NCQA Releases Health Insurance Plan Ratings

More than 1,000 health plans are rated based on performance and quality of care

WASHINGTON, D.C. — A new ratings system created by the National Committee for Quality Assurance (NCQA) provides consumers with a more accurate picture of how health insurance plans perform in key quality areas. 

 Using a methodology that makes its debut after two years of development, NCQA’s Health Insurance Plan Ratings 2015–2016 compare the quality and services of more than 1,000 health plans that collectively cover 138 million people—over 43% of the US population. 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 give unprecedented importance to health outcomes and consumer satisfaction. Key takeaways from the 2015–2016 ratings include:

  • 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, 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 of 1.0 to 2.0. Most plans are in the middle, approximating a “bell curve” when all plans’ performances are plotted on a graph. http://bit.ly/1KsZIKi

The ratings replace the annual health plan rankings that NCQA published each fall for a decade, in partnership with US News & World Report and Consumer Reports.

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.

Advantages of Ratings

  • 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.
  • Consistency with Medicare: The NCQA ratings align with the Medicare Star Ratings, the influential federal assessment of Medicare Advantage health plans. Medicare Advantage plans are increasingly popular, and cover 16.8 million Americans—a 51% increase since 2010.

The NCQA-Consumer Reports relationship continues. The Consumer Reports Web site and the November edition of Consumer Reports magazine will mention the NCQA ratings and urge readers to examine them at ncqa.org/ratings.