Most insurers scored high on an equity measure included for the first time as a part of the National Committee for Quality Assurance’s 2023 health plan ratings.
The measure, which comes from the Healthcare Effectiveness Data and Information Set (HEDIS) and assesses industry preparedness to address disparities and care gaps, asks health plans whether they can report any data stratified by their members’ race and ethnicity.
“Almost all plans, or 92%, successfully reported that measure, which tells us that plans are organized around race and ethnicity data, and are really ready to use that data in more sophisticated ways,” said Andy Reynolds, assistant vice president for external relations at the NCQA.
By encouraging insurers to stratify their data by different population segments, the hope is that health plans will be able to increase their equitable care outcomes, Reynolds said.
Next year, the measure will require health plans to be able to report at least one-fifth of their performance data by race and ethnicity, he said.
In addition to equity, the NCQA also uses insurer performance on measures related to preventive care services, treatment and patient experience to give Medicare, Medicaid and commercial health plans its annual ratings on a five-star scale.
Unlike the Centers for Medicare and Medicaid Services’ star ratings, which follow a slightly different scoring methodology and focus solely on Medicare Advantage plans, the NCQA health plan ratings are not tied to quality bonus payments from CMS.
Findings from this year’s health plan ratings, which use 2022 data, include:
- Lower patient experience scores for commercial plans. Commercial health plans scored an average of 2.98 stars on the patient experience measure category in 2023, compared with 3.01 stars in 2022. This year, both Medicare and Medicaid improved their average patient experience ratings.
- Widespread improvement in prevention measures. All plan types received better scores on measures related to preventive care, with the average rating for Medicaid plans increasing from 2.86 stars in 2022 to 3 stars in 2023.
- Fewer five-star health plans. Just two out of the 1,095 plans surveyed by NCQA received five stars this year: Kaiser Foundation Health Plan of the Mid-Atlantic States and Independent Health Association.
- Ongoing care gaps between Medicaid and commercial plans. While Medicaid plans typically receive higher patient experience ratings, commercial health plans fare better when it comes to treatment and prevention measures like child and adolescent immunizations and diabetes care.
Lately, more health plans have been investing in improving their patient experience metrics due to increasing oversight around quality measurement and consumer satisfaction, said Kimberly Swanson, chief of staff to the CEO at Healthmine, a health plan improvement organization.
To boost their performance, health plans should consider a variety of solutions, such as expanding pay-for-performance or value-based care contracts with provider groups, enhancing portals and apps to improve user experience, and asking members about their access to services in order to provide the necessary resources, Swanson said.
“Understanding who your members are and how you need to reach out to them and take care of them, [as well as] ensuring that they have access to care is a growing area that health plans need to continue to focus on,” she said.