Health plan performance dips on NCQA’s equity measures

Commercial and Medicare insurers' scores dropped slightly on the National Committee for Quality Assurance's prevention and equity measures in this year's health plan ratings as the committee asked more of them.

The ratings, released Monday, included some bright spots. Out of 1,019 rated health plans, three commercial insurers and two Medicare plans achieved 5-star ratings, and patient experience scores increased. NCQA uses insurer performance on measures related to health equity, preventive care services, treatment and patient experience to give Medicare, Medicaid and commercial health plans its annual ratings on a 5-star scale. 

Related: NCQA health plan quality ratings include new equity measure

Unlike the Centers for Medicare and Medicaid Services’ star ratings, which follow a slightly different scoring methodology and focus solely on Medicare Advantage plans, NCQA health plan ratings are not tied to quality bonus payments from CMS. Employers often review NCQA’s ratings to determine whether or not to work with a health plan based on the quality of care provided.

Compared with last year, Medicare plans’ scores on prevention and equity measures decreased to an average of 3.08 stars, from 3.4 stars. Commercial health plans' average score dipped to 3.0 stars, from 3.15 stars in 2023.

This shift was largely expected given NCQA’s updated scoring, said Amar Hundle, assistant director of information products at NCQA. The goal is to push improvement on data stratification by race and ethnicity by continually increasing the threshold, he said.

In 2023, NCQA asked insurers to report if they were prepared to address disparities and care gaps, as well as whether they would be able to stratify performance data by race and ethnicity.

For NCQA to calculate 2024 scores, health plans were required to report at least one-fifth of their performance data by race and ethnicity. NCQA also made it harder for health plans to get a high score on measures tracking their member numbers by race and ethnicity, and put more emphasis on the measure.

“NCQA will continue to focus on health equity in all of its programs,” Hundle said. “So there are going to be other changes down the pipeline.”

Over the past few years, the NCQA has been working to include more stratification and gender-inclusive language in its scoring. In 2021, the organization launched its Health Equity Accreditation program, which offers guidelines for collecting data and identifying health inequities.

Next year, the group will remove its data source reporting requirement for measures stratified by race and ethnicity to lower the burden on insurers.

Between NCQA’s Healthcare Effectiveness Data and Information Set prioritization of equity measurement and CMS’ health equity framework, more insurers are paying attention to members in more vulnerable populations, said Kimberly Swanson, chief of staff at Healthmine, a health plan improvement organization.

“Plans have really been going upstream to understand their members and what risks they have, pushing them to local resources or plan benefits around transportation, housing and food insecurity,” Swanson said.

Overall, plans performed similarly to last year, though more plans received 5-star ratings: Blue Cross and Blue Shield of Massachusetts; Independent Health Association; Kaiser Foundation Health Plan of the Mid-Atlantic States; Kaiser Foundation Health Plan of Colorado; and Network Health Insurance Corporation. Last year, only two plans received top marks.

Commercial and Medicare health plans also improved performance on patient experience measures between 2023 and 2024. Commercial health plans’ scores increased to an average of 3.04 stars, from 2.98 stars. Medicare plans’ average score went to 3.29 stars, from 3.16 stars in 2023.

Across all insurer types, improvement was notable on diabetes-related measures including blood pressure control and kidney health evaluation, said Kathryn Connor, associate vice president for analysis and evaluation at NCQA.

Medicare plans saw higher score averages this year on measures around care transitions for older adults and medication reconciliation, she said.

In 2025, NCQA will retire a few measures from health plans’ data reporting, including a pain assessment indicator, antidepressant medication management and data source reporting requirements. Health plans also will have to follow several new measures tracking mammogram documentation, abnormal breast cancer assessment follow-ups and blood pressure control for patients with hypertension.