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Friday
Sep282018

NCQA Health Plan Ratings: What About the 25% With No Rating?

By Clive Riddle, September 28, 2018

NCQA has released its 2018-2019 Health Insurance Plan Ratings. The ratings are a key tool used by stakeholders in evaluating health plans. NCQA tells us they “studied nearly 1,500 health plans and rated 1,040: 445 private (commercial), 418 Medicare and 177 Medicaid” and that “of the 1,040 rated plans, 85 (8%) received a top rating of 4.5 or 5.0 out of 5. Twenty-five (2%) earned the ratings of 1.0 to 2.0.”

The ratings website is searchable by plan type, state, or plan name and can be sorted by ratings (rated on a scale of 1.0 to 5.0). What isn’t readily available is a summary of the number of plans by each rating category, so we compiled one:

What struck us was the 25% of plans studied that aren’t rated. If you’re a plan that likely would get a rating below 3.0, wouldn’t you be motivated to avoid being rated at all? So let’s look at the ratings methodology.  Here’s a summary of NCQA health plan rating methodology, provided by NCQA

“Health plans are rated in three categories: private plans in which people enroll through work or on their own; plans that serve Medicare beneficiaries in the Medicare Advantage program (not supplemental plans); and plans that serve Medicaid beneficiaries. This year’s ratings do not include Marketplace plans because they have not developed sufficient data for analysis. NCQA ratings are based on three types of quality measures: measures of clinical quality from NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®2); measures of consumer satisfaction using Consumer Assessment of Healthcare Providers and Systems (CAHPS®3); and results from NCQA’s review of a health plan’s health quality processes (performance on NCQA Accreditation standards). NCQA rates health plans that report quality information publicly.”

NCQA provides this explanation of plans listed as having partial data:

“Plans with partial data do not receive a rating, but NCQA lists them in the ratings and shows their scores on the measures they report. A plan is considered to have partial data if it: Submits HEDIS and CAHPS measure data for public reporting, but has “missing values” (i.e., NA or NB) in more than 50 percent of the weight of measures used in the methodology. Plans that fall into this category receive an overall rating status of “Partial Data Reported” and their measure rates are displayed as “NC” (No Credit). Refer to HEDIS Volume 2: Technical Specifications for information about missing values. Submits HEDIS data for public reporting but does not submit CAHPS data, or vice versa. Plans that fall into this category receive an overall rating status of “Partial Data Reported” and their measure rates for the dataset they did not submit are displayed as “NC” (No Credit).  Earned NCQA Accreditation without HEDIS data (health plan accreditation standards only) and did not submit HEDIS or CAHPS data for public reporting. Plans that fall into this category receive an overall rating status of “Partial Data Reported” and their measure rates are displayed as “NC” (No Credit).”

NCQA provides this explanation of plans listed as having no data reported:

“Plans that submit results but do not report data publicly, or plans that report no HEDIS, CAHPS or accreditation information to NCQA, are given a rating status of “No Data Reported” and their measure rates are displayed as “NC” (No Credit). Plans that fall into this category and have fewer than 8,000 members are omitted—they are not rated and are not listed in displays related to ratings.”

Based on these explanations, there are plans that legitimately should not be rated. But some of these aren’t included in the above numbers of plans with partial or no data, such as plans with fewer than 8,000 members with no data reported, or Marketplace plans with not enough data history.

But what about the rest? Could there be plans that avoid full data reporting to avoid potentially low ratings? Certainly the small numbers of plans publicly singled out with 2.0 or lower ratings come across looking far worse that the large number of plans listed with partial data or no data reported.

Perhaps NCQA should come up with a way to make the listings of applicable partial or no data reported plans perceived in a more negative manner?

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