Health Plan Ratings: How Insurance Plans Measure Up

September 21, 2021 · NCQA Communications

At NCQA, the mission is always better health and better health care. The key ingredient for improvement is almost always performance measurement. Measurement creates accountability, and there’s nothing more compelling to improve than comparisons to the competition. That’s how our Health Plan Ratings work. They give businesses and consumers–the people who buy insurance–a user-friendly resource for comparing and choosing health plans.

The ratings also now use a simple and convenient online display to show how health plans perform in key areas. And as a timely reminder, they also include assessments of care for people most at risk of dying from COVID and people at risk for opioid addiction.

National Ratings in Key Quality Areas 

NCQA rated more than 1,000 private, Medicare and Medicaid health plans in three quality areas:

• Patient Experience: What patients say about their health plans in surveys, including how quickly and easily they can get appointments.
• Prevention: Whether a plan provides regular check-ups, tests and other care that keeps people healthy.
• Treatment: Whether a plan provides scientifically recommended care for common, costly conditions.

Enrollment in health plans NCQA rated totals more than 188 million people—almost three fifths of the U.S. population.

The COVID Connection

The new Health Plan Ratings are NCQA’s first since 2019 and are the first to include data about health plan performance during the pandemic (calendar year 2020).

To make the ratings especially relevant to contemporary concerns, the ratings reveal how well health plans handle medical conditions that put people at risk of dying from COVID:

• Asthma: Health Plan Ratings assesses if people with persistent asthma have the right medications to help control their symptoms.
• Diabetes: Health Plan Ratings use five separate measures covering different aspects of care for people with diabetes. These include checks of how well patients’ blood sugar is controlled and whether patients have medications they should have.
• Heart Disease: Health Plan Ratings include four separate assessments of cardiovascular care, including whether patients’ blood pressure is controlled to healthy limits and if people have and use recommended cholesterol-lowering drugs

Responding to the Opioid Crisis

To highlight opioid abuse and addiction as an ongoing public health crisis, ratings include three measures designed to detect and reduce opioid abuse in large populations. Consumers seeking a health plan that has proven to do a good job helping people not become addicted to opioids will want to pay special attention to these measures:

• Avoiding Opioids at High Dosage. This measure checks that people only receive prescriptions for high levels of opioids for short periods.
• Avoiding Opioids from Multiple Prescribers and Multiple Pharmacies. This measure identifies and guards against “doctor shopping” and “pharmacy hopping” that are typical of opioid abuse.
• Avoiding Continued Opioid Use. This measure verifies that people are not on opioid prescriptions for long, uninterrupted periods.

User-Friendly Display

To make Health Plan Ratings easy to use, NCQA presents them in an online report card similar to online sites where millions of Americans shop every day.

Features that users find familiar, handy and user-friendly include:  

• Star Ratings. NCQA rates health plans on a 5-Star scale—5 Stars is top performance and 1 Star is the lowest. Each plan has an overall rating and a separate Star rating for Patient Experience, Prevention and Treatment.
• Filtering. Users can mix and refine search criteria to see only specific kinds of health plans, such as plans in their state above a certain quality level.
• Details on Demand. Consumers can “drill down” into any part of the ratings to learn how well a health plan handles particular health topics or populations. These details are where consumers can find information about COVID, opioid abuse and other conditions.

NCQA’s Health Plan Ratings are available at: reportcards.ncqa.org

We also have more information on how the ratings were calculated.