At the Heart of It: Kaiser Permanente Health Plans Highest Rated by NCQA for Quality and Service

By a News Reporter-Staff News Editor at Insurance Weekly News -- Michelle Melvin was at breakfast with her family one Sunday morning when she began feeling "a little funny." Pain in her jaw and temples. Numbness in her forearms.

"I'm not supposed to have a heart attack," said Michelle, who was 41 at the time. "But I was starting to get scared because I knew something wasn't right."

Despite her anxiety, Michelle knew exactly what to do next. A Kaiser Permanente member in Colorado for many years, she was aware she could seek guidance from Kaiser Permanente's 24-hour advice hotline. After Michelle explained the combination of sensations she was experiencing, the nurse on duty advised her to go to a hospital immediately: Michelle was describing symptoms of a heart attack.

After her husband rushed her to their local hospital, Kaiser Permanente doctors monitored Michelle closely, performing a battery of tests. When her tests came back, they proved the nurse right -- Michelle had sustained a heart attack. After the prompt medical attention, she fully recovered thanks to medication, exercise and routine follow-up care.

This type of high-quality, personalized and accessible care exemplifies Kaiser Permanente. It is so prevalent that once again Kaiser Permanente health plans are classified among the best in the nation for consumer experience, prevention and treatment, according to the National Committee for Quality Assurance report -- NCQA's Health Insurance Plan Ratings 2016-17 -- that was published.

NCQA's annual report rates more than 1,000 health plans, including Medicare, Medicaid and Private (Commercial), on a 0-to-5 scale, with 5 being the best. Only 23 health plans in the country were given a 5 out 5 this year, and Kaiser Permanente has eight of them, more than any other organization. All Kaiser Permanente health plans were rated 4.0 or higher.

In addition, all Kaiser Permanente health plans are again rated highest (or tied for the highest) in both Medicare and Commercial in the areas they serve. Kaiser Permanente serves more than 10.6 million members in eight states and the District of Columbia.

"Being recognized as the top-rated health plan in each of our areas is an exceptional acknowledgment that reflects our drive to provide affordable, high-quality health care coverage to our members and give our patients the outcomes they expect and deserve," said Patrick Courneya, MD, executive vice president and chief medical officer for Kaiser Foundation Health Plan and Kaiser Foundation Hospitals. "Kaiser Permanente's excellence is rooted in our clinical experience and evidence-based medicine approach, and we know our focus on prevention, early intervention and accessibility makes a difference in the lives of our members."

Michelle's follow-up care, which continues today, made a significant impact, she said.

"My cardiac rehab nurse was wonderful," she said. "That was what I really appreciated. That one-on-one attention."

"The Permanente Medical Groups select only the best doctors," said Michael Kanter, MD, executive vice president and chief Quality officer, The Permanente Federation, the national organization for the nearly 19,000 physicians who exclusively provide care to Kaiser Permanente's members. "We are supported by outstanding care teams, technology, data and systems designed to help us deliver the highest quality care with the patient at the center of everything we do."

The NCQA's Health Insurance Plan Ratings are based on combined scores for health plans in the Healthcare Effectiveness Data and Information Set®, commonly called HEDIS; the Consumer Assessment of Healthcare Providers and Systems®, or CAHPS; and NCQA Accreditation standards scores.

This is the 12(th) year NCQA has ranked or rated the nation's health plans. From 2005-14, NCQA ranked the plans numerically from highest to lowest. Last year, for the first time, NCQA implemented a "ratings" system which classifies plans into scores from 0-5 in 0.5 increments. It is a method similar to the 5-Star Quality Rating System used by Centers for Medicare and Medicaid Services.

The ratings and methodology are posted on the NCQA's website and soon will be available on WebMD.com.

Keywords for this news article include: Hospital, Medicaid, Medicare, Cardiology, Heart Attack, Managed Care, Health Policy, Health Insurance, Kaiser Permanente, Insurance Companies.

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