Washington, DC – Health plans that emphasize coordinated care by developing strong partnerships with physicians and hospitals rank among the nation’s best plans. More than half of the top-ranked Medicare plans in the nation are offered by members of the Alliance of Community Health Plans (ACHP). U.S. News and World Report and the National Committee for Quality Assurance’s (NCQA) annual “America’s Best Health Plans” rank 6 ACHP members in the top 10, and 13 in the top 25, in providing the highest quality Medicare Advantage plans.
The annual list, released online today, also rankedACHPmembers Fallon Community Health Plan of Worcester, MA and UPMC Health Plan of Pittsburgh, PA among the nation’s best in all three categories: Commercial, Medicare and Medicaid plans. In all, 14 ofACHP’s 17 member organizations were represented either in the top 25 Medicare and Medicaid plans or the top 50 commercial health plans.
ACHPmembers are community-based and regional health plans and provider organizations located across the country that provide coverage and health services for about 15 million individuals. They share a commitment to coordinating health care delivery and consistently achieve high quality ratings.
ACHPPresident and CEO Patricia Smith commented, “ACHPmembers are important models as Congress and President-elect Obama move forward on health care reform. These plans are ranked so highly because they have developed innovative systems of care incorporating electronic medical records, medical homes, chronic disease management and close collaboration between plans and physicians – all areas which are expected to be part of health care reform.”
These plans offer important lessons for how best to finance and deliver care for conditions that require coordinated efforts across settings and close monitoring of patient care. For example, HEDIS® scores used in the rankings indicate that health plans that are structured to emphasize primary care and coordinated efforts of the health care team performed well on providing mental health follow-up visits and persistence of Beta Blocker treatment after heart attacks. “If you consider that good results on these two services require coordination across different settings and providers and direct, personal interaction with patients, it’s not too great a leap to suggest that these are outcomes that health plans with strong ties to providers and their communities are best capable of producing,” Ms. Smith said.
“Medicare and other public programs, as well as private purchasers, increasingly are concerned about the value of the care they pay for,” commented Ms. Smith. “As we face multiple, competing demands for resources, policymakers, employers, and individual purchasers would do well to look to health plans such as those offered by ACHP members that are delivering good health outcomes and patient satisfaction.”
The U.S. News rankings are based on data from the Health Plan Employer Data and Information Set (HEDIS®), the Consumer Assessment of Healthcare Providers and Systems (CAHPS®), and Medicare’s Health Outcomes Survey. HEDIS® measures are administered by NCQA and are used to determine the quality of care patients receive and health plans pay for. They track a wide range of services, including asthma medication use, diabetes care, and breast cancer screening. Health plans use HEDIS® measures to identify areas for improvement in delivering care.
CAHPS® measures are administered by the U.S. Agency for Healthcare Research and Quality and are used to determine the level of patient satisfaction with the care and experience with providers and health care facilities. CAHPS® measures allow patients to identify aspects of care they believe are strong or in need of improvement.
About 700 health plans voluntarily reported their commercial, Medicare and Medicaid data this year to NCQA. These plans provide coverage for more than 100 million Americans – a 29 percent increase from last year. NCQA attributes much of this increase to the inclusion of 240 PPO plans publicly reporting data for the first time. While the inclusion of PPO plans is important, it is not sufficient. Two-thirds of Americans – including millions of seniors covered by the traditional Medicare fee-for-service system – receive care that is not measured and reported. Congress took an important step to correct this by calling for a report from the Medicare Advisory Payment Commission (MedPAC), due in 2010, on quality measures to compare Medicare Advantage plans to fee-for-service Medicare.
ACHP Member Plans among Highest Ranked
Commercial, Medicare and Medicaid Plans in 2008
Commercial – Top 50
2 Tufts Health Plan
5 Geisinger Health Plan
8 Group Health Cooperative of SouthCentral Wisconsin
13 ConnectiCare (owned by HIP ofNew York)
15 Priority Health
17 Independent Health Plan
18 Fallon Community Health Plan
19 Security Health Plan
23 Capital Health Plan
26 ConnectiCare ofMassachusetts (owned by HIP ofNew York)
27 Kaiser Foundation Health Plan ofGeorgia
41 UPMC Health Plan
42 Kaiser Foundation Health Plan ofColorado
48 Kaiser Foundation Health Plan ofNorthern California
50 Kaiser Foundation Health Plan of the Northwest
Medicare – Top 25
2 Kaiser Foundation Health Plan ofSouthern California
3 Geisinger Health Plan
5 Security Health Plan
7 Capital Health Plan
8 Kaiser Foundation Health Plan ofColorado
10 Tufts Health Plan
11 Fallon Community Health Plan
12 Kaiser Foundation Health Plan ofNorthern California
13 Kaiser Foundation Health Plan ofMid-Atlantic States
14 Kaiser Foundation Health Plan ofHawaii
19 UPMC Health Plan
20 Kaiser Foundation Health Plan of the Northwest
23 Group Health (WashingtonState)
Medicaid – Top 25
1 Fallon Community Health Plan
5 Kaiser Foundation Health Plan ofHawaii
7 Independent Health Plan
11 Priority Health Plan
13 UPMC Health Plan
16 HIP ofNew York
22 Presbyterian Health Plan
Click here to view U.S. News and World Report’s 2008 “America’s Best Health Plans.”
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ACHP is a membership organization of 17 non-profit, community-based and regional health plans from across the country providing coverage and care for approximately 15 million Americans. These health plans are integrated or coordinated delivery systems that have been on the leading edge of patient care coordination, patient-centered medical homes, use of information technology, and other innovations leading to improvements in administrative efficiency and the quality of care. They have built and maintain strong community ties and close plan/physician partnerships. Almost all ACHP member plans participate in Medicare, most are in Medicaid, and most also offer coverage in the commercial market. To learn more about ACHP, go to www.achp.org.