November 23, 2022
  • November 23, 2022

Only six health plans earn top scores in 2022 NCQA health insurance ratings

By on September 15, 2022 0

In the American healthcare landscape, no sector is less reliable than health insurance. According to a 2021 survey by the American Board of Internal Medicine Foundation, only 33% of people said they trust health insurance companies, compared to 85% who said they trust doctors.

New data from the National Committee for Quality Assurance (NCQA) suggests that this figure may not improve.

In the NCQA’s 2022 Health Plan Ratings, released today, satisfaction with care deteriorated among members of commercial and Medicaid health plans. Commercial member satisfaction fell 4 points from 55.9% last year to 51.8% this year, and Medicaid member satisfaction fell 2 points from 58.7% last year. last year to 56.5% this year. Although these changes may seem small, they are statistically significant.

Annual ratings evaluate health plans in the commercial, Medicare and Medicaid segments. Plans are rated on a 0-5 star scale based on nearly 50 ratings of patient access to care, outcomes, experience and satisfaction. These ratings capture things like how easy or difficult it is for members to get the care they need and how satisfied members are with their health insurance plan’s customer service.

The 2022 rankings include health plans serving more than 200 million people, or more than 60% of the US population, according to the NCQA.

Overall, only six of the 1,048 health plans in the 2022 ratings earned 5 stars, the highest possible score. Of the six top-rated plans, four are Kaiser Foundation health plans, including the Mid-Atlantic States Kaiser Foundation Health Plan, which earned 5 stars in all three insurance categories. . Kaiser Foundation Health Plan of Colorado also received the highest score from Medicare.

Kaiser Foundation health plans can do particularly well in these rankings because they use an integrated approach, linking health coverage to health services through the various entities associated with Kaiser Permanente.

According to Andy Reynolds, vice president of external relations support at the NCQA, this approach may help explain the high ratings.

“The key is to align incentives so that payers and providers pursue the same vision of keeping patients healthy, providing evidence-based care when members get sick, rewarding members as customers who deserve and obtain good service, and to organize their work in such a way as to improve quality over time.”

Using an integrated model may not be the only route to 5-star ratings, but rounding out the list of top scores, two health plans offered by Medical Associates Health Plans, another integrated provider organization /payer which operates in Iowa, Illinois and Wisconsin.

At the other end of the spectrum, 11 shots scored only 2 stars, the lowest rating on record. Among the worst were three Molina Healthcare plans as well as one plan each managed by AmeriHealth and UnitedHealthCare.

According to Reynolds, consumers with a range of health plan options may want to select the highest-rated plan possible. But not everyone has a choice.

“We encourage people to hold health plans accountable,” Reynolds said. “For people who don’t have a choice of health plans, that might mean asking your employer/plan/doctor why your plan’s quality results are what they are and what they’re doing to to improve.”

Overall, the average rating was just under 3.4 out of 5. Reynolds said that while the quality varies, it tends to improve over time. But that doesn’t tend to happen automatically; this may require leadership from the people who use and pay for health plan services.

“Patients and employers, who pay for most insured coverage, should use the ratings to continue advocating for good care,” Reynolds said. “Improving the quality of health care is not as advanced as in other industries, so people should continue to push for better care and better service.”

In addition to overall plan scores, the NCQA measures specific aspects of care, several of which have improved in 2022. For example, several measures of the quality of cardiovascular care have improved, particularly measures of hypertension control blood pressure, which improved by 6.9 for commercial plan members. percentage points from 2021 to 2022. In Medicare and Medicaid plans, the improvements were 7.6 points and 2.7 points, respectively.

Similarly, for people with diabetes, measures of blood pressure control improved by 5.5 percentage points in commercial plans, 2.5 points in Medicare plans, and 2.1 points in Medicaid plans. Hemoglobin A1c control, a key measure in diabetes care, improved by 4.1 percentage points in commercial plans and just over 3 points in Medicare and Medicaid plans.

The 2022 results also showed a discrepancy in performance on childhood vaccinations, depending on the population. In commercial plans, vaccination rates increased by 2.2 percentage points but fell by 3 points for children in Medicaid plans.

The details of the assessments can reveal the strengths and weaknesses of specific aspects of the members’ health and care plan experience. These differences can serve as a conversation starter that helps you choose the right plan for your needs, according to Reynolds.

“What is important to you, your business and your family when it comes to health care? What is good skincare for you, and which plan matches what you value? ” he said. “Once you know what you’re looking for, you can find a plan that works best for you.”

But ratings can also be an important way to hold health plans accountable for the quality and value they provide to consumers and their employers.

“It is up to the people who use and pay for health care to rely on measurement and transparency by voting with their dollars and voting with their feet to reward high performers and encourage low performers to improve” , said Reynolds.