We Help Your Mom Pick a Health Plan

September 20, 2022 · Andy Reynolds

Health Plan Ratings are NCQA’s most consumer-friendly summary of where to find good care. We published the 2022-2023 ratings last week to help people choose health plans during fall open enrollment.

Highlights include:

• A Half-Dozen Top-Performers: Six plans earned our highest overall rating of 5 stars.

• • Commercial:Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.
  • Medicaid:Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.
  • Medicare: Kaiser Foundation Health Plan of Colorado; Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.; Medical Associates Clinic Health Plan of Wisconsin dba Medical Associates Health Plans; and Medical Associates Health Plan, Inc.
• Better Care for Heart Disease. We are heartened (no pun intended) to see several measures of cardiovascular care quality improve. The most significant gain was in controlling high blood pressure. After a decline from 2019–2020, average commercial plan performance improved 6.9 percentage points, Medicare plans improved 7.6 points and Medicaid plans improved 2.7 points.
• Rebound in Diabetes Care. Following a drop the year before, care for people with diabetes improved in two areas:
  • Controlling blood pressure: Average commercial plan performance improved 5.5 percentage points, Medicare plans improved 2.5 points and Medicaid plans improved 2.1 points.
  • Controlling Hemoglobin A1c: Average commercial plan performance improved 4.1 percentage points, Medicare plans improved 3.2 points and Medicaid plans improved 3.3 points.
• Divergence in Childhood Immunizations. Immunization rates rose 2.2 percentage points for children enrolled in commercial plans, but declined 3 points for children in Medicaid plans. This >5-point divergence suggests a growing gap in preventive care that puts America’s most vulnerable children at disproportionate risk for disease.
• Decline in Adults’ Satisfaction With Care. Adult patients’ overall ratings of their health care dropped for both commercial (4.2 percentage points) and Medicaid health plans (2.2 points) from the prior year.

Journalists from outlets such as HealthLeaders and ModernHealthcare wrote about the ratings.

Methodology and Help for Health Plans

We make Health Plan Ratings for people who buy and use health care.

We also make guides to help health plans understand and use the ratings.

Resources that plans consult most are the:

• Methodology: The complete “recipe” we use to translate what we know into summaries that even our mothers can understand.
• Measure Lists: The HEDIS measures, CAHPS results and findings from our Health Plan Accreditation surveys that we use in the methodology.
• Advertising Guidelines: Plans like to promote their ratings results. This guide helps everyone do it fairly and accurately.

As an annual project, our Health Plan Ratings follow a regular rhythm that will start again in the spring for the 2023 ratings.

For questions about the ratings from any year, contact NCQA’s Health Plan Ratings Help Desk at my.ncqa.org.