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Few health insurance plans rank highest or lowest in NCQA's plan ratings

NCQA uses HEDIS scores to rate plans, a performance measure used by more than 90 percent of health insurers.

Susan Morse, Senior Editor

NCQA insurance plan ratings. Credit: NCQANCQA insurance plan ratings. Credit: NCQA

The New England States again did well in the 2018 health insurance plan ratings by the National Committee for Quality Assurance.

The 2018 ratings show Massachusetts at the top of the list, followed by Rhode Island and Maine. New Hampshire and Vermont are in the top ten, as are Wisconsin, Minnesota, Hawaii, New York and Iowa.

Connecticut placed 20th.

The top ten states with the highest-rated health plans received a 4.5 or 5 out of a 5 rating based on consumer satisfaction from surveys that include questions on claims processing and customer service. Ratings are also based on prevention and treatment. 

In each category, the outcome of a patient's care counts extra in the scoring. One example is whether blood pressure and diabetes blood sugar are controlled to safe, recommended levels.

"This emphasis on results means that, together with consumer satisfaction, outcomes are the main driver of ratings results," NCQA said.

The NCQA ratings are similar to star ratings for Medicare Advantage plans. The non-profit and private NCQA uses the Healthcare Effectiveness Data and Information Set, or HEDIS scores, a performance measure used by more than 90 percent of health plans. 

Only 8 percent of the plans received a top rating of 4.5 or 5.

But low performers were also rare, with only 2 percent earning ratings of 1 to 2.

NCQA rated 1,040 health plans. Of these, 445 were commercial plans, 418 were Medicare and 177 were Medicaid.

Key takeaways show that states with the top-performing plans have consistently delivered over the last three years. There's been very little movement within the top ten states except for Iowa and Hawaii, that in 2015 were ranked 12th and 11th respectively and moved into the top ten in 2016 and 2017. 

Of the 1,040 rated plans, 85 received a top rating of 4.5 or 5.0 and 25 got a rating of 1 to 2.

The NCQA ratings methodology blends dozens of quality indicators for health plans into a scale from 1–5, where 1 indicates lower performance and 5 indicates higher performance.

Consumers can drill down into any part of the ratings to learn how a health plan handles particular health issues or patient populations, NCQA said. 

For example, expectant parents may be interested in performance on two measures of prenatal and postpartum care. Families may be interested in quality results on 10 measures of pediatric preventive care and treatment, ranging from well-child care for infants, to monitoring ADHD treatment of 12-year-olds.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

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