The Getting Needed Care composit measures members’ perception of how easy it was to get care from their doctor and from specialists in the last 6/12 months (Medicaid/Commercial). Members were asked how often they were able to:
- See a specialist when they needed on.
- Obtain the care, tests or treatment they believed were necessary.
Responses were “Never,” “Sometimes,” “Usually” and “Always.” The rates displayed represent the average percentage of health plan members nationwide who responded “Usually” or “Always.”
Getting Needed Care Usually or Always
| Measure Year | Commercial HMO | Commercial PPO | Medicaid HMO | Medicare HMO | Medicare PPO |
|---|---|---|---|---|---|
| 2022 | 81.9 | 83.2 | 81 | - | - |
| 2021 | 83.8 | 85 | 81.9 | - | - |
| 2020 | 87.1 | 88.8 | 83.6 | - | - |
| 2019 | 86.8 | 87.8 | 83.0 | § | § |
| 2018 | 85.4 | 87.4 | 82.5 | 86.8 | 91.4 |
| 2017 | 86.2 | 87.2 | 82.4 | 87.1 | 91.5 |
| 2016 | 86.3 | 87.6 | 82.0 | 87.1 | 91.7 |
| 2015 | 86.3 | 87.9 | 80.4 | 86.6 | 90.9 |
| 2014 | 87.4 | 88.4 | 80.8 | 87.1 | 91.1 |
| 2013 | 87.9 | 88.3 | 80.5 | 87.9 | 91.8 |
| 2012 | 87.3 | 88.5 | 80.6 | 89.1 | 92.3 |
| 2011 | 85.5 | 86.2 | 75.5 | 89.4 | 92.6 |
| 2010 | 86.2 | 86.6 | 76.0 | 89.9 | 92.8 |
| 2009 | 85.4 | 86.3 | 75.0 | 89.1 | 91.3 |
| 2008 | 85.3 | 86.4 | 75.7 | 88.6 | 90.8 |
| 2007 | 84.2 | 85.3 | 75.2 | 88.8 | 91.0 |
| 2006 | 84.2 | 85.3 | 74.2 | 89.3 | 91.7 |
Getting Needed Care Always
| Measure Year | Commercial HMO | Commercial PPO | Medicaid HMO | Medicare HMO | Medicare PPO |
|---|---|---|---|---|---|
| 2019 | 54.4 | 54.8 | 55.6 | § | § |
| 2018 | 52.8 | 53.3 | 55.3 | 59.7 | 63.9 |
| 2017 | 53.3 | 53.0 | 55.3 | 59.8 | 64.1 |
| 2016 | 53.3 | 53.5 | 55.8 | 60.3 | 64.9 |
| 2015 | 53.0 | 53.8 | 53.7 | 60.7 | 64.5 |
| 2014 | 55.0 | 55.2 | 54.6 | 61.2 | 65.3 |
| 2013 | 57.6 | 58.2 | 55.1 | 62.9 | 66.6 |
| 2012 | 56.4 | 57.6 | 55.1 | 64.6 | 68.3 |
| 2011 | 54.1 | 53.8 | 50.4 | 64.1 | 66.6 |
| 2010 | 53.9 | 53.9 | 50.1 | 63.9 | 66.2 |
| 2009 | 52.9 | 52.7 | 48.5 | 63.6 | 64.4 |
| 2008 | 52.6 | 52.6 | 49.4 | 62.4 | 61.9 |
| 2007 | 50.4 | 49.5 | 48.7 | 62.0 | 63.4 |
| 2006 | 50.1 | 51.2 | 46.7 | 62.6 | 64.6 |
| 2005 | 80.1 | 84.7 | 73.4 | 95.9 | 97.0 |
| 2004 | 79.3 | - | 73.8 | 95.7 | - |
| 2003 | 78.4 | - | 72.1 | 94.9 | - |
| 2002 | 76.9 | - | 72.3 | 94.8 | - |
| 2001 | 76.7 | - | 75.4 | 94.9 | - |
| 2000 | 75.4 | - | - | - | - |
§ Not available due to CMS suspension of data reporting during COVID-19 pandemic.
This State of Healthcare Quality Report classifies health plans differently than NCQA’s Quality Compass. HMO corresponds to All LOBs (excluding PPO and EPO) within Quality Compass. PPO corresponds to PPO and EPO within Quality Compass.
Figures do not account for changes in the underlying measure that could break trending. Contact Information Products via my.ncqa.org for analysis that accounts for trend breaks.