Opinion

Now More Than Ever, Quality Matters

Later this month, the National Committee for Quality Assurance (NCQA) will once again partner with Consumer Reports magazine to publish our annual Health Plan Rankings. As individuals continue to take on more responsibility for choosing, and paying for, their healthcare, it has never been more important that they understand how to gauge the quality of the plans they are offered.

Several factors have converged to increase the role that consumers play in healthcare decision-making today. Continued cost growth (albeit slightly checked of late) has caused employers to consider alternatives to the traditional health benefits package. Specifically, employees are more likely to be presented with the option of choosing a high-deductible health plan (HDHP) – in some cases having no alternative to this type of plan among those offered by their employer. Individuals purchasing coverage on their own have also found the high-deductible option of interest, given its lower monthly price tag. As a result, more than 15 million individuals had an HDHP in 2013. The financial risk these plans entail for consumers heightens the need for transparency on cost and quality measures.

The proliferation of health insurance exchanges operated by both public and private sector entities is another factor. 8 million people are expected to purchase coverage in 2014 through public marketplaces (the term officially adopted by the US Department of Health and Human Services earlier this year). In some cases, this will be the first time these individuals have ever shopped for health coverage. And, depending on the state where they live, Medicaid enrollees may have several plans to choose from. Add to this the array of choices available to seniors through the Medicare Advantage program, and the number of decisions consumers are required to make has exploded over the last few years.

On the commercial side, employers have also moved rapidly to stand up private exchanges for their workforces, many in combination with a transition to a “defined contribution” model, where employees are given a fixed dollar amount to purchase coverage. In exchange for the additional financial liability that this model could entail for employees, employers are offering much greater choice of plan design through the private exchanges. An Accenture study from earlier this year indicates that as many as 3 million individuals will get health insurance through private exchanges this year. They project that number to increase to 40 million by 2018, exceeding estimates for the public exchanges.

For the 2014-2015 rankings, NCQA studied almost 1,400 health plans and ranked more than 1,000 (we only rank health plans that publicly report their quality information). Our rankings are based on three dynamics: measures of clinical quality; measures of consumer satisfaction; and results from NCQA’s review of a health plan’s health quality processes.

Clinical quality metrics include prevention and treatment measures, which are a subset of the NCQA Healthcare Effectiveness Data and Information Set (HEDIS®). The prevention items track the proportion of eligible members who received preventive services, like prenatal and postpartum care, immunizations and cancer screenings. Treatment elements identify the proportion of eligible members who received the recommended care conditions, such as diabetes, heart disease, and mental illness. Consumer satisfaction measures what patients report about their experience of care with doctors and services they had access to, based on responses to the Consumer Assessment of Healthcare Providers and Systems (CAHPS®)—a validated survey overseen by the Agency for Health Care Quality (AHRQ).

Once all of these numbers are crunched, we rank the plans in three categories: private/commercial plans that people enroll in through work or on their own; plans that serve Medicare beneficiaries in the Medicare Advantage program; and health maintenance organizations (HMO) for Medicaid beneficiaries. Individuals can search for any plan on our website, where they will find where they are ranked, as well as a score from 1-5 (5 being best) across the three dynamics. Clicking on a plan’s name will give a detailed score for the plan on each of the 57 measures we collect.

We see our health plan rankings as an important tool in allowing consumers to understand what they can expect from a plan in which they may enroll. Regardless of where a plan is ranked, we believe they are to be commended for publicly reporting their quality results. Making this type of information available in an easily digestible way is an important step toward empowering consumers, and one we are proud to be a part of – particularly with the winds of consumerism blowing through the healthcare market. If you’d like to see how your plan rates, visit us at http://www.ncqa.org/ReportCards/HealthPlans/HealthInsurancePlanRankings.aspx.

Frank Micciche is Vice President for Public Policy & Communications at the National Committee for Quality Assurance

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