NCQA Releases Health Plan Performance Ratings with COVID-19 Data

The National Committee for Quality Assurance (NCQA) has released its first set of Health Plan Ratings since 2019, providing insight into health plan performance during the coronavirus pandemic.

“Ratings use a simple and convenient online display to show how health plans perform in key areas,” the press release summarized. “They also include assessments of care for people most at risk of dying from COVID and people at risk for opioid addiction.”

For the Health Plan Ratings, NCQA analyzes three types of health plans: commercial health plans, Medicare Advantage plans, and Medicaid plans. The ratings assess clinical quality of care, patient experience, and health quality processes.

Not all health plans undergo NCQA’s rating process, but only the health plans that make the necessary data publicly available. The rating methodology relies on Healthcare Effectiveness Data and Information Set (HEDIS), Health Outcome Survey (HOS), Consumer Assessment of Healthcare Providers and Systems (CAHPS), and NCQA accreditation.

Similar to Medicare Advantage Star Ratings, NCQA ratings use a scale of one to five stars, with five stars indicating strong plan performance and one star representing lower quality plan performance.

For 2021, NCQA evaluated over 1,000 health plans and issued them health plan ratings. These health plans’ combined consumer base represented approximately three-fifths of the national population. Nearly 600 plans were Medicare plans, 573 plans were commercial health plans, 264 plans were Medicaid plans, and 258 were exchange plans.

New York had the most health plans that NCQA reviewed at 117 rated health plans. California and Texas followed close behind with 110 and 112 rated plans respectively. Not all of these plans received a star rating.

The most popular product type overall was the health maintenance organization model, which accounted for 815 health plans. The second most common product type was the health maintenance organization and point-of-service combined model, which described 175 of the rated health plans.

Of the health plans that qualified to receive a star rating, most received between a 3.0 star rating and 4.5 star rating. Over 350 health plans earned 3.5 stars and nearly 270 plans achieved a 4.0 star rating.

Over 650 health plans did not receive a star rating because they did not have to report data, reported the data only partially, or did not report the data that NCQA needed to make the evaluation and assign a star rating.

The star ratings serve as general indicators for a number of specific quality measures. For the first Health Plan Rating since the coronavirus pandemic struck the US, NCQA included measures that would be particularly relevant for the current public health emergency.

For example, the rating system includes health plan performance on care for asthma, diabetes, and heart disease. Each of these are risk factors for coronavirus as well as expensive chronic diseases.

By clicking on a plan, consumers can see how the health plan performs on individual metrics including five diabetes quality measures, an asthma care metric, and four heart disease measures.

The NCQA ratings also acknowledge the escalating opioid epidemic and hold health plans accountable for their actions to prevent overprescription of opioids. 

During the coronavirus pandemic, the opioid epidemic continued to stay strong. Payers have been balancing coronavirus response endeavors with continued efforts to stem the opioid crisis.

NCQA includes three quality measures in its Health Plan Ratings that addressed the opioid crisis. The organization assesses whether health plan members avoided opioids at high dosage, avoided receiving many prescriptions from different prescribers and pharmacies, and avoided long-term opioid use.

The Health Plan Ratings are assembled into an online report card that allows consumers to filter plans by certain features, compare their coverage options, and view the star ratings for individual measures.

NCQA will release the ratings for 2022 on September 22, 2021, only a week after releasing the 2021 ratings.