NCQA Shares Health Plan Performance Ratings Ahead of Open Enrollment

The National Committee for Quality Assurance (NCQA) has released its 2022 Health Plan Ratings, revealing that most plans earned three stars or higher for overall health plan performance.

Each year, NCQA evaluates commercial, Medicare, and Medicaid health plans that report Healthcare Effectiveness Data and Information Set (HEDIS) results. The latest ratings reflect 2021 data gathered from HEDIS, the CMS Health Outcomes Survey, the Consumer Assessment of Healthcare Providers and Systems (CAHPS), and NCQA’s review of health plan quality improvement processes.

The annual evaluation ranks health plans based on clinical quality, patient experience, patient outcomes, and health plan efforts to continue improving.

“With open enrollment for health plans beginning in November, the NCQA 2022 Health Plan Ratings provide timely insight to help consumers and businesses make informed decisions about their healthcare,” Margaret E. O’Kane, president of NCQA, said in the press release.

The 2022 ratings included data from nearly 1,800 health plans representing 203 million people. Almost 650 were Medicare plans, 576 were commercial plans, 285 were exchange plans, and 278 were Medicaid plans.

NCQA rates health plans using a scale of one to five stars. Out of 1,048 health plans that received a numerical rating, six plans earned the highest rating of five stars.

Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. achieved a five-star rating for its commercial, Medicaid, and Medicare health plans. The other three health plans that earned five stars were Medicare plans: Kaiser Foundation Health Plan of Colorado, Medical Associates Clinic Health Plan of Wisconsin dba Medical Associates Health Plans, and Medical Associates Health Plan, Inc.

The plans with the highest ranking were all health maintenance organizations (HMOs).

Nearly 70 plans received 4.5 stars and 255 plans earned a four-star rating. The majority of plans (336 plans) received 3.5 stars, while 269 plans received three stars. The remaining 113 plans earned a rating of 2.5 or lower.

The most popular plan type was HMO (886 plans), while 364 plans were preferred provider organizations (PPOs).

Texas had the most health plans at 122, California followed with 120 plans, and New York had 105 plans included in the review.

Health plans saw improvements in some areas but faced shortcomings in others.

For example, cardiovascular care quality improved compared to the year before. Specifically, plans achieved better results for controlling high blood pressure. After declining between 2019 and 2020, commercial plan performance grew by an average of 6.9 percentage points, Medicare plans improved by 7.6 points, and Medicaid plans improved by 2.7 points.

Similarly, diabetes care improved after declining in 2020. Commercial plan performance with controlling hemoglobin A1c improved by 4.1 percentage points, Medicare plan performance grew by 3.2 points, and Medicaid plans improved by 3.3 points.

Childhood immunization rates increased 2.2 percentage points in commercial plans but fell 3 points in Medicaid plans. This suggests that the preventive care gap is growing, putting vulnerable children at risk for disease, according to NCQA.

While health plans generally received positive ratings, satisfaction was lagging for adult members. Overall healthcare ratings from adult members dropped 4.2 percentage points for commercial plans and 2.2 points for Medicaid plans.

Through NCQA’s Health Plan Report Cards, members can click on any health plan and access individual star ratings for patient experience, prevention, and treatment. The report card also includes additional services a health plan offers, such as multicultural healthcare and long-term services and supports.

In 2022, NCQA recognized several payers for their health equity efforts. Centene received the NCQA Innovation Award for Health Equity, while Aetna’s California Medicaid plan received the NCQA Multicultural Health Care Distinction.

NCQA recently added new HEDIS quality measures for 2023, which aim to improve race and ethnicity data collection and boost gender inclusivity.