New England, Midwest States Score High in NCQA Rankings


If you’re going to get sick and have health insurance, do so in New England. Several states in the upper righthand corner of the country scored highest in the 2018 state rankings by the National Committee for Quality Assurance (NCQA).

NCQA ranks states by the proportion of the health plans sold in the state that have a 4.5 rating or higher on its one to five scale. NCQA uses HEDIS measures of clinical quality, CAHPS ratings of consumer satisfaction, and its own rating of a plan’s health quality processes to grade health plans and put them somewhere on that scale.

NCQA’s Top 10 States

  1. Massachusetts
  2. Rhode Island
  3. Maine
  4. Wisconsin
  5. Minnesota
  6. New Hampshire
  7. Hawaii
  8. Vermont
  9. New York
  10. Iowa

Massachusetts nabbed the top spot in organization’s state rankings. Other New England states in the top 10 included Rhode Island (ranked second), Maine (third), New Hampshire (sixth), and Vermont (eighth).

The Midwest states were also well represented in the top 10 with Wisconsin ranking fourth, Minnesota, fifth, and Iowa, 10th.

The health plans included in NCQA tabulations include employer-­sponsored, Medicare Advantage, and Medicaid plans. ACA marketplace plans were not included “because they have not developed sufficient data for analysis,” according to the NCQA. NCQA pointed out that its ratings system is “similar to CMS Star Ratings of Medicare Advantage plans and give unprecedented importance to health outcomes and consumer satisfaction.”

Alan G. Adler, MD, a former senior medical director of Independence Blue Cross and a member of Managed Care’s Editorial Advisory Board, believes that Star ratings are the major focus of plans now because they affect Medicare reimbursement.

Over time most plans have achieved rather high ratings because they have been doing NCQA accreditation for so many years now. NCQA has to keep raising the bar to be able to differentiate plans and justify the cost and time for what they do, says Adler.

“It’s generally important to keep the scores in the higher performance range (4 or 5) to appease employers, but there is a lot of bunching in this range,” says Adler.

Still, Adler believes that most employers pick plans based on price rather than NCQA and other kinds of rating. And he doubts that patients pay attention to NCQA ratings.

Steve Wojcik, vice president of public policy at the National Business Group on Health, told Managed Care in an email that “while health plan quality ratings are important and necessary, what is more important from the patient perspective is how do the hospitals and physicians in the local area rate on quality, particularly for their conditions or the services they need, and customer satisfaction, not to mention price.”

Health plans can work with employers to rate local providers and provide tools for employees and their families to check out the ratings, he said.

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