The top-performing Medicare and Medicaid health plans for the 2020-21 plan year earned exceptional quality scores based on the plans’ customer satisfaction, preventive care, and treatment outcomes of beneficiaries, according to the most recent National Committee for Quality Assurance (NCQA) rankings for Medicare health plans and Medicaid health plans.
Each year, NCQA determines which plans in the public payer sector performed the best by aggregating HEDIS scores, NCQA accreditations, and consumer assessments. NCQA uses a one- to five-star scale to rank the plans, with five stars representing the highest quality.
The ratings are based on data from calendar year 2021 and uses Healthcare Effectiveness Data and Information Set (HEDIS) results. In 2022, there were 1,048 health plans that received a numerical rating. Of those, six plans received five stars.
The measures are updated occasionally and NCQA has announced that it will apply new race and ethnicity data and gender-relevant care measures to the HEDIS measures for 2023. NCQA has also introduced health equity distinctions, which certain payers such as Centene and Aetna received for their health equity efforts.
For the 2022 health plan ratings, the nonprofit ranked the top Medicare and Medicaid health plans in the following order:
TOP 5 MEDICARE PLANS
Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.
Overall Rating: 5.0
Scores: Patient Experience 3.5; Prevention 5.0; Treatment 4.5
Kaiser Foundation Health Plan of the Mid-Atlantic States was one of two Kaiser Foundation Health Plans in the top ten Medicare plans. The plan has over 104,000 enrollees in the District of Columbia, Maryland, and Virginia.
The payer’s most effective area of quality was its prevention category, where it earned five stars in every subcategory—cancer screenings, flu shots, and pneumonia shots. It also performed well in the treatment category, receiving mostly from 4.0 to 5.0 star ratings except in behavioral health medication adherence (3.0 stars).
The payer has earned the Health Equity Accreditation as well as the Multicultural Health Care (MHC) distinction.
Kaiser Foundation Health Plan of Colorado
Overall Rating: 5.0
Scores: Patient Experience 4.0; Prevention 5.0; Treatment 4.5
Kaiser Foundation Health Plan of Colorado serves almost 111,600 members in the state.
The payer’s quality of care was most evident in its preventive care efforts, where it achieved five stars in each category except breast cancer screenings (4.0 stars). Kaiser Foundation Health Plan of Colorado also achieved a high star rating in the treatment category, receiving five stars for heart disease, behavioral health care coordination, and care coordination overall.
Patient experience was the health plan’s lowest-ranked category, largely due to its three-star rating on how quickly and easily members could access care.
Medical Associates Health Plan, Inc.
Overall Rating: 5.0
Scores: Patient Experience 5.0; Prevention 4.5
The Medical Associates Health Plan, Inc. serves 14,500 members in Iowa and Illinois.
The health plan achieved high ratings on the two categories for which it provided data, but had insufficient data for the treatment category.
Patient experience was particularly strong for this health plan. It achieved five stars in every category—access to care, satisfaction with plan providers, and satisfaction with plan and plan services. In the prevention category, the plan performed best on breast cancer screenings and flu shots for adults ages 65 and older. The plan received 4.0 stars on colorectal cancer screenings and pneumonia shots.
Although most of the treatment category did not have enough data to apply a star rating, the health plan was able to receive a score in a couple of individual subcategories.
The plan received 4.5 stars for its diabetes care, even though two categories did not have enough data. Heart disease treatment received 4.0 stars based on one measure. Care coordination received 3.0 stars based solely on its performance with follow-ups after emergency department visit for patients with multiple high-risk chronic diseases.
Medical Associates Clinic Health Plan of Wisconsin dba Medical Associates Health Plan
Overall Rating: 5.0
Scores: Patient Experience 5.0; Prevention 4.0
Medical Associates Health Plan of Wisconsin serves 3,762 members in the state of Wisconsin.
The health plan performed very well in almost every subcategory of patient experience. The only category in which the plan did not achieve 5.0 stars was satisfaction with plan providers, in which the plan received a 4.5 star rating.
In prevention, the health plan achieved a 4.5 star rating on the cancer screening section, 4.0 stars for its flu shot services, and 3.0 stars for its pneumonia shot services.
Like Medical Associates Health Plan, Inc., this health plan achieved a high score but did not have sufficient data in certain categories that were considered not applicable.
UCare Health Inc.
Overall Rating: 4.5
Scores: Patient Experience 3.5; Prevention 4.0; Treatment 4.0
Of all of the top-rated Medicaid health plans, UCare was the only health plan that was not a health maintenance organization (HMO). The plan is a preferred provider organization (PPO) that serves more than 2,130 members in Minnesota and Wisconsin.
Prevention and treatment were the health plan’s highest-scoring categories. The plan achieved 5.0 stars for its diabetes care and risk-adjusted utilization. It lacked enough data to assess behavioral health care coordination, medication adherence, or access. UCare Health Inc. also achieved a 4.5-star rating on cancer screenings.
The health plan was recognized for its electronic clinical data work.
Source: HealthPayer Intelligence
