Insurance

Sep 9 2017

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How does your plan compare?

A good insurance plan can steer you to the care that helps and away from wasting your time and money on unnecessary tests and treatments. For the third year running, we are presenting health plan rankings from the National Committee for Quality Assurance (NCQA), a nonprofit health care accreditation and quality measurement group, of a record 984 plans on their quality of care, customer satisfaction, and commitment to improvement and disclosure of information.

This year, the NCQA ranked 474 private plans (which consumers obtain through a job or purchase on their own), 395 Medicare Advantage plans, and 115 Medicaid HMOs.

Highlights for 2012

In recent years, the NCQA has detected some improvement in the quality of health maintenance organizations (HMOs) and preferred provider organizations (PPOs). HMOs require patients to get care from providers in the plan network; PPOs allow treatment out of network, for an extra cost. Of the 32 clinical performance measures that the NCQA tracks, private HMOs show clear improvement in 23. Overall, more people receive certain recommended tests, such as colorectal cancer screening and blood sugar tests for people with diabetes.

Kaiser tops the big names

Why accreditation matters

Unaccredited plans lose ground in the NCQA rankings because accreditation counts for up to 15 points out of a possible 100. Here’s why.

During the accreditation process, evaluations by physicians and managed-care experts make sure not only that the plan has the right policies and procedures but also that the plan is following them. Do the plans provide accurate marketing material? Do they give clear information to members on coverage and denial decisions? Do the providers in their networks have proper credentials?

“It’s not enough to have an appeals process,” says Andy Reynolds, an NCQA assistant vice president. “The on-site survey looks to see how the plan executes it.”

Accredited plans also commit to being held accountable for their performance by reporting data on it. Experience has shown that when plans report on their performance, it usually gets better. In fact, the health care reform law will require that any plan sold through exchanges in 2014 and beyond must be accredited.

A total of 254 ranked plans are not accredited, of which 22 are scheduled for accreditation and two were going through the accreditation process as we went to press. There are a number of reasons a plan might skip NCQA accreditation, including the expense—plans pay a fee to the NCQA for it. Plans might be accredited by another organization, again for a fee. Many more Medicare and Medicaid plans than private plans are not accredited.

All unaccredited ranked plans do submit some quality and consumer satisfaction data, so you can compare both types of plans in your area.

Written by CREDIT


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