NCQA Releases Health Insurance Plan Ratings For 2015-16 & Debuts New Rating System

On September 17, 2015, the NCQA announced the release of the 2015–16 Health Insurance Plan Ratings, debuting a new ratings methodology as well. These ratings — a shift from the “ranking” system previously used by the accrediting body — compare the services and quality of over 1,000 health plans. According to the NCQA, they are designed to give consumers a more accurate picture of how health insurance plans perform in key quality areas.

Health Insurance Plan Ratings 2015–16

The Health Insurance Plan Ratings, published annually, compare the quality and services of more than 1,000 health plans that collectively cover 138 million people — over 43% of the US population. The NCQA studied 1,358 health plans and rated 1,016: 491 private (commercial), 376 Medicare, and 149 Medicaid. The ratings align with the CMS Star Ratings of Medicare Advantage plans and place unprecedented importance on health outcomes and consumer satisfaction.

The easy-to-use system lets consumers search for health plans by state, plan name, or plan type (Private, Medicaid, Medicare). Consumers can also sort the listings by accredited status, consumer satisfaction, prevention, and treatment, in addition to overall rating. Top performers nationwide — with an overall 5.0 rating and 4.5 consumer satisfaction — include Capital District Physicians’ Health Plan, Harvard Pilgrim Health Care, and Kaiser Foundation Health Plan of Northern California. To learn more about the new ratings system, you can visit the NCQA website.

You can view the 2015–16 ratings here.

Below are two key takeaways the NCQA published from the 2015–16 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 Maine, Massachusetts, New Hampshire, New York, Pennsylvania, Rhode Island, and Vermont, as well as Michigan, Minnesota, and Wisconsin.
• High and low performers are rare. 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, from 1.0 to 2.0. Most plans fall in the middle, approximating a bell curve when all plans’ performances are plotted on a graph.

Many media outlets have published comprehensive collections of the highest- and lowest-rated health plans. You can see the 11 lowest-rated health plans here. HealthLeaders Media published some helpful graphs showing the variety of ratings across different types of health plans.

via HealthLeaders Media / NCQA

About the Ratings

According to the NCQA, the ratings focus on three major categories of performance, and the outcome of a patient’s care is weighted extra in the scoring for each category:

• 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.

The National Committee for Quality Assurance (NCQA) is a private, 501(c)(3) not-for-profit organization dedicated to improving healthcare quality. Since its founding in 1990, the NCQA has been a central figure in driving improvement throughout the healthcare system, helping to elevate the issue of healthcare quality to the top of the national agenda. For more information, please visit the NCQA website.

Quotes and information taken from the NCQA press release, which can be found here.