National Committee for Quality Assurance (NCQA) is releasing its 2018 Health Insurance Plan Ratings. These ratings provide consumers with a more accurate picture of how health insurance plans perform in the key quality areas of consumer satisfaction, prevention and treatment.
NCQA’s Health Insurance Plan Ratings 2018–2019 compare the quality and services of more than 1,000 health plans in the United States and provide consumers with a practical and meaningful guide to understanding their health care options and choosing the best health plans for themselves and their families.
The ratings are a system similar to CMS Star Ratings of Medicare Advantage plans and give unprecedented importance to health outcomes and consumer satisfaction.
NCQA studied nearly 1,500 health plans and rated 1,040: 445 private (commercial), 418 Medicare and 177 Medicaid.
Top Ten States with the Highest-Rated Health Plans (receiving a 4.5 or 5.0 out of 5 rating) for Three-Year Average:
- Massachusetts
- Rhode Island
- Maine
- Wisconsin
- Minnesota
- New Hampshire
- Hawaii
- Vermont
- New York
- Iowa
Key Takeaways from the 2018–2019 Ratings:
- States with the Top-Performing Plans Consistently Deliver: 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 12th and 11th respectively and moved into the top ten in 2016 and 2017.
- High and Low Performers Are Rare: Of the 1,040 rated plans, 85 (8%) received a top rating of 4.5 or 5.0 out of 5. Twenty-five (2%) earned the ratings of 1.0 to 2.0.
Ratings Focus on Satisfaction & Outcomes
The ratings consist of three major performance categories: consumer satisfaction, prevention and treatment.
- 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.
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.
Ratings Provide:
- Simple, User-Friendly Scale: The NCQA ratings blend dozens of quality indicators for health plans into a simple scale from 1–5, where 1 indicates lower performance and
5 indicates higher performance.
By grouping plans into a few broad categories, the ratings give consumers a practical, meaningful guide to understanding their health care choices at a level of detail they choose.
- Details on Demand: Consumers can “drill down” into any part of the ratings to learn how a health plan handles particular health issues or patient populations.
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.
