In the landscape of American healthcare, no sector is less trusted than health insurance. According to a 2021 American Board of Internal Medicine Foundation surveyjust 33% of people said they trust health insurance companies, compared with 85% who said they trust doctors.
New data from the National Committee for Quality Assurance (NCQA) suggests this figure may not be improving.
In NCQA’s 2022 Health Plan Ratings, released today, satisfaction with care got worse among members on commercial and Medicaid health plans. Commercial member satisfaction dropped 4 points, from 55.9% last year to 51.8% this year, and Medicaid member satisfaction dropped 2 points, from 58.7% last year to 56.5% this year. Though these changes may look small, they are statistically significant.
The annual ratings evaluate health plans across the commercial, Medicare, and Medicaid segments. Plans are rated on a scale of 0 to 5 stars based on nearly 50 assessments of patients’ access to care, outcomes, experience, and satisfaction. These assessments capture things like how easy or hard it is for members to get the care they need and how satisfied members are with their health plan’s customer service.
The 2022 ratings include health plans serving more than 200 million people, more than 60% of the United States population, according to NCQA.
Overall, just six out of 1,048 health plans in the 2022 ratings earned 5 stars, the best possible score. Of the six top-rated plans, four are Kaiser Foundation Health Plans, including Kaiser Foundation Health Plan of the Mid-Atlantic States, which earned 5 stars in all three insurance categories. Kaiser Foundation Health Plan of Colorado also earned the top score in Medicare.
Kaiser Foundation Health Plans may do particularly well on these ratings because they use an integrated approach, connecting health coverage with healthcare services through the various entities associated with Kaiser Permanente.
According to Andy Reynolds, assistance vice president of external relations at NCQA, this approach may help explain the high marks.
“The key is to align incentives so payers and providers pursue the same vision of keeping patients healthy, delivering evidence-based care when members get sick, prizing members as valuable customers who deserve and get good service, and organizing their work in ways that improve quality over time.”
Using an integrated model may not be the only path to 5-star ratings, but rounding out the list of top scorers were two health plans offered by Medical Associates Health Plans, another integrated provider/payer organization that operates in Iowa, Illinois, and Wisconsin .
On the other end of the spectrum, 11 plans earned just 2 stars, the lowest rating recorded. Among the bottom scorers were three Molina Healthcare plans as well as one plan each operated by AmeriHealth and UnitedHealthCare.
According to Reynolds, consumers with a range of health plan options may want to select the highest-rated plan possible. But not everyone has a choice.
“We encourage people to hold health plans accountable,” Reynolds said. “For people who don’t have a choice of health plans, that could mean asking your employer/plan/doctor why your plan’s quality results are what they are and what they’re doing to get better.”
Overall, the average rating was just below 3.4 out of 5. Reynolds said that though quality varies, it tends to get better over time. But that does not tend to happen automatically; it may require a push from the people who use and pay for health plan services.
“Patients and employers, who pay for most insured people’s coverage, should use the ratings to keep advocating for good care,” Reynolds said. “Quality improvement in healthcare is not as advanced as in other industries, so people should keep pushing for better care and better service.”
In addition to the overall plan ratings, NCQA measures specific aspects of care, several of which improved in 2022. For example, several measures of cardiovascular care quality got better, especially measures of controlling high blood pressure, which improved for commercial plan members by 6.9 percentage points from 2021 to 2022. In Medicare and Medicaid plans, improvements were 7.6 points and 2.7 points, respectively.
Similarly, for people with diabetes, blood pressure control measures improved by 5.5 percentage points in commercial plans, 2.5 points in Medicare plans, and 2.1 points in Medicaid plans. Controlling Hemoglobin A1c, a key measure in diabetes care, improved 4.1 percentage points in commercial plans and just over 3 points in both Medicare and Medicaid plans.
The 2022 results also showed a divergence in performance on childhood immunizations, depending on the population. In commercial plans, vaccination rates rose by 2.2 percentage points but fell by 3 points for kids in Medicaid plans.
The details within the ratings can expose strengths and weaknesses in specific aspects of care and health plan member experience. These differences can serve as a conversation starter that helps you choose the right plan for your needs, according to Reynolds.
“What’s important to you, your company, and your family when it comes to health care? What is good care to you, and which plan’s ratings match what you value?” he said. “Once you know what you’re looking for, you can find a plan that suits you best.”
But the ratings can also be an important way to hold health plans accountable for the quality—and value—they deliver to consumers and their employers.
“It’s up to people who use and pay for health care to build on the measurement and transparency by voting with their dollars and voting with their feet to reward high performers and encourage low performers to improve,” Reynolds said.
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