Blue Cross Blue Shield of Massachusetts (BCBSMA) has been recognized as having one of the best health plans in the country, outperforming more than 1,000 other products across various insurance markets. In 2024, the National Committee for Quality Assurance (NCQA) rated health plans based on nearly 50 factors, including patient experience and clinical quality. BCBSMA stood out as one of only three commercial plans to receive the prestigious five-star rating, a significant achievement for the organization.
Introduction
Blue Cross Blue Shield of Massachusetts has consistently demonstrated its commitment to providing high-quality healthcare to its members. In 2024, BCBSMA’s Preferred Provider Organization (PPO) plan was one of only three commercial health plans in the U.S. to receive a five-star rating from the National Committee for Quality Assurance (NCQA), a testament to its focus on quality care and patient experience.
The NCQA Rating System
The National Committee for Quality Assurance (NCQA) is a leading organization that evaluates health plans in the U.S. based on a comprehensive set of nearly 50 factors. These include clinical quality, preventive measures, and patient experience. Plans are rated on a zero- to five-star scale, with five being the highest possible rating.
In 2024, 1,019 health plans across the U.S. were assessed, and only five received the highest score. BCBS Massachusetts’ PPO plan was among those elite five, marking a historic moment for the organization, which had previously held a 4.5-star rating for many years.
BCBS Massachusetts: A Five-Star Health Plan
BCBSMA’s achievement in receiving a five-star rating is a reflection of its decade-long commitment to prioritizing quality and experience for its members. According to Dr. Mark Friedberg, Senior Vice President of Performance Measurement and Improvement at BCBSMA, the organization’s success stems from its focus on working closely with provider partners to enhance care quality and ensure access to top-tier healthcare services.
“Being a 4.5-star plan for many years is a great accomplishment, but achieving five stars for our PPO plan is a first,” Dr. Friedberg said. “This recognition is the result of a concerted effort by hundreds of individuals across the organization who have worked tirelessly to improve the quality of care we deliver.”
The Alternative Quality Contract (AQC)
One of the key drivers behind BCBSMA’s high ratings is its innovative Alternative Quality Contract (AQC), launched in 2009. The AQC was designed to incentivize high-quality care while managing overall medical expenses. This initiative laid the groundwork for the development of Accountable Care Organizations (ACOs) before the Affordable Care Act was implemented.
The AQC emphasizes the importance of both clinical quality and patient experience. By integrating quality measures into its incentive structure, BCBSMA encourages its provider partners to focus on delivering affordable, evidence-based care that meets the evolving needs of members. The AQC has continually been updated to adapt to changes in healthcare, most recently incorporating an equity component.
The Role of Equity in Healthcare
BCBS Massachusetts became the first health plan in the nation to include equity measures in its ACO-type payment model. This significant enhancement reflects the organization’s commitment to addressing disparities in healthcare and promoting equitable access to quality care for all members. By prioritizing equity, BCBSMA sets a new standard for healthcare organizations nationwide.
“Our goal is to ensure that every member receives the same high-quality care, regardless of their background or circumstances,” Dr. Friedberg explained. “Incorporating equity into our payment model is a critical step toward achieving this goal.”
Overcoming Pandemic Challenges
The COVID-19 pandemic presented unique challenges for healthcare providers and insurers, and Massachusetts was no exception. Many medical services were delayed or postponed due to shutdowns, creating a backlog of necessary care, such as routine screenings and preventive services.
To address this issue, BCBSMA worked closely with its provider network to offer alternative screening options. For example, rather than waiting for delayed colonoscopies, members were offered other methods, such as fecal immunochemical testing and Cologuard. This ensured that members continued to receive timely, evidence-based care despite the pandemic-related disruptions.
“The pandemic has forced us to think creatively about how we deliver care,” Dr. Friedberg said. “We’ve had to find new ways to ensure our members receive the care they need, even in the face of unprecedented challenges.”
Data-Driven Quality Management
A critical element of BCBSMA’s success in maintaining high-quality care is its rigorous data submission efforts to the NCQA. The organization focuses on two primary areas: technical quality measures and member experience surveys.
Technical Quality Measures
Technical quality measures involve monitoring the quality of preventive care and chronic disease management. For example, BCBSMA tracks preventive services like mammograms for breast cancer screening and monitors chronic conditions such as hypertension. This data is collected from billing claims and clinical data exchanges with provider partners and submitted to the NCQA for annual audits.
Member Experience Surveys
Member experience surveys are another essential component of BCBSMA’s quality management program. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, administered by an NCQA-authorized vendor, evaluates various aspects of the member experience, such as access to care, communication with providers, and overall satisfaction.
Payers, including BCBSMA, receive aggregated scores based on the survey results, which helps them identify areas for improvement while maintaining the confidentiality of individual member responses.
Maintaining High Standards
BCBSMA’s success in achieving and maintaining its five-star rating is the result of a robust internal quality management program and strong relationships with its provider partners. By fostering a culture of collaboration and continuous improvement, BCBSMA ensures that its members receive the highest quality care possible.
“Ultimately, high-quality care requires a dedicated team, strong provider relationships, and a commitment to supporting our members,” Dr. Friedberg said. “It’s about more than just meeting metrics—it’s about delivering care that truly makes a difference in our members’ lives.”
Conclusion
Blue Cross Blue Shield of Massachusetts has set a new standard for healthcare plans with its five-star rating from the NCQA. Through innovative programs like the Alternative Quality Contract and a focus on equity, BCBSMA continues to lead the way in providing high-quality, affordable healthcare to its members. By embracing data-driven quality management and overcoming challenges posed by the pandemic, BCBSMA demonstrates its unwavering commitment to delivering exceptional care.
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FAQs
Q1: What is the NCQA rating system?
A1: The NCQA rating system evaluates health plans based on nearly 50 factors, including clinical quality and patient experience. Plans are rated on a scale of zero to five stars.
Q2: How did BCBS Massachusetts achieve a five-star rating?
A2: BCBS Massachusetts earned a five-star rating through its decade-long focus on quality and patient experience, strong provider partnerships, and innovative programs like the Alternative Quality Contract.
Q3: What is the Alternative Quality Contract (AQC)?
A3: The AQC is an initiative launched by BCBS Massachusetts in 2009 that incentivizes high-quality care and affordability. It emphasizes clinical quality, patient experience, and total medical expense management.
Q4: How did BCBS Massachusetts handle the challenges of the COVID-19 pandemic?
A4: BCBSMA worked closely with providers to offer alternative screening options and ensure members received timely care despite pandemic-related delays.
