Community-Based Health Plans Move Up in 2010 Quality Rankings

Eleven community-based health plans that are members of the Alliance of Community Health Plans (ACHP) have been named as the nation’s best health plans measured by the National Committee for Quality Assurance (NCQA’s) annual Health Insurance Plan Rankings. In the 2010-2011 rankings of more than 200 plans in the United States, six ACHP members rank among the list of the top ten highest performing private plans, and 11 were included in the list of the top 25 health plans.

ACHP members named in the top 10 quality plans in the nation included Tufts Health Plan of Watertown, Mass. (#2), Capital Health Plan of Tallahassee, Fla. (#4), Geisinger Health Plan of Danville, Pa. (#5), Group Health Cooperative of South Central Wisconsin of Madison, Wis. (#7), Fallon Community Health Plan of Worcester, Mass. (#8) and Kaiser Foundation Health Plan of Colorado (#9). ACHP counts 21 community-based health plans and provider organizations as members, of which 20 were named in the top 50 health plans. NCQA ranks health plans based on clinical performance, member satisfaction and NCQA accreditation.

“Health care reform sets up a new health insurance marketplace going forward, and the NCQA rankings provide consumers, employers and others with a trusted guide to pick high quality and reliable health plans,” said Patricia Smith, ACHP President and CEO. “The rankings also show that the investments and innovations regional, non-profit health plans are making in their communities are helping to make health care better and more affordable.”  NCQA President Margaret E. O’Kane said, “Informing and engaging patients so they can shop for health care based on quality is crucial in an effective, 21st century health care system.”

Group Health Cooperative of South Central Wisconsin (GHC-SCW) is an example of how ACHP plans are improving quality through innovation, strong physician leadership and the use of information technology. As a result, it has shown top performance on several HEDIS® measures, including Avoidance of Antibiotics in Adults with Acute Bronchitis. One intervention that contributed to improvement for this measure is a Best Practice Advisory within GHC-SCW’s electronic health record (EHR) system. This system provides doctors with real-time guidance they can use during a patient visit, while minimizing excessive notices to decrease distractions. The plan’s comprehensive program around proper antibiotic use has resulted in nation-leading rates in HEDIS® on appropriate use of antibiotics, while steadily decreasing total antibiotic overuse across the plan’s population. GHC-SCW continues to be well above the 90th percentile in this area for the last four years of HEDIS® reporting. “As an organization, we are intensely dedicated to proper antibiotic use both for the health of our patients and our community,” says Kim Volberg, Clinical Quality Manager at GHC-SCW.

GHC-SCW also uses innovative technology to get members involved in their own health care decisions. The plan engages members electronically with its Web‐based GHCMyChart system, mobile engagement for their members with smartphones and an electronic enrollment system for employer group purchasers. GHC‐SCW’s rapid engagement of its community using technology and its EHR tools is a result of a commitment to quality improvement. “We are an organization committed to continuous quality improvement,” says GHC-SCW Executive Director, Larry Zanoni. “Each of our employees, providers and management contributed to the NCQA ranking and accreditation process in some way, and we are committed to bringing these improvements to our Cooperative members.”

Other ACHP member plans are also engaging consumers in their care through innovative initiatives, including Minneapolis-based HealthPartners and Fallon Community Health Plan in Worcester, Massachusetts. HealthPartners interacts with members using a variety of online and mobile phone tools to deliver timely and understandable care messages, for example, an urgent care locator and a Member ID card on mobile Web site. Other components of HealthPartners’ engagement strategy include standards for clear consumer communications, online provider comparisons by quality ratings and price, treatment decision support resources through member communications and doctor-patient interactions, and personalized preventive care reminders. Fallon Community Health Plan (FCHP) is connecting with members through an initiative known as It Fits! In this program, FCHP members are reimbursed up to $400 per family per year for a wide range of fitness expenses such as health club memberships, yoga classes, school and town sports programs and ski lift tickets. These initiatives help people lead healthy lives and are part of a comprehensive health and wellness approach that has contributed to the high scores that have kept HealthPartners and FCHP in the top 25 NCQA plans in recent years.

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 asthma and bronchitis 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, 227 health plans voluntarily reported their commercial data to NCQA.


ACHP Member Plans Among Highest Ranked Commercial Plans in 2010 – 2011

Commercial Plans – Top 25

Rank –  Plan

2        Tufts Associated Health Maintenance Organization

4        Capital Health Plan

5        Geisinger Health Plan

7        Group Health Cooperative of South Central Wisconsin

8        Fallon Community Health Plan

9        Kaiser Foundation Health Plan of Colorado

13        Priority Health

16        Independent Health Association

19        HealthPartners

21        Kaiser Foundation Health Plan of Northern California

22        ConnectiCare (EmblemHealth)

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 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 21 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