NCQA health plan quality ratings show care gaps

Medicare plans scored better in 2021 than Medicaid and commercial plans in key quality areas measured by the National Committee for Quality Assurance.

The committee rates Medicare, Medicaid and commercial plans annually on a five-star scale, using data from the Healthcare Effectiveness Data and Information Set, the Consumer Assessment of Healthcare Providers and Systems’ Health Plan Survey, and the Centers for Medicare and Medicaid Services’ Health Outcomes Survey.

Unlike CMS’ star ratings, which follow a slightly different scoring methodology and focus solely on Medicare Advantage plans, the committee’s health plan ratings are not tied to quality bonus payments from CMS.

While the main purpose of the ratings is to inform consumers and businesses as they decide which health plans to work with in open enrollment, the quality scores are also useful benchmarks for insurers, said Andy Reynolds, assistant vice president for external relations at NCQA.

“We would encourage health plans to consider how they’re doing compared to their peers and assess what they can do to improve,” Reynolds said, urging them “to use the measurement and transparency to hold partners accountable and hold themselves accountable.”

A number of individual treatment areas such as diabetes and heart disease care saw improvement last year following the pandemic’s impact on their scores in 2020, said Sarah Shih, assistant vice president for research and analysis at NCQA.

Health plans’ work in controlling high blood pressure saw the most significant rebound in 2021, Shih said.  Medicare plans’ performance increased by an average of 7.6 percentage points, commercial plans by 6.9 points and Medicaid plans by 2.7 points.

In managing patients’ hemoglobin levels, commercial, Medicare and Medicaid plans improved by an average of 4.1 percentage points, 3.2 points and 3.3 points, respectively.

“Another area that was a concern, and we were monitoring very closely, is immunizations,” Shih said. “This year, we’ve seen a slight increase in the patient immunization rates for commercial health plans, but a decline in rates for children in Medicaid health plans.” 

This disparity suggests a growing gap in preventive care, putting children and adolescents in Medicaid at disproportionate risk of developing diseases, she said.

Out of 1,048 health plans surveyed, only six received 5-star ratings overall. They were commercial and Medicare plans part of either the Kaiser Foundation Health Plan network or the Medical Associates Health Plan network. 

As a group, commercial plans received an average overall rating of 3.54 stars. Medicaid and Medicare plans scored an overall average of 3.44 stars and 3.37 stars, respectively. 

For the first time, the NCQA saw a decrease in adult patients’ overall satisfaction with their healthcare, Shih said. Commercial member satisfaction dropped to 51.8%, from 55.9% in 2020, and Medicaid member satisfaction dropped to 56.5%, from 58.7%.

Solid communication and care coordination, easy access and the close integration of specialists and primary care doctors can play a role in health plans’ performance and ratings, said Kimberly Swanson, senior vice president of consulting and professional services at Healthmine, a health plan improvement organization.

“We tend to see higher member experience and higher quality scores for those plans that are more integrated,” Swanson said.

Health plans can also add bonus points to their overall scores by pursuing accreditation through the NCQA. 

Insurers not accredited by the NCQA tended to score lower than accredited health plans, not only on their overall 2021 rating, but on each individual measure category as well.

Although Medicare has the largest percentage of non-accredited plans and didn’t receive as many bonuses on its overall rating, Medicare plans on average had some of the highest quality measure scores, regardless of their accreditation status.

In the treatment category, Medicare plans that weren’t accredited scored an average of 3.95 stars, compared with an average of 2.55 stars for non-accredited commercial plans and 2.17 for non-accredited Medicaid plans.

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