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:
- measures of clinical quality;
- measures of consumer satisfaction; and
- 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/