that states with the top-performing plans have
consistently delivered over the last three years. There's been very
little movement within the top ten states except for Iowa and Hawaii,
that in 2015 were ranked 12th and 11th respectively and moved into the
top ten in 2016 and 2017.
Of the 1,040 rated plans, 85 received a top rating of 4.5 or 5.0 and 25 got a rating of 1 to 2.
The NCQA ratings methodology
blends dozens of quality indicators for health plans into a scale from
1–5, where 1 indicates lower performance and 5 indicates higher
performance.
Consumers can drill down into any part of the ratings to learn
how a health plan handles particular health issues or patient
populations, NCQA said.
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.
source : https://www.healthcarefinancenews.com/news/few-health-insurance-plans-rank-highest-or-lowest-ncqas-plan-ratings