This week, our In Focus section reviews the annual Medicaid health plan ratings released in September by the National Committee for Quality Assurance (NCQA), which rated 171 Medicaid plans. For 2019-20, NCQA used a ratings methodology that scored each health plan from 0 to 5 in 0.5 increments – a system similar to the Five-Star Quality Rating System used by the Centers for Medicare and Medicaid Services. A plan is considered top-rated if it scores a 4.5 or 5 and low-rated if it scores a 1 or 2. For 2019-20, only 15 Medicaid plans across the country were awarded a 4.5 or 5.

Below, we briefly summarize the NCQA rating methodology, highlight the highest-rated Medicaid plans, and provide an overview of how the larger multi-state Medicaid MCOs performed.

NCQA Methodology Overview

NCQA ratings are based on three types of quality measures:

1. measures of clinical quality;
2. measures of consumer satisfaction; and
3. results from NCQA’s review of a health plan’s health quality processes.

NCQA rates health plans that report quality information publicly. Clinical measures include prevention and treatment measures, which are a subset of the NCQA Healthcare Effectiveness Data and Information Set (HEDIS) measures.

Consumer satisfaction measures come from the HEDIS survey measurement set—Consumer Assessment of Healthcare Providers and Systems (CAHPS) 2—a survey overseen by the Agency for Health Care Quality (AHRQ). Consumer satisfaction measures assess patient experience with care, including their experiences with doctors, services and customer service.

Prevention measures assess the proportion of eligible members who received preventive services like prenatal and postpartum care, immunizations and cancer screenings.

Treatment measures assess the proportion of eligible members who received the recommended care for conditions like diabetes, heart disease and mental illness.

A detailed methodology document for the 2019-20 ratings is available here.

Highest-Rated Medicaid MCOs for 2019-20

The highest-rated Medicaid MCOs for 2019-20 were Jai Medical Systems MCO and Kaiser Foundation Health Plan of the Mid-Atlantic States, both with a five rating. AmeriHealth Caritas’ Pennsylvania plan, Centene’s New Hampshire Healthy Families and UnitedHealthcare RIte Care in Rhode Island were among those receiving a rating of 4.5.  Aetna, Anthem, and WellCare all have at least one plan receiving a rating of four.

2019/20 Rating	Plan Name	State	NCQA Accreditation	Consumer Satisfaction	Prevention	Treatment
5	Jai Medical Systems Managed Care Organization	MD	Yes	4.5	4.5	4
5	Kaiser Foundation Health Plan of the Mid-Atlantic States	MD	Yes	3	5	4.5
4.5	Allways Health Partners	MA	Yes	4.5	4.5	4
4.5	Capital District Physicans’ Health Plan	NY	Yes	3.5	4	4
4.5	Excellus Health Plan dba Excellus BlueCross BlueShield	NY	Yes	4	4	4
4.5	Excellus Health Plan, dba Univera Healthcare	NY	Yes	4	4	4
4.5	Fallon Community Health Plan	MA	Yes	3.5	4	4
4.5	Granite State Health Plan dba NH Healthy Families	NH	Yes	3.5	3	4
4.5	Health Partners Plans	PA	Yes	3	4.5	3.5
4.5	Kaiser Foundation Health Plan – Hawaii	HI	Yes	3	4.5	4
4.5	Neighborhood Health Plan of Rhode Island	RI	Yes	3.5	4.5	4
4.5	Tufts Health Public Plans	MA	Yes	3.5	4.5	4.5
4.5	UnitedHealthcare of New England dba UnitedHealthcare Community Plan	RI	Yes	3.5	4	4
4.5	Upper Peninsula Health Plan	MI	Yes	4	3.5	4
4.5	Vista Health Plan dba AmeriHealth Caritas Pennsylvania	PA	Yes	4.5	3.5	4

 

Rhode Island, Massachusetts, Iowa, New Hampshire and Pennsylvania are the top five states in terms of average Medicaid MCO rating. New York, Maryland, Minnesota, Wisconsin, Ohio, Michigan, Kansas, Nebraska, Tennessee and Utah were also above average. District of Columbia, Texas, Nevada, New Mexico and Mississippi make up the bottom five.

Overview of Larger and Multi-State Plan Ratings

Overall, most multi-state managed care organizations had Medicaid plan ratings that were slightly under the national average in 2019-20. AmeriHealth Caritas and Anthem had above average ratings. The table below shows the average rating by MCO, excluding plans without a rating for 2019-20.

MCO	Number of Plans Rated	Average 2019/2020 Rating
Aetna	9	3.22
AmeriHealth Caritas	7	3.57
Anthem	15	3.43
Centene	16	3.28
Humana	2	3.25
Molina	10	3.40
UnitedHealthcare	23	3.39
WellCare	11	3.23
All Other Rated Plans	78	3.49
Total (All Rated Plans)	171	3.42

Full rankings available at: http://healthinsuranceratings.ncqa.org/