Consumer Reports: Annual Health Plan Rankings Find Non Profits Leading the Pack

Kaiser plans top National Committee for Quality Assurance (NCQA) Rankings of Private Health Insurance Plans

WASHINGTON, DC — Non profit health plans are leading the pack in the annual health plan rankings from the National Committee for Quality Assurance (NCQA), published in the November issue of Consumer Reports. This year, 984 plans are ranked, including 474 private plans, 395 Medicare Advantage plans, and 115 Medicaid HMOs. Open enrollment for private plans typically takes place in October and/or November while Medicare open enrollment runs from October 15 to December 7.  

For the third year running, Consumer Reports is presenting health plan rankings from NCQA, a non profit health-care accreditation and quality measurement group. Of the 32 clinical performance measures that the NCQA tracks, private HMOs show clear improvement in 23. Overall, more people receive certain recommended tests, such as colorectal cancer screening and blood sugar tests for people with diabetes. 

"All the insurers in these rankings are commendable for disclosing their quality results. If not for that transparency, consumers would be in the dark when they choose a health plan," said NCQA President Margaret E. O'Kane. "With growing numbers of Americans joining PPOs, it's especially encouraging to see PPOs' rising quality." 

Seven indicators of consumer satisfaction tracked by NCQA have improved almost every year since 2007.  But not everything is coming up roses, states Consumer Reports in its November issue and online at www.ConsumerReports.org , where summaries of the rankings are available for free. Detailed findings for Medicaid plans are available for free and details for private and Medicare plans can be mined by subscribers.

Measures designed to track overuse show particularly troubling trends. For instance, research shows that imaging tests aren’t helpful for most forms of lower-back pain and can even be harmful. But insurance plans have failed to rein in imaging claims for back pain in the seven years the NCQA has tracked it. In its reporting on unnecessary medical care, Consumer Reports has repeatedly advised consumers to be wary of imaging tests for lower-back pain. Imaging can expose patients to needless radiation while potentially leading to further tests and treatments and sometimes even unnecessary surgery.    

For the third straight year, the top ranked private plan in the nation was the nonprofit Harvard Pilgrim Health Care’s HMO in New England, and one of its PPOs finished fifth in the NCQA’s rankings.  In fact, every one of the top 10 private plans is a nonprofit that doesn’t have to satisfy investors with growing profits.   

Consumer Reports’ analysis found that five out of ten of the top performers in NCQA’s rankings of private plans are integrated health systems, which provide insurance while also employing the doctors, and in some cases owning the hospitals, that care for their customers. “I think we’re going to be hearing a lot more about these systems, which are leading the way in large part because they are avoiding wasteful care,” said Nancy Metcalf, senior program editor, Consumer Reports.   

The five integrated health systems that rise to the top of NCQA’s health plan rankings are: Capital Health Plan in Florida, Group Health Cooperative of South Central Wisconsin, and Kaiser Foundation Health Plans in Colorado, Northern California, and Southern California.

The rankings reveal that Kaiser performs the best of any of the major private insurers, with 75 percent of its private plans in the top 25 percent of rankings. Plans not affiliated with a major national brand come next, with 53 percent in the top quarter, followed by Blue Cross Blue Shield plans, with 41 percent. 

Other big brands did not fare as well as Kaiser. Aetna, Humana, and UnitedHealthcare (the second-largest health insurer in America after Blue Cross Blue Shield) all have more private plans in the bottom 100 than in the top 100. Coventry, which Aetna is in the process of buying, has two-thirds of its plans in the bottom quarter, all of them unaccredited. A caveat: Plans that don’t have NCQA accreditation or have a lot missing, undisclosed, or less thorough data tend to be lower in the rankings.

Consumer Reports also provides a Countdown to 2014 to give consumers a window into health reform’s next big changes.   Starting this fall, all private health insurance plans must use a standard “Summary of Benefits and Coverage,” which allows consumers to compare plans side by side, including coverage examples that show the generosity of a given plan versus another. “It’s like a nutrition label—boiling all of the salient details down to a summary that is very consumer-friendly. The key is allowing consumers to compare plans and giving them information that they can actually digest and make sense of,” said Metcalf.  Details about the “Summary of Benefits and Coverage” are available online at www.ConsumerReports.org/SBCinfo.

Other changes to come are available online at www.ConsumerReports.org.

NOVEMBER 2012
© 2012 Consumer Reports. The material above is intended for legitimate news entities only; it may not be used for advertising or promotional purposes. Consumer Reports® is an expert, independent nonprofit organization whose mission is to work for a fair, just, and safe marketplace for all consumers and to empower consumers to protect themselves. We accept no advertising and pay for all the products we test. We are not beholden to any commercial interest. Our income is derived from the sale of Consumer Reports®, ConsumerReports.org® and our other publications and information products, services, fees, and noncommercial contributions and grants. Our Ratings and reports are intended solely for the use of our readers. Neither the Ratings nor the reports may be used in advertising or for any other commercial purpose without our permission. Consumer Reports will take all steps open to it to prevent commercial use of its materials, its name, or the name of Consumer Reports®.

About NCQA

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA is committed to providing health care quality information for consumers, purchasers, health care providers and researchers.

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