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National Committee for Quality Assurance ranks health plans for comparison during open enrollment

Five plans scored highest with Northeast and Midwest dominating as areas with the highest rated plans.

Susan Morse, Senior Editor

In time for open enrollment, the National Committee for Quality Assurance has released its annual health insurance plan ratings.

Five plans received the top rating of 5.0. They are Capital District Physicians' Health Plan in New York, the Capital District Physicians' Healthcare Network in New York; the Kaiser Family Foundation Plan of the Mid-Atlantic states in the District of Columbia, Maryland and Virginia; Tufts Associated Health Maintenance Organization of Massachusetts and Rhode Island; and Tufts Benefits Administrators of Massachusetts.

NCQA rated 1,021 health plans and compared them in the areas of consumer satisfaction, prevention, and treatment. These included 438 commercial plans, 412 Medicare plans and 171 Medicaid plans.
 
WHY THIS MATTERS

NCQA's Health Insurance Plan Ratings 2019–2020 are meant to be a guide for consumers to understand their options in choosing the best health plan coverage.

Its ratings calculation methodology are similar to the Centers for Medicare and Medicaid Services five-star quality rating system for Medicare Advantage plans.

THE TAKEAWAY

The top 10 states with the highest percentage of highly-rated plans scoring 4.5 or 5.0 out of 5.0 rating and over a three-year average are Rhode Island, Massachusetts, Minnesota, Maine, Wisconsin, Hawaii, New York, Iowa, Maryland and New Hampshire.

High and low performers are rare. Of the 1,021 rated plans, 79, or 8%, received a top rating of 4.5 or 5.0. Sixteen, or 2% percent, earned the ratings of 1.0 to 2.0.

NCQA ratings are based on the plans' combined HEDIS, CAHPS and NCQA accreditation standards scores. It also recognizes clinicians and practices in key areas of performance.

These include: consumer satisfaction based on assessing patients' feedback in satisfaction surveys, including the processing of claims and customer service; prevention measured by patients' ranking of annual visits, flu vaccinations, screening tests, dental cleanings, well-woman appointments and other types of preventative care services; and the treatment of common but costly chronic conditions such as diabetes, depression, asthma and heart disease.

In each of the three categories, the health outcomes resulting from a patient's care contribute extra points to the scoring, such as the control of blood pressure and blood sugar levels.

THE LARGER TREND

States with the top performing plans consistently deliver, the report said.
Over the last three years, the 10 states with top performing plans reportedly experienced little movement. One exception is New Hampshire, which ranked seventh in 2017 and dropped to 11th and 10th place, respectively, in 2018 and 2019.

NCQA is a private, non-profit organization that accredits and certifies a range of healthcare organizations.

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