September 18, 2023
WASHINGTON, DC—September 18, 2023—The National Committee for Quality Assurance (NCQA) today announced its 2023 Health Plan Ratings, an annual list that evaluates commercial, Medicare and Medicaid health plans based on assessments of quality and patient experience. The 2023 Health Plan Ratings are based on data from calendar year 2022, when 215 million people were enrolled in health plans that reported Healthcare Effectiveness Data and Information Set (HEDIS®) results to NCQA.
Health plans are rated on a scale of 0–5 stars. There was a nearly 6% increase in Medicaid plans that achieved 4-star and 4.5-star ratings compared to 2022, demonstrating improvement across several health quality measures.
As part of NCQA’s commitment to improve health equity through all NCQA products and programs, the 2023 Health Plan Ratings methodology is the first to include scoring for the diversity of health plan membership. 92% of plans successfully reported the Direct Race and Direct Ethnicity measure to earn the maximum possible points in their ratings.
“The NCQA 2023 Health Plan Ratings provide vital understanding of the quality of care people receive from health plans and provide valuable insight to help families make informed decisions about their care. This year’s ratings underscore health plans’ efforts to improve quality and health equity,” said NCQA President Margaret E. O’Kane. “By including our Direct Race and Direct Ethnicity measure in the ratings, NCQA reinforces our expectations for equity throughout the industry. Health plans’ success reporting that measure shows they are making encouraging strides in health equity.”
Each year, NCQA rates health plans that choose to publicly report HEDIS results. Ratings are based on almost 50 assessments of patient care outcomes and experience, including measures of clinical quality from NCQA’s HEDIS and CMS’s Health Outcomes Survey (HOS); measures of patient experience using the Consumer Assessment of Healthcare Providers and Systems (CAHPS®); and NCQA’s review of health plan quality improvement processes (NCQA Accreditation).
The overall rating is the weighted average of a plan’s HEDIS, CAHPS and HOS measure ratings, plus Accreditation bonus points, calculated on a 0–5 scale in half-points (5 is highest), displayed as stars and rounded to the nearest .5 point.
Visit the NCQA website for details on the 2023 Health Plan Ratings, measures and methodology.
NCQA is a private, nonprofit 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. In recognition for its leadership in diversity, equity and inclusion, NCQA has won the Excellence in Diversity Award from the Chesapeake Human Resources Association. NCQA’s website (ncqa.org) contains information to help consumers, employers and others make informed health care choices. NCQA can also be found at Twitter @ncqa and on LinkedIn at linkedin.com/company/ncqa.
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HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).