December 15, 2004

NCQA NAMES NATION’S TOP 10 MEDICARE, MEDICAID HEALTH PLANS; MORE THAN 100 MEDICAID PLANS NOW MAKE DATA AVAILABLE

Many top Medicaid plans from states that link pay and performance; Medicare plans gain in cholesterol, blood pressure control; fee-for-service data still unavailable 

WASHINGTON— The National Committee for Quality Assurance (NCQA) today identified the nation’s highest quality Medicare and Medicaid health plans on two “Top 10” lists (see below) designed to recognize industry leaders and draw consumer attention to the issue of health plan quality. More and more data about the performance of Medicare and Medicaid plans has become available in recent years – the Centers for Medicare & Medicaid Services (CMS) requires all Medicare Advantage plans to publicly report their results, and more than 100 Medicaid plans now do the same. The growing availability of data from managed care organizations can help the elderly and economically disadvantaged Americans who participate in these programs make more informed health plan choices. The traditional fee-for-service system offers no such data. 

“By measuring and reporting on their performance, the Medicare and Medicaid plans on these lists have provided beneficiaries with an answer to the question: ‘Is this a good health plan?’” said NCQA President Margaret E. O’Kane. “These health plans provide daily proof that achieving excellence isn’t a question of plan type or market or profit status – it’s hard work and accountability. They provide a model for the rest of the country and the fee-for-service sector to follow.”

The health plans named to the lists were the nation’s top overall performers on a range of key clinical performance measures related to issues such as cancer, diabetes, asthma, heart disease and immunizations. Of the top 10 Medicaid plans, at least six are from states where Medicaid health plans earn reimbursement incentives if they deliver higher quality care – a compensation strategy called “pay for performance” that is gaining widespread acceptance in health care. More than 80 pay-for-performance projects are currently underway and CMS, the nation’s largest purchaser of health care, is among the most committed supporters of the strategy.

Consumer advocates praised the release of the list and urged people with Medicare and Medicaid to consider quality in addition to cost and benefits when making their health plan choices.

“We are pleased that NCQA is calling attention to the nation’s best Medicare and Medicaid plans and commend the ‘top tens’ for their commitment to high performance,” said John Rother, AARP Director of Policy and Strategy. “For consumers the message is still: do your homework. Health plans are not all the same. Make a list of what is important to you and find information from NCQA at http://www.healthchoices.org/ or Medicare’s Web site at http://www.medicare.gov/.”  

Medicaid Top 10

The nation’s top performing Medicaid plan was Kaiser Permanente, Hawaii, which recorded best in class scores on a half dozen different performance measures. 

"The big difference at Kaiser Permanente is that our patients don't just have a doctor, they have a team of doctors focused on their care," said Geoff Galbraith, M.D., Vice President, Hawaii Permanente Medical Group and Quality Management Improvement. "Our physicians, nurses and staff confer and collaborate so each patient has 4-5 people working together to make sure they get the care they need. The second opinion and the safety check are built into the process. At the same time, we work to support and strengthen a patient's relationship with their primary doctor."     

Three of the Medicaid plans named to the Top Ten list are from Michigan, a state that requires Medicaid plans to report their performance scores publicly and offers incentives to plans that do well. Another three plans on the Medicaid list are from New York, which takes a very similar approach to public reporting and performance incentives.          

"We've been successful in encouraging the majority of New York's health plans participating in Medicare and Medicaid to make a real commitment to ensuring access to quality care,” said New York State Health Commissioner Antonia C. Novello, M.D., M.P.H., Dr.P.H. “Today, New Yorkers have real choices and expanded access to managed care. NCQA's new report showing high performance ratings in quality measures for several of the state's health plans validates the effectiveness of these policies.”

Neighborhood Health Plan of Rhode Island, a Medicaid-only plan that serves 73,000 beneficiaries throughout Rhode Island, also rated among the top 10.

“We were founded by Rhode Island's community health centers,” said Christopher F. Koller, CEO of Neighborhood Health Plan of Rhode Island. “That partnership gives us an up close perspective on the lives and needs of our members. This member and provider understanding guides our staff, programs and materials and, in turn, helps our members successfully overcome barriers to care.”  

Medicare Top 10

The Medicare Top 10 list includes the Medicare Advantage offerings of many of the same health plans that were named to NCQA’s Commercial Top 10 list in September.  At the top of this list was Harvard Pilgrim Health Care, which also topped both the clinical care and member satisfaction Top 10 lists for commercial health plans.

“We're delighted that NCQA has recognized our First Seniority program as the top Medicare plan in the country,” said Charles D. Baker, President and CEO of Harvard Pilgrim Health Care. “We were one of the first health plans in the country to enroll seniors, and we've worked very hard to provide all of our members, of any age, with high quality and great value.”

Average scores for both Medicare and Medicaid plans on most measures have improved steadily over the past several years, with Medicare plans recording improvements in cardiac and diabetes care, and Medicaid plans improving on a range of measures such as immunizations, cancer screening and treating asthma (see chart for details).  These improvements follow federal and state mandates to report performance scores in these and other areas suggesting that public reporting of such scores is an effective way to improve health care quality.  

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations.  NCQA provides health care quality information free of charge through the Web and media in order to help consumers, employers and others make more informed health care choices.

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Medicaid Top 10 (listed alphabetically)  

• BlueCross BlueShield of Western New York (NY)
• BlueShield of Northeastern New York (NY)
• Coordinated Health Partners, Inc. dba Blue CHiP (RI)
• Excellus BlueCross BlueShield, Rochester Region (NY)
• HealthPlus of Michigan (MI)
• Kaiser Foundation Health Plan of Hawaii (HI)
• M-CARE, Inc. (MI)
• Neighborhood Health Plan of Rhode Island (RI)
• Priority Health (MI)
• UPMC Health Plan, Inc. (PA)  

Medicare Top 10* (listed alphabetically)  

• Blue Cross and Blue Shield of Massachusetts (MA)
• Capital Health Plan, Inc. (FL)
• Excellus BlueCross BlueShield, Rochester Region (NY)
• Fallon Community Health Plan (MA)
• Harvard Pilgrim Health Care, Inc. (MA)
• HealthPartners (MN)
• Kaiser Foundation Health Plan of Colorado (CO)
• Kaiser Foundation Health Plan of the Mid-Atlantic (MD)
• Kaiser Foundation Health Plan of Hawaii, Inc. (HI)
• Keystone Health Plan Central (PA)
• Rochester Area Health Maintenance Organization dba Preferred Care (NY)  

* This “Top Ten” list includes 11 plans because some scoring differences were too small to draw distinctions.

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