NCQA is pleased to announce our continuing collaboration with U.S. News & World Report to assess the performance of health plans.

“America’s Best Health Insurance Plans” will be featured in print and online editions of U.S. News & World Report. The December 2009* issue will feature U.S. News/NCQA rankings of the nation’s top 50 commercial health plans based on their combined HEDIS®, CAHPS® and NCQA Accreditation standards scores. The issue will also feature lists of the nation’s Top 25 Medicare and Medicaid plans.  

Plans named to the America’s Best Health Insurance Plans lists enjoy exceptional visibility from one of the nation’s leading and most-trusted sources of news. In addition, visitors to usnews.com will be able to view health plans’ performance on HEDIS measures in selected areas and make comparisons between and among plans in their area.

In order to allow sufficient time for analysis, commercial and Medicaid plans must submit their HEDIS and CAHPS results by June 15, 2009 in order to be included in this year’s rankings. The deadline for Medicare plans is June 30. In addition, for the purpose of calculating the rankings, the Accreditation status and standards scoring results will be frozen on July 31, 2009.

2009 Rankings to Include Managed Care Organizations Only

It should be noted that the 2009 edition of America’s Best Health Insurance Plans will apply only to managed care organizations.  NCQA and U.S. News are currently exploring options to rank preferred provider organizations in 2010. 

Improvements to the 2009 Production Schedule

Health plans that have submitted HEDIS data to NCQA will receive an e-mail from NCQA during the week of August 3rd that will serve to confirm the HEDIS submission NCQA will use to calculate the America’s Best Health Insurance Plans rankings. You will have 5 business days to respond to this e-mail should you wish to request changes.

Additionally, this year plans will have the opportunity to review your rankings well before they are published. On Monday, October 19, contacts at health plans reporting HEDIS data to NCQA will receive an e-mail detailing your own plan’s preliminary rank and scores for 2009. Please review this information very carefully. Plans will have until 5:30 pm Eastern time on Thursday, October 22, to review the information contained in the report and raise any questions to the attention of NCQA. As a result, NCQA will make no changes or adjustments to the rankings after they are posted.

Final rankings and scores will be distributed to plans that submitted HEDIS to NCQA on Monday, November 9. Note that all scores, ranks and associated data—in both preliminary and final form—are strictly embargoed and may not be made public until the rankings go live on usnews.com on Thursday, November 12. The feature is slated to appear in the issue of U.S. News that will hit newsstands on December 1, 2009.

While there are no major changes to the methodology this year, it should be noted that the group of measures used to rank plans has, as always, evolved slightly. Some HEDIS measures have been added to the measure set while others have been retired in the past year.

Please contact NCQA’s Communications Manager, Lauren Funk, at funk@ncqa.org with any questions.

* U.S. News & World Report has changed the print issue date to December 2009. The date the rankings will be posted online, November 12, has not changed. Rankings are considered to be public on November 12, 2009 and plans can advertise accordingly (updated July 1, 2009).

• Clarification of Childhood Immunization Status score. Combination 2 is the indicator used in scoring for the purposes of the rankings. (Updated October 27)

• Clarification of HOS scoring for Medicare plans. The Health Outcomes Survey (HOS) survey is fielded to a cohort of plan members each year; two years later, a follow-up survey is administered to the surviving members.  Five measures from this survey are scored for the rankings.  
  
  Plans that did not submit and were not required by CMS to submit HOS data in the cohort year(s) being used are given “NA” designations for the applicable HOS measures. Plans that did not submit and were required by CMS to submit HOS data will be given “NR” designations for these measures.  Note that two of the HOS measures rely on a baseline and a remeasurement year and are scored based on the change between the two. Accordingly, plans that fielded the HOS survey only in the remeasurement year will receive "NA" designations for the two applicable measures. (Updated October 9)

• Clarification of CAHPS scoring for Medicare plans. As noted below, NCQA is using CAHPS results from 2007 for scoring in Medicare plans. However, some plans were not required by CMS to submit CAHPS data in 2007; those plans will be recieve “NA” designations for all CAHPS measures. 
  
  Plans required by CMS to submit CAHPS data in 2007 that did not submit such data will receive “NR” designations. (Updated October 9)
  
  

• Timeline Adjustment U.S. News recently moved its publication schedule to a biweekly format; all the above dates have been adjusted accordingly. The new dates, which are displayed above, are one week later than previously published timelines. (updated August 26)
  
  
• HbA1c <7% measure not included in ranking methodology. Owing to preliminary data from a number of recent studies of the effects of stringent HbA1c management, NCQA will not publicly report the HbA1c <7% measures in 2008. This measure had been slated for public reporting for the first time this year; the measure will be considered for public reporting in calendar year 2009. Accordingly, the measure will be removed from the plan ranking methodology for America’s Best Health Plans; the remaining measures in the Prevention category will be rebalanced accordingly. (updated August 8)
  
  
• CAHPS data for Medicare plans. NCQA will not receive Medicare CAHPS data in time to include 2008 CAHPS data in the rankings this year. However, NCQA believes measures of patient satisfaction to be integral to any comprehensive assessment of quality. Accordingly, we have made the decision to use 2007 CAHPS data for Medicare plans in this year’s rankings.
  
  Note that select measures of prevention and treatment, such as Flu Shots in Adults and Medical Assistance with Smoking Cessation, are collected via CAHPS. The data will be weighted in a manner consistent with the 2008 methodology.
  
  NCQA is currently assessing the best way incorporate Medicare CAHPS data each year. We continue to review our options with an aim towards enabling a consistency in year-over-year rankings.
  
  

• Measures Removed to Avoid Widespread Imputation. Every year, NCQA removes any measure reported by fewer than half of all reporting plans in any given product line to avoid widespread imputation of values. This year, the measures to be removed are as follows:

   

  Commercial

  Medical Assistance with Smoking Cessation - Advising Smokers to Quit

  Medical Assistance with Smoking Cessation - Medications for Quitting

  Medical Assistance with Smoking Cessation - Strategies for Quitting

   

  Medicaid

  Medication for Rheumatoid Arthritis

  Antidepressant Medication Management - Contacts

  Antidepressant Medication Management - Acute Phase

  Antidepressant Medication Management - Continuation Phase

  7-Day Follow-up after Mental Illness

  Alcohol/Drug Dependence Treatment - Initiation of Treatment

  Alcohol/Drug Dependence Treatment - Engagement of Treatment

  Follow-up Care for Children w/ADHD Medication - Initiation

  Follow-up Care for Children w/ADHD Medication - Continuation and Maintenance

  Persistence of Beta-Blocker Treatment After a Heart Attack

  Use of Spirometry in the Assessment and Diagnosis of COPD
  
  No further measures were removed for Medicare plans. All the above changes are reflected in the updated methodology document.