Top 10 Highest Performing Medicare, Medicaid Health Plans

Top 5 Medicare Plans

Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.

Overall Rating: 5.0

Scores: Patient Experience 3.5; Prevention 5.0; Treatment 4.5

Kaiser Foundation Health Plan of the Mid-Atlantic States was one of two Kaiser Foundation Health Plans in the top ten Medicare plans. The plan has over 104,000 enrollees in the District of Columbia, Maryland, and Virginia.

The payer’s most effective area of quality was its prevention category, where it earned five stars in every subcategory—cancer screenings, flu shots, and pneumonia shots. It also performed well in the treatment category, receiving mostly from 4.0 to 5.0 star ratings except in behavioral health medication adherence (3.0 stars).

The payer has earned the Health Equity Accreditation as well as the Multicultural Health Care (MHC) distinction.

Kaiser Foundation Health Plan of Colorado

Overall Rating: 5.0

Scores: Patient Experience 4.0; Prevention 5.0; Treatment 4.5

Kaiser Foundation Health Plan of Colorado serves almost 111,600 members in the state.

The payer’s quality of care was most evident in its preventive care efforts, where it achieved five stars in each category except breast cancer screenings (4.0 stars). Kaiser Foundation Health Plan of Colorado also achieved a high star rating in the treatment category, receiving five stars for heart disease, behavioral health care coordination, and care coordination overall.

Patient experience was the health plan’s lowest-ranked category, largely due to its three-star rating on how quickly and easily members could access care.

Medical Associates Health Plan, Inc.

Overall Rating: 5.0

Scores: Patient Experience 5.0; Prevention 4.5

The Medical Associates Health Plan, Inc. serves 14,500 members in Iowa and Illinois.

The health plan achieved high ratings on the two categories for which it provided data, but had insufficient data for the treatment category.

Patient experience was particularly strong for this health plan. It achieved five stars in every category—access to care, satisfaction with plan providers, and satisfaction with plan and plan services. In the prevention category, the plan performed best on breast cancer screenings and flu shots for adults ages 65 and older. The plan received 4.0 stars on colorectal cancer screenings and pneumonia shots.

Although most of the treatment category did not have enough data to apply a star rating, the health plan was able to receive a score in a couple of individual subcategories.

The plan received 4.5 stars for its diabetes care, even though two categories did not have enough data. Heart disease treatment received 4.0 stars based on one measure. Care coordination received 3.0 stars based solely on its performance with follow-ups after emergency department visit for patients with multiple high-risk chronic diseases.

Medical Associates Clinic Health Plan of Wisconsin dba Medical Associates Health Plan

Overall Rating: 5.0

Scores: Patient Experience 5.0; Prevention 4.0

Medical Associates Health Plan of Wisconsin serves 3,762 members in the state of Wisconsin.

The health plan performed very well in almost every subcategory of patient experience. The only category in which the plan did not achieve 5.0 stars was satisfaction with plan providers, in which the plan received a 4.5 star rating.

In prevention, the health plan achieved a 4.5 star rating on the cancer screening section, 4.0 stars for its flu shot services, and 3.0 stars for its pneumonia shot services.

Like Medical Associates Health Plan, Inc., this health plan achieved a high score but did not have sufficient data in certain categories that were considered not applicable.

UCare Health Inc.

Overall Rating: 4.5

Scores: Patient Experience 3.5; Prevention 4.0; Treatment 4.0

Of all of the top-rated health plans, UCare was the only health plan that was not a health maintenance organization (HMO). The plan is a preferred provider organization (PPO) that serves more than 2,130 members in Minnesota and Wisconsin.

Prevention and treatment were the health plan’s highest-scoring categories. The plan achieved 5.0 stars for its diabetes care and risk-adjusted utilization. It lacked enough data to assess behavioral health care coordination, medication adherence, or access. UCare Health Inc. also achieved a 4.5 star rating on cancer screenings.

The health plan was recognized for its electronic clinical data work.

Top 5 Medicaid Plans

Kaiser Mid-Atlantic States, Inc. - Maryland

Overall Rating: 5.0

Scores: Patient Experience 3.0; Prevention 5.0; Treatment 4.0

The HMO Medicaid plan serves 110,640 members in the state of Maryland. It has also earned the Health Equity Accreditation and Multicultural Health Care (MHC) distinctions from NCQA. Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. also goes by the name HealthChoice (Maryland Medicaid).

The health plan performed the best in its prevention efforts, where it received a 5.0-star rating. Its children and adolescent well-care, women’s reproductive health, and cancer screening subcategories each achieved a 5.0-star rating.

In the treatment category, the health plan received a 4.5-star rating for diabetes care and heart disease care. It also received a 4.5-star rating for overuse of opioids by avoiding prescribing high dosages, avoiding prescribing from multiple prescribers and pharmacies, and avoiding potentially risky continued use.

Kaiser Foundation Health Plan, Inc. – Hawaii

Overall Rating: 4.5

Scores: Patient Experience 3.0; Prevention 5.0; Treatment 3.5

Kaiser Foundation Health Plan, Inc. – Hawaii serves 44,083 enrollees in the state of Hawaii. This health plan is accredited but under corrective action.

It achieved a 5.0-star rating for preventive care, scoring particularly high on its cancer screenings and child and adolescent well-care services. It also received a 5.0-star rating for screening of Chlamydia in sexually active women between the ages of 16 and 24.

The health plan received 3.5 stars in the treatment category, primarily due to its lower performance in behavioral health access, monitoring, and safety. The plan received 2.0 stars for its alcohol or drug abuse or dependence treatment and 2.0 stars for its diabetes screenings for individuals with schizophrenia or bipolar disorder.

The payer is also known as Kaiser Permanente Hawaii QUEST Integration.

Excellus BCBS New York

Overall Rating: 4.5

Scores: Prevention 4.0; Treatment 3.5

Excellus Health Plan, Inc. dba Excellus BlueCross BlueShield serves over 256,820 members in New York.

The health plan received a 4.0-star rating for its work in preventive care. This score was driven largely by its cancer screening subcategory, where it received 5.0 stars for both breast cancer screening and cervical cancer screening. It also received 4.0 stars for children and adolescent well-care.

The treatment category was the health plan’s second-highest category. In this category, the health plan performed particularly well in its behavioral health care coordination, diabetes care, and respiratory care.

The health plan achieved a 5.0-star satisfaction rating for its plan services, but the patient experience category received an incomplete designation overall mainly due to a lack of data for getting care, which was marked as not applicable.

NCQA also awarded Excellus Health Plan, Inc. dba Excellus BlueCross BlueShield with the Electronic Clinical Data distinction. The health plan goes by many names, including Blue Choice Option, Premier Child Health Plus, Premier Option Plus, and more.

Vista Health Plan dba AmeriHealth Caritas Pennsylvania

Overall Rating: 4.5

Scores: Patient Experience 4.5; Prevention 4.0; Treatment 3.5

Vista Health Plan dba AmeriHealth Caritas Pennsylvania has 310,328 enrollees in the state of Pennsylvania.

Patient experience was the health plan’s highest-scoring category. Satisfaction with network’s primary care doctors was high (5.0 stars) and members found that they were able to access care quickly. Satisfaction with the health plan itself and its services received a 4.0-star rating.

The plan also did well on the prevention category, receiving 4.0 stars in three subcategories: children and adolescent well-care, women’s reproductive health, and cancer screenings.

The health plan did not have sufficient data to receive a score on behavioral health care coordination, which was marked as not applicable.

Vista Health Plan dba AmeriHealth Caritas Pennsylvania received three distinctions from NCQA: the Health Equity Accreditation and distinctions for electronic clinical data and multicultural health care.

UnitedHealthcare of the Midlands, Inc. dba UnitedHealthcare Community Plan (NE)

Overall Rating: 4.5

Scores: Patient Experience 4.0; Prevention 3.5; Treatment 4.0

UnitedHealthcare of the Midlands, Inc. dba UnitedHealthcare Community Plan (NE) serves almost 108,580 members in the state of Nebraska.

The health plan achieved a 4.0 star-rating for patient experience, with 5.0 stars for the primary care doctor rating balancing out a 3.5-star rating for health plan satisfaction. The payer also received 4.0 stars for the treatment category, driven largely by its 5.0-star rating in diabetes care and 4.5 stars for behavioral health medication adherence and heart disease care.

Preventive care services had the lowest rating but was bolstered by some strong scores in women’s reproductive health—particularly postpartum care (5.0 stars)—and breast cancer screenings (5.0 stars).

The payer received a Health Equity Accreditation from NCQA as well as a distinction for electronic clinical data.