MANAGED CARE December 2006. ©MediMedia USA
No sooner had the quality rankings of health plans in the nation, as measured by the National Committee for Quality Assurance (in partnership with U.S. News & World Report), been released then it was pointed out that most of the top performers werenot-for-profit insurers. Of course, making that argument was the lobbying group, the Alliance for Advancing Nonprofit Healthcare, whose name says it all.
Still, the Alliance made some valid points, including:
- Commercial plans — 70 percent of the top 50 are not for profit.
- Medicare HMOs — 80 percent of the top 25 are not for profit.
- Medicaid HMOs — 76 percent of the top 25 are not for profit.
"We encourage researchers both within and outside these organizations to perform their own analyses of possible correlations between quality and ownership status," says Bruce McPherson, the executive director.
One such study, published in the journal Health Services Research in August, suggests that health plans that contract with tightly organized physician practice groups score higher on preventive health care indicators measured by the NCQA and the Consumer Assessment of Healthcare Providers and Systems surveys. Of course, the health plans that tend to contract with tightly organized physicians, or employ them outright, are not-for-profit plans.
Charles M. Cutler, MD, the head of national quality management at Aetna, told us in October that every approach has its strengths — and weaknesses. "The staff- and group-model health plans provide an infrastructure such as patient registries and electronic medical records that supports better performance on HEDIS measures," Cutler said. "On the other hand, they have much narrower networks and they have practice bureaucracies that some patients find daunting."
Top five commercial plans:
- Harvard Pilgrim Health Care (Maine, Mass.)
- Tufts Associated Health Maintenance Organization (Mass., N.H., R.I.)
- Harvard Pilgrim Health Care of New England (N.H.)
- Blue Cross and Blue Shield of Massachusetts
- Capital District Physicians' Health Plan (N.Y.)
Top five Medicare plans:
- Preferred Care (N.Y.)
- Harvard Pilgrim Health Care (Mass.)
- Tufts Associated Health Maintenance Organization (Mass.)
- Capital Health Plan (Fla.)
- Kaiser Foundation Health Plan of Southern California (Calif.)