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The best health insurance plans can be difficult for the average person to rate, but our five-star health plans satisfy members and excel at preventing and treating illness

As Congress gets ready to redefine the shape of healthcare for the next few decades, millions of Americans are just trying to figure out by December 31 which health insurance plan they should choose for the coming year from the options offered by their employer. To help, U.S. News and the National Committee for Quality Assurance, managed care’s major accrediting and standards-setting body, have ranked commercial, Medicare, and Medicaid health plans for the fifth year. The top 50, 25, and 25 plans respectively are listed later in this post. The Honor Roll appears on Page 92 of their journal. Full rankings will be listed in our next news article.

To assemble the rankings and determine the best plan, NCQA analyzed quality-related information from 730 plans. Each policy was then evaluated on dozens of measures in three broad areas: member satisfaction (for example, how well doctors communicate), prevention (such as diligence in screening for various illnesses), and treatment (success in controlling high blood pressure in members with heart disease, for instance). Commercial plans were graded on 50 measures, Medicare plans on 44, and Medicaid plans on 41. Each plan got a score of 0 to 100 according to how well it performed compared with other commercial or Medicare or Medicaid plans. Member satisfaction made up 25 percent of the score, prevention and treatment together 60 percent, and NCQA accreditation 15 percent. Rank was determined by plan score.

Star power. Plans also got ratings of one to five stars in individual measures; in groups of measures (such as satisfaction with physicians and screening for different cancers); in the three major categories of member satisfaction, prevention, and treatment; and overall. Five stars indicate performance in the top 10 percent of all plans of that type; one star indicates the bottom 10 percent.

Families who have a special focus or issue will want to see how well plans under consideration perform in related measures. Having a toddler in the family suggests checking to see how well plans keep young children up on immunizations. If there’s an adult with diabetes, another measure shows performance in keeping blood sugar and LDL cholesterol below critical levels. Member satisfaction measures include the ease of making appointments and getting care, whether doctors communicate effectively, and how claims are handled.

Of the 730 HMOs and POS (point-of-service) plans assessed for the rankings, 610 gave NCQA performance information and agreed it could be made public. Of these, 490 provided enough data to be ranked, and 120 were listed but not ranked because of insufficient data. Reasons include too few members for statistics to be considered reliable.

The remaining plans–some with more than 100,000 members, as shown on the facing page–either declined to report any data or stipulated that the data could not be released. In either case, such plans are ineligible both for NCQA accreditation and for ranking.

In many states, plans that do business there must be NCQA-accredited or meet equivalent standards. In states like Texas that don’t impose an accreditation requirement, some plans say that the cost of going through NCQA’s accreditation process outweighs the potential benefits. If there is no market advantage in having accreditation–meaning that employers don’t care–or if a plan is barely staying afloat, accreditation may be judged pointless.

Consumers, however, should look skeptically at unaccredited plans. On balance, their care compared with accredited plans is worse–often much worse. NCQA’s latest analysis shows that unaccredited commercial plans did far less well in immunizing children, managing cholesterol in members with diabetes or heart disease, and providing postpartum care. Unaccredited Medicare plans are laggards in breast and colon cancer screening, care of diabetic patients, and osteoporosis testing. And unaccredited Medicaid programs aren’t as good at checking children’s lead levels or in any diabetes-related measure.

Not that accreditation guarantees high quality. NCQA President Margaret O’Kane calls overall plan performance “pitiful” in mental health and substance abuse–such as followup after hospitalization for mental illness–and stuck at an “unacceptable level of mediocrity” in screening for colon and cervical cancer. Just slightly more than half of all adults in health plans are screened for colorectal cancer even with a self-administered stool-smear test. Getting members to go along is hard, O’Kane concedes; “colon cancer screening is not popular.” She points out, however, that the best plans attain screening rates of 67 percent or better. “If they can do it,” O’Kane says, “there’s no reason the rest can’t.”

Now you know how the best health insurance plans are rated using our independent information and ratings, and what to look for when purchasing your policy. Next up we will name and rank the best insurance companies using this ranking system outlined above.

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