NCQA Releases 2018 Health Insurance Plan Ratings
The ratings are a system similar to CMS Star Ratings of Medicare Advantage plans and give unprecedented importance to health outcomes and consumer satisfaction.
Top Ten States with the Highest-Rated Health Plans (receiving a 4.5 or 5.0 out of 5 rating) for Three-Year Average:
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Key Takeaways from the 2018-2019 Ratings:
* States with the Top-Performing Plans Consistently Deliver: Over the last three years, there's been very little movement within the top ten states except for
* High and Low Performers Are Rare: Of the 1,040 rated plans, 85 (8%) received a top rating of 4.5 or 5.0 out of 5. Twenty-five (2%) earned the ratings of 1.0 to 2.0.
Ratings Focus on Satisfaction & Outcomes
The ratings consist of three major performance categories: consumer satisfaction, prevention and treatment.
* Consumer Satisfaction: What patients say about their health plans in satisfaction surveys, including about claims processing and customer service.
* Prevention: Checkups, tests and other care that keeps people--especially children--healthy.
* Treatment: How consistently a plan provides scientifically recommended care for common, costly conditions such as diabetes, depression and heart disease.
In each category, the results--outcomes--of a patient's care count extra in the scoring; for example, whether blood pressure and diabetics' blood sugar are controlled to safe, recommended levels.
This emphasis on results means that, together with consumer satisfaction, outcomes are the main driver of ratings results.
Ratings Provide:
* Simple, User-Friendly Scale: The
* 5 indicates higher performance.
By grouping plans into a few broad categories, the ratings give consumers a practical, meaningful guide to understanding their health care choices at a level of detail they choose.
* Details on Demand: Consumers can "drill down" into any part of the ratings to learn how a health plan handles particular health issues or patient populations.
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