Community-Based Health Plans Move Up in 2009 Quality Rankings

ACHP Members Comprise Half or More of Top Ten in Commercial and Medicare Plans

The regional, non-profit health plans that are members of the Alliance of Community Health Plans (ACHP) increased their numbers at the top of the very best health plans measured by the annual “US News & World Report/NCQA’s Best Insurance Plans.”  In the 2009-2010 rankings of over 700 plans across the United States, five ACHP members rank among the list of the top ten highest performing commercial plans, and 11 were included in the list of the top 25 in this category.

In Medicare managed care, the ACHP plans achieved even more impressive gains, with nine among the top ten and 15 in the top 25.  ACHP plans remained strong in the Medicaid category, as well, with four in the top 10 Medicaid managed care plans.

“We are pleased that more ACHP plans have scored in the top 10 and top 25 than ever before, and that their standing  is due not only to their clinical excellence, but also to their scores on patient satisfaction measures,” said Patricia Smith, ACHP President and CEO.  “These quality rankings reflect an investment by our member plans in delivery system reforms including coordinated care and innovative strategies to transform medical practice.  As long-time leaders in their communities, high performing plans often improve the quality of care for an entire health care market because their provider partners incorporate delivery system innovations across their entire practice.” 

The National Business Group on Health, whose members include 281 employers, and 60 of the Fortune 100, that are interested in finding innovative and forward-thinking solutions to their most important health care and benefits-related issues, commended the ACHP plans on their high scores. The Business Group President Helen Darling said, “The business community pays close attention to these innovators.  Hopefully, Congress will use health care reform legislation to improve quality across the entire health delivery system by rewarding plans such as these.”

Capital Health Plan (CHP), an ACHP member based inTallahassee,FL, is an example of how ACHP member plans are improving quality through aggressive coordination made possible because of improved information technology.  Carla Belcher, RN is responsible for calling newly diagnosed patients with serious lung disease who have not yet been measured for lung function. “Because of CHP’s electronic records system, I have access to an automated report that lists the members who need spirometry,” Ms. Belcher explained.  “They are often heavy, long time smokers and they tend to be fairly resistant to hearing another lecture about the evils of smoking.  Using the spirometer, I can give them a graphic image of their lung capacity – it has been extremely effective in convincing many smokers to seek smoking cessation treatment.” Capital Health Plan tests the lung function of over 84 percent of its commercial members newly diagnosed with serious lung disease, compared to the national average of 38 percent.

 

Health reform legislation provides the opportunity to increase quality across the health care system. House and Senate bills include important provisions that would reward value rather than volume in both traditional Medicare and Medicare Advantage.  Ms. Smith noted, “With strong quality incentive provisions in Medicare Advantage, Congress can promote more of the kinds of investments in coordinated, high quality, and efficient care that characterize the best of the health plans in the U.S. News/NCQA rankings. But Congress can also make decisions that would jeopardize these plans which the President and Congressional leaders have pointed to as models of delivery system reform.”

 

The U.S. News and World Report/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 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.

 

More than 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 largely attributable to the inclusion of 240 PPO plans publicly reporting data for the first time.

 

ACHP Member Plans Among Highest Ranked

Commercial, Medicare and Medicaid Plans in 2009-2010

Commercial – Top 25

Rank/Plan

3          Tufts Associated Health Maintenance Organization

5          Capital Health Plan

6          Geisinger Health Plan

7          Fallon Community Health Plan

10        Group Health Cooperative of SouthCentral Wisconsin

13        Kaiser Foundation Health Plan ofColorado

14        Universal Benefits (Capital District Physicians’ Health Plan)

15        Capital District Physicians’ Health Plan

22        Priority Health

23        Capital District Physicians’ Healthcare Network (Self-Funded)

25        Health Partners

 

Medicare – Top 25

Rank/Plan

1          Kaiser Foundation Health Plan ofColorado

2          Fallon Community Health Plan

3          Geisinger Health Plan

4          Tufts Associated Health Maintenance Organization

5          Capital Health Plan

7          Kaiser Foundation Health Plan of the Northwest

8          Kaiser Foundation Health Plan ofSouthern California

9          Kaiser Foundation Health Plan of the Northwest (Demonstration Project)

10        Capital District Physicians’ Health Plan

11        Group Health Cooperative

13        Kaiser Foundation Health Plan ofNorthern California

14        Kaiser Foundation Health Plan ofHawaii

15        Kaiser Foundation Health Plan of theMid-Atlantic States

18        Independent Health Association

19        Security Health Plan ofWisconsin

 

Medicaid – Top 25

Rank/Plan

1          Kaiser Foundation Health Plan ofHawaii

3          Fallon Community Health Plan

6          Capital District Physicians’ Health Plan

8          HIP Health Plan ofNew York

12        Independent Health Association

14        Priority Health

15        UPMC Health Plan

 

 

Click here to view U.S. News and World Report’s 2009-2010 “America’s Best Health Plans.”

_____

 

ACHP is a national leadership organization that brings together innovative health plans and provider groups that are among America’s best at delivering affordable, high-quality coverage and care in their communities. The non-profit, 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 18 million Americans. These 19 organizations focus on improving the health of the communities they serve and are on the leading edge of patient care coordination, patient-centered medical homes, accountable health care delivery, use of information technology and other innovations leading to improvements in affordability and the quality of care. To learn more about ACHP, go to www.achp.org.

 

# # #