In the American healthcare landscape, no sector is less trusted than health insurance. According to a 2021 survey by the American Board of Internal Medicine Foundation, only 33% of people said they trust health insurance companies, compared to 85% who said they trust doctors.
New data from the National Committee for Quality Assurance (NCQA) suggests that number may not be improving.
In the NCQA’s 2022 Health Plan Ratings, released today, satisfaction with care deteriorated among commercial and Medicaid health plan members. Commercial member satisfaction fell 4 points, from 55.9% last year to 51.8% this year, and Medicaid member satisfaction fell 2 points, from 58.7% last year to 56, 5% this year. Although these changes may seem small, they are statistically significant.
The annual ratings evaluate healthcare plans in the Commercial, Medicare, and Medicaid segments. Plans are rated on a 0-5 star scale based on nearly 50 ratings of patient access to care, outcomes, experience and satisfaction. These ratings measure, for example, how easy or difficult it is for members to get the care they need and how satisfied members are with their health plan’s customer service.
The 2022 assessments include health plans for more than 200 million people, more than 60% of the United States population, according to the NCQA.
Overall, only six out of 1,048 health plans received 5 stars in the 2022 reviews, the best possible score. Of the six top-rated plans, four are Kaiser Foundation Health Plans, including the Mid-Atlantic States’ Kaiser Foundation Health Plan, which received 5 stars in all three insurance categories. Kaiser Foundation Health Plan of Colorado also achieved the highest score in Medicare.
Kaiser Foundation Health Plans score particularly well on these ratings because they take an integrated approach, combining health insurance with health services through the various entities affiliated with Kaiser Permanente.
According to Andy Reynolds, associate vice president of external relations at NCQA, this approach could help explain the good grades.
“The key is to align incentives so that payers and providers share the same vision of keeping patients healthy, providing evidence-based care when members fall ill, recognizing members as valuable customers who deserve and receive good service, and to organize their work in such a way that they improve quality over time.”
Using an integrated model may not be the only route to 5-star ratings, but rounding out the list of top scorers were two health plans offered by Medical Associates Health Plans, another integrated provider/payment organization based in Iowa, Illinois, and Wisconsin.
At the other end of the spectrum, 11 plans received just 2 stars, the lowest rating ever recorded. At the bottom were three plans from Molina Healthcare and one each from AmeriHealth and UnitedHealthCare.
According to Reynolds, with a range of health plan options, consumers may want to select the top-rated plan. But not everyone has a choice.
“We encourage people to hold health plans accountable,” Reynolds said. “For people who don’t have a choice between health plans, this could mean asking your employer/plan/doctor why your plan’s quality outcomes are the way they are and what they are doing to get better.”
Overall, the average rating was just under 3.4 out of 5. Reynolds said that while quality varies, it tends to get better over time. But that doesn’t usually happen automatically; It may require a push from the people who receive and pay for healthcare.
“Patients and employers, who pay for most planers’ coverage, should use the reviews to continue to advocate for good care,” Reynolds said. “Quality improvement in healthcare isn’t as advanced as in other industries, so people should keep pushing for better care and better service.”
In addition to general rate ratings, NCQA measures specific aspects of care, some of which improved in 2022. For example, several measures of quality of cardiovascular care improved, particularly measures to control hypertension, which improved by 6.9 percentage points for commercial plan members from 2021 to 2022. For Medicare and Medicaid plans, the improvements were 7.6 points and 2.7 points.
Similarly, in people with diabetes, blood pressure control measures improved by 5.5 percentage points in commercial plans, 2.5 points in Medicare plans, and 2.1 points in Medicaid plans. Control of hemoglobin A1c, a key measure of diabetes care, improved 4.1 percentage points in commercial plans and just over 3 points in Medicare and Medicaid plans.
The 2022 results also showed differential childhood immunization performance by population size. In commercial plans, vaccination rates increased 2.2 percentage points but fell 3 points for children in Medicaid plans.
The details in the reviews can reveal strengths and weaknesses in certain aspects of the long-term care and health plan member experience. These differences can serve as conversation starters, according to Reynolds, to help you choose the right plan for your needs.
“What is important to you, your company and your family when it comes to health care? What is good care for you and what tariffs match your values?” he said. “Once you know what you’re looking for, you can find a plan that works best for you.”
But the reviews can also be an important way to hold health plans accountable for the quality — and value — they provide to consumers and their employers.
“It’s up to the people who use and pay for healthcare to build on measurement and transparency, voting with their dollars and voting with their feet to reward high performers and encourage high performers to improve,” Reynolds said.