NCQA – Moving Health Plans Toward Quality Improvement

October 20, 2016 · NCQA Communications

We know NCQA’s Health Plan Ratings move health plans toward quality improvement; that’s one reason we collect and publish the data each year. The other reason is to give consumers a “buyer’s guide,” to help them make informed decisions about choosing the best health plan best for them.

How Ratings Drive Improvement

In a recent Politico Florida article, reporter Christine Sexton looked at the health plans in the state, noting the high and low performers…and everyone in between, which is the majority. Interestingly, she found that plans are using ratings as we intend; as a benchmark from where they can improve.

That’s the case with Community Care Plan, formerly the South Florida Community Care network, which earned an overall score of 2.0, among the lowest in the national ratings. Responding to that low score, Community Care Plan instituted an “aggressive” quality improvement plan.

That’s exactly how NCQA’s Health Plan Ratings should work. Plans use their scores to drive improvement and quality. Consumers use the scores, too… because they provide a more accurate picture of how health plans perform in the key quality areas of consumer satisfaction, prevention and treatment. It’s a win-win situation: Ratings give health plans the data they need to improve their services; improvements mean that consumers get better quality care.

Some Background…

NCQA’s Health Insurance Plan Ratings 2016–2017 compare the quality and services of more than 1,000 health plans in the United States. The ratings are a system similar to CMS Star Ratings of Medicare Advantage plans, and give unprecedented importance to health outcomes and consumer satisfaction.

Under a new agreement, WebMD is publishing the ratings, which as Steve Zatz, M.D., Chief Executive Officer, WebMD says, “…support our mission of empowering health decision-making for WebMD’s large and engaged audience of consumers.”