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.
Given the unusual circumstances of the coronavirus pandemic and how the pandemic interfered with quality measurement data collection, NCQA tweaked its methodology.
The overall rating score for 2021 is the best score from health plan rating (HPR) between HPR 2019 and HPR 2021. The Medicare HPR used Consumer Assessment of Healthcare Providers and Systems (CAHPS) from 2019 and Health Outcome Survey (HOS) data from 2018.
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.
For HPR 2021, the nonprofit ranked the top Medicare and Medicaid health plans in the following order:
TOP 5 MEDICARE PLANS
Medical Associates Clinic Health Plan of Wisconsin dba Medical Associates Health Plans
Overall Rating: 5.0
Scores: Patient Experience 5.0; Prevention 4.0; Treatment 4.5
Medical Associates Health Plan of Wisconsin received a perfect score on every measure for patient experience for HPR 2021. The plan suffered slightly on the prevention score, receiving three stars on its pneumonia and flu vaccination rates.
The payer also had incomplete data for all of the mental and behavioral healthcare quality measures. Still, the treatment section received a 4.5-star rating, boosted by high scores for diabetes and cardiovascular quality of care.
Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.
Overall Rating: 5.0
Scores: Patient Experience 3.0; Prevention 4.5; Treatment 5.0
Kaiser Foundation Health Plan of the Mid-Atlantic States was one of four Kaiser Foundation Health Plans in the top ten Medicare plans. The payer’s quality of care shone brightest in its treatment metrics including perfect ratings in diabetes care, heart disease care, and nearly all of the metrics categorized under “other treatment measures.”
However, the payer only attained three stars on patient experience. No single measure was at fault for this score. Nearly all of the health plan’s patient experience measures uniformly achieved three stars. The sole exception was the “satisfaction with plan services” category which attained four stars.
This health plan boasts multicultural health care (MHC) accreditation, meaning that the payer has pursued health equity and provides culturally-appropriate care.
Kaiser Foundation Health Plan Inc. – Southern California
Overall Rating: 5.0
Scores: Patient Experience 4.0; Prevention 5.0; Treatment: 4.5
Kaiser Foundation Health Plan of Southern California had strong performance in the preventive services category. The plan achieved five stars on all four of its preventive services quality measures: breast cancer screenings, colorectal cancer screenings, flu vaccinations, and pneumonia vaccinations.
Its patient experience score was at the same level of performance. In particular, fast access to care and care coordination each received only three stars. Although Kaiser Foundation Health Plan of Southern California achieved an overall 4.5-star rating for the treatment category, the plan received a two-star rating for avoiding prescribing opioids from multiple sources for a single patient.
This health plan also has MHC accreditation.
Kaiser Foundation Health Plan, Inc. – Northern California
Overall Rating: 5.0
Scores: Patient Experience 4.0; Prevention 5.0; Treatment 4.0
Kaiser Foundation Health Plan of Northern California had a nearly perfect score on preventive services. However, like its sister plan in the south, fast access to care and care coordination were two areas in which Kaiser Foundation Health Plan of Northern California could improve. The health plan achieved a three-star rating on each of these measures.
Kaiser Foundation Health Plan of Colorado
Overall Rating: 5.0
Scores: Patient Experience 4.5; Prevention 4.5; Treatment 4.0
Kaiser Foundation Health Plan of Colorado did not receive a perfect score on any of the quality measure categories in HPR 2021, though it did receive five stars for individual measures.
The health plan’s treatment quality measures were particularly mixed.
For example, Kaiser Foundation Health Plan of Colorado achieved five stars on quality measures such as avoiding prescribing drugs that conflict with each other to seniors and emergency department follow-up for patients with substance use disorders.
But the payer also received a one-star rating on avoiding prescribing opioids from multiple sources, managing fall risk, and emergency department follow-up for patients with high-risk chronic diseases.
This health plan is accredited and under corrective action.
Source: HealthPayerIntelligence