Two health plans earn 5 stars in NCQA's annual assessment
Kaiser Foundation Health Plan of the Mid-Atlantic States and Independent Health Association earned 5 stars.
Photo: Cavan Images/Getty Images
Two commercial health plans achieved a 5-star rating – doubling the amount from 2022 – according to the new 2023 Health Plan Ratings published by the National Committee for Quality Assurance.
The Health Plan Ratings is an annual list that evaluates commercial, Medicare and Medicaid health plans based on assessments of quality and patient experience. The 2023 list is based on data from calendar year 2022, when 215 million people were enrolled in health plans that reported Healthcare Effectiveness Data and Information Set (HEDIS) results to NCQA.
WHAT'S THE IMPACT?
Health plans are rated on a scale of 0–5 stars. In addition to the increase in 5-star plans, there was also a nearly 6% increase in Medicaid plans that achieved 4-star and 4.5-star ratings compared to 2022, showing improvement across several health quality measures.
The methodology for 2023 is the first to include scoring for the diversity of health plan membership. Ninety-two percent of plans successfully reported the Direct Race and Direct Ethnicity measure to earn the maximum possible points in their ratings.
Kaiser Foundation Health Plan of the Mid-Atlantic States and Independent Health Association were the two plans earning 5 stars in this year's list. Seventy-five plans earned 4.5 stars, 285 earned 4 stars, 377 earned 3.5 stars and 258 earned 3 stars.
The two lowest-ranked health plans – Gold Coast Health Plan and Tokio Marine Pacific Insurance Limited – garnered just 1.5 stars apiece.
"The NCQA 2023 Health Plan Ratings provide vital understanding of the quality of care people receive from health plans and provide valuable insight to help families make informed decisions about their care," said NCQA President Margaret E. O'Kane. "This year's ratings underscore health plans' efforts to improve quality and health equity. By including our Direct Race and Direct Ethnicity measure in the ratings, NCQA reinforces our expectations for equity throughout the industry. Health plans' success reporting that measure shows they are making encouraging strides in health equity."
THE LARGER TREND
The Medicare measures in the NCQA ratings are for Medicare Advantage plans. The Centers for Medicare and Medicaid Services also releases a 1 to 5 star rating for MA plans. The methodology and mix of measures for NCQA ratings is different than the CMS star ratings of the same plans, NCQA said.
Each year, NCQA rates health plans that choose to publicly report HEDIS results. Ratings are based on almost 50 assessments of patient care outcomes and experience, including measures of clinical quality from NCQA's HEDIS and CMS's Health Outcomes Survey; measures of patient experience using the Consumer Assessment of Healthcare Providers and Systems; and NCQA's review of health plan quality improvement processes.
The overall rating is the weighted average of a plan's HEDIS, CAHPS and HOS measure ratings, plus Accreditation bonus points, calculated on a 0–5 scale in half-points, displayed as stars and rounded to the nearest half-point.
Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com
