In the National Committee for Quality Assurance’s 2022 Health Plan Ratings, several measures of cardiovascular care quality improved from the prior year and diabetes care rebounded.
The annual list evaluates commercial, Medicare and Medicaid health plans based on the quality of patient care, how happy patients are with their care and health plans’ efforts to keep improving.
The 2022 Health Plan Ratings are based on data from calendar year 2021, when 203 million people were enrolled in health plans that reported Healthcare Effectiveness Data and Information Set (HEDIS) results to NCQA. Plans are rated on a 0–5 stars scale.
Each year, NCQA rates health plans that choose to publicly report HEDIS results. NCQA ratings are based on almost 50 assessments of patient care outcomes and experience, including measures of clinical quality from NCQA’s HEDIS and CMS’s Health Outcomes Survey; measures of patient experience using the Consumer Assessment of Healthcare Providers and Systems (CAHPS); and NCQA’s review of health plan quality improvement processes (NCQA Accreditation).
Only six out of 1,048 health plans earned a numerical rating of 5 stars—the highest possible rating:
• Commercial: Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.
• Medicaid: Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.
• Medicare: Kaiser Foundation Health Plan of Colorado; Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.; Medical Associates Clinic Health Plan of Wisconsin dba Medical Associates Health Plans; and Medical Associates Health Plan, Inc.
Overall, NCQA noted that several measures of cardiovascular care quality improved from the prior year. The most significant improvement was in controlling high blood pressure: After a decline from 2019–2020, average commercial plan performance improved 6.9 percentage points, Medicare plans improved 7.6 points and Medicaid plans improved 2.7 points.
There also was a rebound in diabetes care. Following a decrease the year before, care for people with diabetes improved in two areas:
• Controlling blood pressure: Average commercial plan performance improved 5.5 percentage points, Medicare plans improved 2.5 points and Medicaid plans improved 2.1 points.
• Controlling Hemoglobin A1c: Average commercial plan performance improved 4.1 percentage points, Medicare plans improved 3.2 points and Medicaid plans improved 3.3 points.
Immunization rates rose 2.2 percentage points for children enrolled in commercial plans, but declined 3 points for children in Medicaid plans. This divergence suggests a growing gap in preventive care that puts America’s most vulnerable children at disproportionate risk for disease, NCQA said.
The study also identified a decline in patient satisfaction. Adult patients’ overall ratings of their healthcare dropped for both commercial (4.2 percentage points) and Medicaid health plans (2.2 points) from the prior year.
“With open enrollment for health plans beginning in November, the NCQA 2022 Health Plan Ratings provide timely insight to help consumers and businesses make informed decisions about their health care,” said NCQA President Margaret E. O’Kane, in a statement. “NCQA was founded as an independent nonprofit in 1990 to ‘turn on the lights’ by measuring and holding health plans accountable for health care quality. With the 2022 ratings, we’re proud to spotlight top performers and identify ways to improve healthcare quality, access and equity.”
