NCQA Releases 2017-2018 Health Plan Ratings

By Clive Riddle, September 22, 2017 The National Committee for Quality Assurance (NCQA) has just released its 2017-2018 Health Insurance Plan Ratings. NCQA reports that they evaluated 1,429 health plans and rated 1,062: 498 private (commercial), 386 Medicare and 178 Medicaid. NCQA’s ratings are based on a scale of 1.0 to 5.0, and they state their system is similar to the CMS Star Rating approach for Medicare Advantage plans. NCQA tells us that “the overall rating is the weighted average of a plan’s HEDIS and CAHPS measure ratings, plus accreditation standards (if the plan is accredited by NCQA), rounded to the nearest half point. Accreditation standards are given 10 percent of the weight of the valid HEDIS and CAHPS measures that a plan submits. The overall rating is based on performance on dozens of measures of care and is calculated on a 0–5 (5 is highest) scale in half points. Performance includes three subcategories (also scored 0–5 in half points): Consumer Satisfaction, Prevention and Treatment.” If you really want to get into the weeds regarding their methodology, you can click here to review their 16-page methodology report. NCQA share that the “Top Ten States with the Highest-Rated Health Plans (receiving a 4.5 or 5.0 out of 5 rating) for Three-Year Average: 1.     Massachusetts 2.     Rhode Island 3.     Maine 4.     New Hampshire 5.     Wisconsin 6.     Minnesota 7.     Hawaii 8.     New York 9.     Vermont 10.  Iowa NCQA also tells us that “high and low performers Are rare: of the 1,062 rated plans, 103 (10%) received a top rating of 4.5 or 5.0 out of 5. Twenty-three (2%) earned the ratings of 1.0 to 2.0. Digging into their website, we compiled this list of health plans with 5.0 overall ratings for Private, Medicaid or Medicare: ·         BCBS MA (Private) ·         Johns Hopkins US Family MD (Private) ·         Kaiser Northern California (Private) ·         Tufts MA, NH, RI (Private) ·         Jai Medical Systems MD (Medicaid) ·         Group Health Plan MN, WI (Medicare) ·         Gundersen Health Plan IA, WI (Medicare) ·         Kaiser Southern CA (Medicare) ·         Kaiser Northwest OR, WA (Medicare) ·         Kaiser Washington (Medicare) ·         Kaiser Hawaii (Medicare) ·         Medical Associates Health Plan WI (Medicare) ·         Medical Associates Health Plan IL, IA (Medicare) On the flip side, here’s the plans we identified with ratings of 2.0 or less: ·         Cigna NM  (Private 2.0) ·         Cigna Utah (Private 2.0) ·         Connecticut General NM (Private 2.0) ·         Human Puerto Rico (Private 2.0) ·         Anthem BCBS Nevada (Private 2.0) ·         Triple S Salud PR (Private 1.5) ·         UnitedHealthcare of Texas (Private 1.5) ·         Tokio Marine Pacific Guam (Private 1.0) ·         Union Health Service IL (Private 1.5) ·         Aetna Better Health IL (Medicaid 2.0) ·         Family Health Network IL (Medicaid 2.0) ·         Health Plan of Nevada (Medicaid 2.0) ·         South Florida Community Care Network (Medicaid 2.0) ·         Aetna Better Health NJ (Medicaid 1.5) ·         Community Care Alliance IL (Medicaid 1.5) ·         Cook Children's Health Plan TX (Medicaid 1.5) ·         Affinity NY (Medicare 2.0) ·         Atrio (Medicare 2.0) ·         Community Care Alliance IL (Medicare 2.0) ·         Elderplan NY (Medicare 2.0) ·         Gateway KY, NC, OH (Medicare 2.0) ·         Group Health Inc. NY (Medicare 2.0) ·         Inland Empire CA (Medicare 2.0) ·         Meridian IL (Medicare 2.0) ·         United Healthcare of New York (Medicare 2.0) ·         Virginia Premier (Medicare 2.0) ·         VNS Choice NY (Medicare 2.0) To be fair to the above plans rated 2.0 and less, there were 367 NCQA evaluated but did not rate due to only partial or no data available – and it is quite possible that a number of these would have received low ratings as well.