As the National Committee for Quality Assurance (NCQA) announced its 2024 Health Plan Ratings, only five out of 1,019 rated plans achieving the highest rating of five stars.
The annual list evaluates commercial, Medicare and Medicaid health plans based on assessments of patient experience and clinical quality. The 2024 Health Plan Ratings are based on data from calendar year 2023, when approximately 227 million people were enrolled in health plans that reported Healthcare Effectiveness Data and Information Set (HEDIS) results to NCQA.
Of the plans winning five stars, three were commercial and two were Medicare plans. Two were Kaiser Permanente’s: its commercial plan available in the mid-Atlantic states area (Baltimore, suburban Maryland, Northern Virginia, and Washington, D.C.) and its Medicare plan in Colorado.
Kaiser Permanente noted that it has more 5-star and 4.5-star plans combined than any other healthcare organization for the ninth ratings cycle in a row.
“The NCQA ratings once again show our dedication to providing high-quality care to our members across all of our markets,” said Andrew Bindman, M.D., executive vice president and chief medical officer for Kaiser Permanente, in a statement. “Our integrated model is designed to reliably deliver high-value care to our members.”
Other 5-star winners were Blue Cross Blue Shield of Massachusetts’ Commercial PPO plan, New York-based Independent Health Association Inc.’s commercial HMO/POS combined, and Wisconsin-based Network Health Insurance Corp.’s Medicare PPO.
There was also a slight increase in Medicaid and Medicare plans that achieved 4- and 4.5-star ratings, compared to 2023, demonstrating improvement across several health quality measures.
“Annual Health Plan Ratings are vital to providing healthcare consumers with transparent and objective information about the quality and performance of health plans. Ratings not only help individuals make informed choices to receive the best possible care but also motivate health plans to improve their operations, with a focus on quality, equity and accountability,” said NCQA President Margaret E. O’Kane, in a statement.
NCQA continues to prioritize health equity in its ratings methodology. This year, NCQA increased the scoring threshold for the Race/Ethnicity Diversity of Membership (RDM) measure and increased the measure weight from 0.5 to 1.0. The organization said that collecting race and ethnicity data is crucial for closing gaps in quality of care and promoting health equity. By encouraging broader stratification and collection of race and ethnicity data by health plans, ratings can drive continuous quality improvement across the healthcare industry, ensuring that all patients receive the best possible care.
Here is more detail about the ratings methodology: Each year, NCQA rates health plans that choose to publicly report their HEDIS data. Ratings are based on nearly 50 assessments of patient care outcomes and experience, including measures of clinical quality from NCQA’s HEDIS and CMS’s Health Outcomes Survey (HOS); measures of patient experience using the Consumer Assessment of Healthcare Providers and Systems (CAHPS®); and NCQA’s review of health plan quality improvement processes (NCQA Accreditation).
The overall rating is the weighted average of a plan’s HEDIS, CAHPS and HOS measure ratings, plus Accreditation bonus points, calculated on a 1–5 scale (5 is highest), displayed as stars and rounded to the nearest half-point.