Community-Based Health Plans Focus on Quality, Show Results

In the 2011-2012 rankings of health plans published Tuesday, nine of the nation’s top ten Medicare plans are offered by members of the Alliance of Community Health Plans (ACHP), and six of the top ten plans in the commercial (or private) rankings and seven of the top ten plans in the Medicaid rankings are offered by ACHP members. The National Committee for Quality Assurance (NCQA) publishes its Health Insurance Plan Rankings annually.

“High performance in NCQA’s Health Insurance Plan Rankings is an honor and the direct result of the work ACHP plans do every day to improve health care for their members and their communities,” said Patricia Smith, ACHP president and CEO.

Looking further at the performance of community-based plans, the rankings show that among the top 50 private plans across the country, nearly half (23) are offered by community or regionally-based plans that are members of ACHP; while 17 ACHP member plans are ranked among the top 25 Medicare plans and eight among the top 25 Medicaid plans.

“The patient-centered focus of non-profit health plans and commitment to continuous improvement consistently places ACHP plans in the top ranks for quality,” said ACHP Chairperson Scott Armstrong, president and CEO of Group Health Cooperative, based in Seattle.

ACHP counts 22 community-based health plans and provider organizations as members, providing health care coverage to approximately 16 million people. NCQA ranks health plans based on clinical performance, member satisfaction and NCQA accreditation.

Geisinger Health Plan (GHP)—a non-profit health plan based in Danville, Pennsylvania, and ranked among the top ten private plans—is an example of how ACHP plans are improving quality through a focus on the patient experience, combined with value-based reimbursement for physicians. GHP is committed to improving the health of its community and has shown top performance on several HEDIS® measures related to its disease management program, including hypertension treatment, appropriate medicine use for patients with asthma, and cholesterol control for members with diabetes.

Patients in need of more hands-on coordination and personalized care are directed towards Geisinger Health Plan’s care management program, which is part of its ProvenHealth NavigatorTMpatient-centered medical home model. Geisinger Health Plan uses a predictive modeling tool to identify high-risk individuals, many of whom have multiple chronic illnesses. Specially-trained nurse care managers work out of physicians’ offices and meet with these patients face-to-face to provide them with education and self-management training, coordinate their care across multiple providers and specialists, and connect them to community resources. “Geisinger has a long standing commitment to assuring our members have access to the highest quality care,” says Janet Tomcavage, RN with Geisinger Health Plan. “Our focus on primary care redesign in ProvenHealth NavigatorTM is a further expansion of that commitment. Working collaboratively with physicians in our network, Geisinger strives to provide additional resources and tools that assist with primary care redesign and complement the new care delivery model. ProvenHealth Navigator’sTM goal is to optimize member outcomes by delivering high value care.”

A key component of Geisinger’s medical home model is value-based reimbursement, which is centered around rewards for improving access to care, pay-for-performance based on quality incentives and shared savings for quality and efficiency targets achieved. Aligning provider payment incentives with the goals of improving access, quality and efficiency, is necessary to transform the health care system into one that is centered on high-quality, coordinated care.

Another ACHP member, Kaiser Permanente, has had an intensive focus over the past several years on improving the care and service experience for members, and shows dramatic improvements in member satisfaction and overall performance this year. Four Kaiser Permanente plans were included in the list of the top 25 private health plans, and an additional two were ranked in the top 50.  For Medicare, Kaiser Permanente represented four of the top five ranked plans, and an additional two were ranked in the top 50.  For Medicaid, Kaiser Permanente was ranked among the top two plans.  “We are very proud and greatly honored by being recognized as having many of the nation’s top Commercial, Medicare and Medicaid health plans,” said Jed Weissberg, MD, senior vice president, Hospitals, Quality and Care Delivery Excellence, Kaiser Permanente. “The rankings reflect the efforts of our outstanding physicians, nurses and care teams, our cutting-edge electronic medical record and our organization’s commitment to delivering the highest quality care to our members and patients.”

One key area of focus has been Kaiser Permanente’s increasing use of health information technology and its integrated electronic health record, Kaiser Permanente HealthConnect®, which is the largest private EHR in the world. Kaiser Permanente provides members with convenient, 24-7 access to their personal health information and to their care teams with goals of increasing self-management and improving health outcomes.

Kaiser Permanente’s electronic health record is available to all members through www.kp.org—currently 3.7 million members are registered users. This Web portal also provides patients access to secure messaging with their physicians, laboratory test results, pharmacy records, prescription refill information, self-care instructions and online educational materials. Members are taking advantage of this increased electronic access to their health information and to their health care providers. In 2010, 26 million test results were viewed by members on kp.org; 10.7 million secure emails were sent to doctors; 8.3 million prescriptions were refilled; and 2.3 million appointments were scheduled.

The NCQA 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 for Medicare Advantage. HEDIS® measures are administered by NCQA and are used to determine the quality of care patients receive. They track a wide range of services, including appropriate 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.

This year, 390 health plans voluntarily reported their private data to NCQA; 341 plans reported Medicare data; and 99 reported Medicaid data.

 

ACHP Member Plans Among Highest Ranked Health Plans in 2011 – 2012

Private Plans – Top 50

Rank     Plan

2           Tufts Associated Health Maintenance Organization

3           Capital Health Plan

4           Tufts Health Plan (PPO)

6           Kaiser Foundation Health Plan of Colorado

7           Group Health Cooperative of South Central Wisconsin

8           Geisinger Health Plan (HMO/POS)

12         Kaiser Foundation Health Plan of Southern California

13         Fallon Community Health Plan

14         Kaiser Foundation Health Plan of Northern California

17         Geisinger Health Plan (PPO)

18         UPMC Benefit Management Services

18         UPMC Health Plan

21         Kaiser Foundation Health Plan of the Northwest

22         Capital District Physicians’ Health Plan

24         HealthPartners

27         Capital District Physicians’ Healthcare Network (HMO/POS)

28         Independent Health Association

33         Kaiser Foundation Health Plan of the Mid-Atlantic States

37         Kaiser Foundation Health Plan of Hawaii

38         Security Health Plan of Wisconsin

40         CDPHP Universal Benefits

41         Priority Health

45         Capital District Physicians’ Healthcare Network (PPO)

 

Medicare Plans – Top 25

1           Kaiser Foundation Health Plan of Northern California

2           Kaiser Foundation Health Plan of Southern California

3           Kaiser Foundation Health Plan of Colorado

4           Kaiser Foundation Health Plan of the Northwest

6           Capital Health Plan

7           Kaiser Foundation Health Plan of Hawaii

8           Tufts Associated Health Maintenance Organization

9           Geisinger Gold Classic

10         Kaiser Foundation Health Plan of the Northwest – Demonstration Project

11         Group Health (HealthPartners)

12         Fallon Community Health Plan

13         Security Health Plan of Wisconsin

14         Group Health Cooperative

16         Capital District Physicians’ Health Plan

17         Kaiser Foundation Health Plan of the Mid-Atlantic States

19         Kaiser Foundation Health Plan of Ohio

23         Independent Health Association

 

Medicaid Plans – Top 25

1           Fallon Community Health Plan

2           Kaiser Foundation Health Plan of Hawaii

5           Capital District Physicians’ Health Plan

6           Security Health Plan of Wisconsin

7           Network Health (Tufts Health Plan)

9           Priority Health

10         UPMC For You

21         Independent Health Association

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About ACHP

The Alliance of Community Health Plans (ACHP) is a national leadership organization bringing together innovative health plans and provider groups that are among America’s best at delivering affordable, high-quality coverage and care. The community based and regional health plans and provider organizations from across the country that make up ACHP’s membership provide coverage and care for approximately 16 million Americans. These 22 organizations focus on improving the health of the communities they serve and are on the leading edge of innovations in affordability and the quality of care, including patient care coordination, patient-centered medical homes, accountable health care delivery and use of information technology. For more information visit www.achp.org.

About NCQA

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care.