ACHP Plans Are Leaders In Health Care Quality

Alliance of Community Health Plans members have a proud heritage of working to improve the quality of coverage and care they provide in their communities. In fact, it was ACHP members who created the original measures of health plan clinical quality, also known as HEDIS®, which are now administered by the National Committee for Quality Assurance (NCQA).

ACHP members dedicate significant resources toward monitoring the quality and level of care received by their enrollees. They use this information to identify opportunities and implement initiatives for improvement. In addition, ACHP members have a patient-centered focus to ensure a high level of satisfaction among their enrollees. These commitments consistently place ACHP members as leaders in health plan rating systems.

ACHP has developed communications materials highlighting how its member plans achieve this high performance.

NCQA Health Insurance Plan Ratings

Each fall, NCQA evaluates the quality provided by health plans through its Health Insurance Plan Ratings. Commercial, Medicare and Medicaid health plans are rated on a number of measures relating to clinical performance, member satisfaction and NCQA accreditation. Plans are assigned an overall rating from 1 to 5 in half point increments, where a rating of 5 indicates exceptional performance. ACHP members’ dedication to quality performance and improvement consistently puts them at the top of these ratings.

In the 2015-16 NCQA ratings, 7 of the 9 Medicare contracts assessed the top rating of 5 are offered by ACHP member plans. Likewise, 8 of the 11 commercial plans rated a 5 and the only Medicaid plan in the nation to receive a rating of 5 are also ACHP members.

A list of ACHP plans and their ratings is available in the full press release.

The complete 2015-16 rankings are available on the NCQA website.

CMS MA Star Ratings

Since 2007, the Center for Medicare and Medicaid Services (CMS) has rated health plans participating in the Medicare Advantage program through its star rating system. All Medicare Advantage plans are rated on a 1- to 5-star scale, with 5 stars representing excellent performance. The ratings consist of 47 quality measures assessing areas such as clinical treatment, member satisfaction and operational processes.

Each year, ACHP member plans demonstrate superior performance on the star ratings.

In the 2016 MA Star Ratings, 8 members of ACHP earned 5 Stars from CMS, the highest score awarded to health plans participating in the Medicare program. Only 12 plans (contracts) in the country received this rating. Overall, 30 Medicare plans (contracts) operated by ACHP members received 5, 4.5 or 4 stars this year; plans offer combined Medicare Advantage (Part C) and prescription drug (Part D) coverage. Additionally, one plan offered by an ACHP member received 5 stars for its stand-alone Medicare plan (Part C).

A list of ACHP member performance in the 2016 CMS MA Star Ratings is available in the full press release.

The 2016 quality ratings can be viewed on the CMS website.