Because the Nationwide Committee for High quality Assurance (NCQA) introduced its 2024 Well being Plan Rankings, solely 5 out of 1,019 rated plans attaining the best ranking of 5 stars.
The annual record evaluates industrial, Medicare and Medicaid well being plans primarily based on assessments of affected person expertise and scientific high quality. The 2024 Well being Plan Rankings are primarily based on information from calendar yr 2023, when roughly 227 million folks had been enrolled in well being plans that reported Healthcare Effectiveness Knowledge and Data Set (HEDIS) outcomes to NCQA.
Of the plans successful 5 stars, three had been industrial and two had been Medicare plans. Two had been Kaiser Permanente’s: its industrial plan obtainable within the mid-Atlantic states space (Baltimore, suburban Maryland, Northern Virginia, and Washington, D.C.) and its Medicare plan in Colorado.
Kaiser Permanente famous that it has extra 5-star and 4.5-star plans mixed than every other healthcare group for the ninth rankings cycle in a row.
“The NCQA rankings as soon as once more present our dedication to offering high-quality care to our members throughout all of our markets,” mentioned Andrew Bindman, M.D., government vp and chief medical officer for Kaiser Permanente, in an announcement. “Our built-in mannequin is designed to reliably ship high-value care to our members.”
Different 5-star winners had been Blue Cross Blue Defend of Massachusetts’ Business PPO plan, New York-based Unbiased Well being Affiliation Inc.’s industrial HMO/POS mixed, and Wisconsin-based Community Well being Insurance coverage Corp.’s Medicare PPO.
There was additionally a slight improve in Medicaid and Medicare plans that achieved 4- and 4.5-star rankings, in comparison with 2023, demonstrating enchancment throughout a number of well being high quality measures.
“Annual Well being Plan Rankings are important to offering healthcare shoppers with clear and goal details about the standard and efficiency of well being plans. Rankings not solely assist people make knowledgeable selections to obtain the absolute best care but in addition inspire well being plans to enhance their operations, with a concentrate on high quality, fairness and accountability,” mentioned NCQA President Margaret E. O’Kane, in an announcement.
NCQA continues to prioritize well being fairness in its rankings methodology. This yr, NCQA elevated the scoring threshold for the Race/Ethnicity Range of Membership (RDM) measure and elevated the measure weight from 0.5 to 1.0. The group mentioned that amassing race and ethnicity information is essential for closing gaps in high quality of care and selling well being fairness. By encouraging broader stratification and assortment of race and ethnicity information by well being plans, rankings can drive steady high quality enchancment throughout the healthcare business, guaranteeing that each one sufferers obtain the absolute best care.
Right here is extra element concerning the rankings methodology: Annually, NCQA charges well being plans that select to publicly report their HEDIS information. Rankings are primarily based on practically 50 assessments of affected person care outcomes and expertise, together with measures of scientific high quality from NCQA’s HEDIS and CMS’s Well being Outcomes Survey (HOS); measures of affected person expertise utilizing the Shopper Evaluation of Healthcare Suppliers and Methods (CAHPS®); and NCQA’s evaluation of well being plan high quality enchancment processes (NCQA Accreditation).
The general ranking is the weighted common of a plan’s HEDIS, CAHPS and HOS measure rankings, plus Accreditation bonus factors, calculated on a 1–5 scale (5 is highest), displayed as stars and rounded to the closest half-point.
