23 plans earn top marks in health insurance ratings

September 22, 2016 — Twenty-three of more than 1,000 insurance plans received a top score of 5.0, according to new ratings released Thursday by the National Council for Quality Assurance (NCQA).

82 NCQA’s assistant vice president Andy Reynolds said the program earned a 4.5, which is considered very good. The nonprofit has evaluated the ratings of private, Medicaid and Medicare plans annually since 2005. Private plans include employer-based plans and plans that individuals can purchase on their own.

Kaiser Permanente, University of Pittsburgh Medical Center, Capital District Physicians, Tufts, and Massachusetts’ Blue Cross Blue Shield were 2016 top performers. Each company has more than one program earning 5 points.

2016 NCQA Ratings

These ratings are designed to help consumers make decisions about health insurance, which can be confusing and difficult to navigate. Other organizations such as U.S. News & World Report, JD Power, and Medicare also rate insurance plans.

The ratings provided here cover the plans used by most Americans and use a 0 to 5 rating system, says Reynolds.

NCQA does not rate Marketplace programs offered under the Affordable Care Act because those ratings are supposed to come from the federal government. For those considering a Marketplace plan, it’s useful to see NCQA ratings for the same plan offered as a private plan outside of Marketplace, Reynolds said.

The ratings take into account three main categories:

  • Consumer Satisfaction: What patients say in satisfaction surveys, such as how the company handles Claims and Customer Service.
  • Prevention: How well does the company do this, including checks, tests, and other care that keeps people, especially children, healthy.
  • Treatment: Plan how to provide care for common and expensive conditions, including heart disease, diabetes, and depression.

The point, says Reynolds, is results. For example, can a program help people with diabetes manage their blood sugar safely?

Top Plans

This year, 23 plans received a 5, including 13 business plans, 8 Medicare plans and 2 Medicaid plans. The business plan is:

  • Blue Cross and Blue Shield of Massachusetts HMO Blue Inc. — HMO/POS
  • Capital District Physicians’ Health Plan Inc. (CDPHP) — — HMO
  • Capital District Physicians’ Healthcare Network Inc. (CDPHN) — HMO/POS
  • Capital Health Plan Inc. — HMO
  • John Hope, USA Kings University Family Health Plan — HMO
  • Kaiser Foundation Health Plan of the Mid-Atlantic States Inc. — HMO
  • Kaiser Foundation Health Plan Inc. – Northern California — HMO
  • Martin’s Point US Family Health Plan (ME) — HMO
  • Tufts Associated Health Maintenance Organization Inc. — HMO/POS
  • Tufts Benefit Administrators Inc. — PPO
  • UPMC Benefit Management Services Inc. — HMO
  • UPMC Health Coverage Inc. — HMO
  • UPMC Health Plan Inc. — HMO< /li>

The Medicare plan is:

  • Group Health Plan Inc. — HMO
  • Gundersen Health Plan Inc . – – HMO
  • Kaiser Foundation Health Plan Inc. — Southern California — HMO
  • Kaiser Foundation Health Plan of Georgia Inc. — HMO< /li>
  • Kaiser Foundation Health Plan of the Northwest Inc. — HMO
  • Kaiser Foundation Health Plan Inc. — Hawaii — HMO
  • Kaiser Foundation Health Plan Inc. — Northern California — HMO
  • Medical Associates Health Plan Inc. — HMO

Medicaid is:

  • Jai Medical Systems Managed Care Organization Inc. — HMO
  • Kaiser Foundation Health Plan Inc. — Hawaii — HMO

Get Good or The percentage of programs with very good ratings fell slightly from last year, from 11.4 percent in 2015 to 10.4 percent this year, Reynolds said.

”The decline may be due to a decline in consumer satisfaction, even among programs that scored high on prevention and treatment measures,” Reynolds said.

Consumer satisfaction Appointment and wait times are considered for the following factors.

A below-average plan

One commercial PPO plan earned a 1.5: Hawaii Medical Services Association. 13 Medicare Program received a Level 2:

  • Care Improvement Plus South Central Insurance Company — PPO
  • Cigna HealthCare of Indiana Inc. — HMO
  • Cuatro LLC dba Access Medicare New York — HMO
  • Easy Choice Health Plan Inc. — HMO
  • Elderplan Inc. — HMO
  • Group Health Incorporated — PPO
  • HAP Midwest Health Plan Inc. — HMO
  • HealthSpring Life and Health — HMO
  • Molina Healthcare of California Partner Plan Inc. — HMO< /li>
  • Molina Healthcare of Ohio Inc. — HMO
  • Sierra Health & Life — PPO
  • WellCare Health Program Cheap Sweatshirts Wholesale Company — HMO

1.5 points for two Medicaid programs:

  • Santa Clara County Health Bureau — HMO
  • United Healthcare — Texas — HMO

In some cases, a low rating could mean that the new plan doesn’t have enough data yet, Elisa Said Yadao, a senior vice president of the Hawaii Medical Services Association, which received a 1.5 for a business plan.

“A 1.5 doesn’t reflect our actual performance in that plan,” Yadao said. Say. “Next year, we’ll be submitting this data, so we’ll get a more accurate rating, which we believe will match the 4.0 rating we’ve received for other commercial PPO plans this year.” point.

How to Use Ratings

In addition to looking at the overall rating, people should ‘drill down’ into areas that are important to them to see how the program fits into these measures How effective, Reynolds said.

For example, pregnant women may want to know how effective the program is in prenatal and postnatal care. Families with young children may be most interested in pediatric care and treatments.

If the health plan you’re considering isn’t rated, but the same plan is highly rated in another state, it’s an indication, but not a guarantee, that the one in your state is also doing well, Reynolds said. “There’s never been a direct link between states, but if a health plan is strong in one place, its corporate culture and way of working often contribute to comparable performance elsewhere,” he said.

Expert Views

Objective information such as NCQA ratings can be helpful to consumers, said Dr. Glenn Melnick, California Blue Cross Chair of Healthcare Finance at the USC Schaeffer Center. He reviewed the new NCQA ratings.

“It’s systematic, it’s transparent, and you know what they’re measuring,” said Melnick, who is also a resident advisor to the nonprofit research organization RAND Corporation. “I congratulate them on collecting all this data and building the system.”

But, he said, “it’s a tool” and “it’s one of the few tools.”

Like other ratings, he said, it has limitations. “It’s program-level data,” he said. Hospitals and doctors provide care. “So the result, he said, is an average. That means even if you choose a program with a high score, you might get a doctor with a low score, but be “averaged”

he said , which is especially important, for example, if you’re looking at a program ranked 2. “You’re more likely to end up with a provider that reflects this low score,” he said.

“Some scores also depend on It depends on the characteristics of people who enroll in the plan,” Melnick said. Plans that have a lot of people who regularly use health care may have lower levels of patient satisfaction. He said the more people who go to the doctor, the more likely they are frustrating situation and common