Provider-run plans lead pack in NCQA health plan ratings

A baker's dozen of 13 commercial health insurance plans ranked at the top and rated a 5 in the NCQA health insurance plan ratings for 2016-2017.

Another eight rated top scores for Medicare plans: Group Health Plan; Gundersen Health Plan; Kaiser Foundation Health Plans in southern California, Georgia, the Northwest, Hawaii, and northern California; and Medical Associates Health Plan.

The Medicaid plans that rated a 5 are: Jai Medical Systems Managed Care Organization, and Kaiser Foundation Health Plan  in Hawaii.

The independent National Committee for Quality Assurance report was released Wednesday.

The percentage of plans that received a good or very good rating fell slightly compared to last year, from 11.4 percent in 2015 to 10.4 percent this year, according to NCQA ratings published on WebMD. The decline is due to lower consumer satisfaction scores, through marks remained high in the other two categories of prevention and treatment.

The top-rated plans, which scored well on customer satisfaction, prevention and treatment, had similarities. All but one were HMOs or had HMO plans as well as point-of-service plans.

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Those at the top tended to be concentrated in New England and the Great Lakes.

States with the highest percentage of plans receiving a 4.5 or 5.0 out of 5 rating included Massachusetts, Rhode Island, Wisconsin, Maine, New Hampshire, Minnesota, Vermont and New York, according to a released statement from NCQA. Hawaii and Iowa rounded out the top 10. Integration appears to be a benefit. Half of those in the top tier fall within an AIS list of the largest 25 provider-sponsored health plans. These include Capital District Physicians' Health Plans, Kaiser Foundation Health Plans, and UPMC Health Plans.

Robert Pearl, MD, executive director and CEO of The Permanente Medical Group and president and CEO of the Mid-Atlantic Permanente Medical Group, said NCQA only gave a rating of 5 to one insurer for both commercial and Medicare plans, and that was Kaiser.

"In California, it's the second year in a row we got this," Pearl said. "I attribute it to the excellence of people and our 70-year approach to healthcare."

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Pearl said he believes health systems and insurance plans need to be integrated to get to the level of care needed to serve complex medical conditions and to achieve quality results.

A health plan without a high-performing medical group is trying to do thousands of one-offs, he said, trying to negotiate with 5,000 physicians.

"I have an entire integrated medical group," Pearl said. "It's almost impossible to do this as an insurance company contracting with a bunch of doctors."

Other factors are the longevity of time patients stay with their doctors at Kaiser, and the use of technology to handle 12 million virtual visits each year.

"Patients stay with us for 17 years," he said.

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Another major piece is of the 9,000 physicians in northern California, 2,000 have been trained in leadership roles.

"We're at a crossroads," Pearl said. "Quality has to be physician-led, increasingly it's handed over to administrators."

The commercial plans rating a 5 are: Blue Cross and Blue Shield of Massachusetts HMO Blue; Capital District Physicians' Health Plan of New York; Capital District Physicians' Healthcare Network of New York; Capital Health Plan of Florida; John Hopkins US Family Health Plan of Maryland; Kaiser Foundation Health Plan of the Mid-Atlantic States; Kaiser Foundation Health Plan of Northern California; Martin's Point US Family Health Plan of Maine; Tufts Associated Health Maintenance Organization of Massachusetts and Rhode Island; Tufts Benefit Administrators of Massachusetts and Rhode Island; UPMC Benefit Management Services in Pennsylvania; UPMC Health Coverage; and UPMC Health Plan.

At the bottom rating a 1.5 is Hawaii Medical Service Association, a PPO that received a 3 in customer satisfaction but 1 for prevention and 0.5 for treatment.

Five plans rated a 2: UnitedHealthcare of Oklahoma, an HMO; Rocky Mountain Hospital & Medical Services, dba Anthem Blue Cross Blue Shield in Nevada, a PPO; Human Health Plans of Puerto Rico, a PPO;  Connecticut General Life Insurance Company in New Mexico, a PPO; and Cigna Health and Life Insurance Company in New Mexico, a PPO.

However, in health plan ratings, high and low performers are rare. NCQA said in a released statement.

Of 1,012 private/commercial, Medicare and Medicaid plans, 105, or 10 percent received a top rating of 4.5 or 5.0; and 27, or 3 percent, earned the lowest ratings of 1.0 to 2.0.

Most plans are in the middle, approximating a "bell curve" when all plans' results are plotted on a graph, NCQA said.

Harvard Pilgrim, which rated a 5.0 last year and 4.5 this year, said Harvard Pilgrim was proud to once again be ranked among the top health plans in the country. 

"Our HEDIS (The Healthcare Effectiveness Data and Information Set)  quality measures continue to be very high and consistent with previous years. Our CAHPS (Consumer Assessment of Healthcare Providers and Systems) member experience scores declined slightly this year in some service areas," Harvard Pilgrim said in a statement. "However, implementation of our new IT system, which positions us well for the future, is strengthening our ability to provide excellent service to our members."

NCQA studied 1,401 health plans and rated 1,012: 503 private (commercial), 338 Medicare and 171 Medicaid.

Numerous plans were not rated, but were said to have no, or partial data, reported.

The ratings are a system similar to Centers for Medicare and Medicaid Services Star Ratings of Medicare Advantage plans, NCQA said. They show the importance of health outcomes and consumer satisfaction.

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To better target the information to consumers, NCQA has teamed up with WebMD to publish the ratings. The ratings will be published on WebMD starting Thursday.

"WebMD is committed to providing tools and resources that address consumers' need for greater transparency related to costs and quality when choosing health care options," said Steve Zatz, MD, CEO, WebMD.

In consumer satisfaction, preventative measures and treatment, outcomes are the main driver of ratings results, NCQA said.

"Now, more people who are engaged and interested in their health care will have access to these ratings, enabling them to make more informed decisions about which health plans are best suited for their needs," said Margaret E. O'Kane, president of NCQA. 

Twitter: @SusanJMorse