Medicare plans scored higher in 2021 than Medicaid and industrial plans in key high quality areas measured by the Nationwide Committee for High quality Assurance.
The committee charges Medicare, Medicaid and industrial plans yearly on a five-star scale, utilizing information from the Healthcare Effectiveness Knowledge and Data Set, the Shopper Evaluation of Healthcare Suppliers and Programs’ Well being Plan Survey, and the Facilities for Medicare and Medicaid Companies’ Well being Outcomes Survey.
Not like CMS’ star scores, which observe a barely totally different scoring methodology and focus solely on Medicare Benefit plans, the committee’s well being plan scores will not be tied to high quality bonus funds from CMS.
Whereas the principle objective of the scores is to tell shoppers and companies as they determine which well being plans to work with in open enrollment, the standard scores are additionally helpful benchmarks for insurers, stated Andy Reynolds, assistant vp for exterior relations at NCQA.
“We’d encourage well being plans to contemplate how they’re doing in comparison with their friends and assess what they will do to enhance,” Reynolds stated, urging them “to make use of the measurement and transparency to carry companions accountable and maintain themselves accountable.”
Quite a few particular person remedy areas akin to diabetes and coronary heart illness care noticed enchancment final 12 months following the pandemic’s impression on their scores in 2020, stated Sarah Shih, assistant vp for analysis and evaluation at NCQA.
Well being plans’ work in controlling hypertension noticed probably the most important rebound in 2021, Shih stated. Medicare plans’ efficiency elevated by a mean of seven.6 share factors, industrial plans by 6.9 factors and Medicaid plans by 2.7 factors.
In managing sufferers’ hemoglobin ranges, industrial, Medicare and Medicaid plans improved by a mean of 4.1 share factors, 3.2 factors and three.3 factors, respectively.
“One other space that was a priority, and we had been monitoring very intently, is immunizations,” Shih stated. “This 12 months, we have seen a slight improve within the affected person immunization charges for industrial well being plans, however a decline in charges for youngsters in Medicaid well being plans.”
This disparity suggests a rising hole in preventive care, placing youngsters and adolescents in Medicaid at disproportionate threat of growing illnesses, she stated.
Out of 1,048 well being plans surveyed, solely six acquired 5-star scores general. They had been industrial and Medicare plans a part of both the Kaiser Basis Well being Plan community or the Medical Associates Well being Plan community.
As a bunch, industrial plans acquired a mean general score of three.54 stars. Medicaid and Medicare plans scored an general common of three.44 stars and three.37 stars, respectively.
For the primary time, the NCQA noticed a lower in grownup sufferers’ general satisfaction with their healthcare, Shih stated. Business member satisfaction dropped to 51.8%, from 55.9% in 2020, and Medicaid member satisfaction dropped to 56.5%, from 58.7%.
Strong communication and care coordination, easy accessibility and the shut integration of specialists and first care medical doctors can play a task in well being plans’ efficiency and scores, stated Kimberly Swanson, senior vp of consulting {and professional} companies at Healthmine, a well being plan enchancment group.
“We are inclined to see greater member expertise and better high quality scores for these plans which are extra built-in,” Swanson stated.
Well being plans may also add bonus factors to their general scores by pursuing accreditation by means of the NCQA.
Insurers not accredited by the NCQA tended to attain decrease than accredited well being plans, not solely on their general 2021 score, however on every particular person measure class as nicely.
Though Medicare has the most important share of non-accredited plans and didn’t obtain as many bonuses on its general score, Medicare plans on common had among the highest high quality measure scores, no matter their accreditation standing.
Within the remedy class, Medicare plans that weren’t accredited scored a mean of three.95 stars, in contrast with a mean of two.55 stars for non-accredited industrial plans and a couple of.17 for non-accredited Medicaid plans.