NCQA Releases Health Insurance Plan Ratings

More than 1,000 health plans are rated based on performance and
quality of care

WASHINGTON–(BUSINESS WIRE)–A new ratings system created by the National Committee for Quality
Assurance (NCQA) provides consumers with a more accurate picture of how
health insurance plans perform in key quality areas.

Using a methodology that makes its debut after two years of development, NCQA’s
Health Insurance Plan Ratings 2015–2016
compare the quality and
services of more than 1,000 health plans that collectively cover 138
million people—over 43% of the US population.

NCQA studied 1,358 health plans and rated 1,016: 491 private
(commercial), 376 Medicare and 149 Medicaid.

The ratings align with the CMS Star Ratings of Medicare Advantage plans,
and give unprecedented importance to health outcomes and consumer

Key takeaways from the 2015–2016 ratings include:

  • New England and Great Lakes Plans Perform Best: States with the
    highest percentage of plans receiving a 4.5 or 5.0 out of 5 rating
    include Maine, Massachusetts, New Hampshire, New York, Pennsylvania,
    Rhode Island, Vermont, as well as Michigan, Minnesota and Wisconsin.
  • High and Low Performers Are Rare: Of the 1,016 rated plans, 116
    (11%) received a top rating of 4.5 or 5.0 out of 5. Fifty-four (5%)
    earned the lowest ratings of 1.0 to 2.0. Most plans are in the middle,
    approximating a “bell curve” when all plans’ performances are plotted
    on a graph.

The ratings replace the annual health plan rankings that NCQA
published each fall for a decade, in partnership with US News &World
Report and Consumer Reports.

Ratings Focus on Satisfaction & Outcomes

The ratings consist of three major performance categories: consumer
satisfaction, prevention and treatment.

  • Consumer Satisfaction: What patients say about their health
    plans in satisfaction surveys, including about claims processing and
    customer service.
  • Prevention: Checkups, tests and other care that keeps
    people—especially children—healthy.
  • Treatment: How consistently a plan provides scientifically
    recommended care for common, costly conditions such as diabetes,
    depression and heart disease.

In each category, the results—outcomes—of a patient’s care count extra
in the scoring; for example, whether blood pressure and diabetics’ blood
sugar are controlled to safe, recommended levels.

This emphasis on results means that, together with consumer
satisfaction, outcomes are the main driver of ratings results.

Advantages of Ratings

  • Simple, User-Friendly Scale: The NCQA ratings blend dozens of
    quality indicators for health plans into a simple scale from 1–5,
    where 1 indicates lower performance and 5 indicates higher performance.

    grouping plans into a few broad categories, the ratings give consumers
    a practical, meaningful guide to understanding their health care
    choices at a level of detail they choose.

  • Details on Demand: Consumers can “drill down” into any part of
    the ratings to learn how a health plan handles particular health
    issues or patient populations.

    For example, expectant
    parents may be interested in performance on two measures of prenatal
    and postpartum care. Families may be interested in quality results on
    10 measures of pediatric preventive care and treatment, ranging from
    well-child care for infants, to monitoring ADHD treatment of

  • Consistency with Medicare: The NCQA ratings align with the
    Medicare Star Ratings, the influential federal assessment of Medicare
    Advantage health plans. Medicare Advantage plans are increasingly
    popular, and cover 16.8 million Americans—a 51% increase since 2010.

The NCQA-Consumer Reports relationship continues. The Consumer Reports
Web site and the November edition of Consumer Reports magazine
will mention the NCQA ratings and urge readers to examine them at

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. NCQA’s Web site (
contains information to help consumers, employers and others make more
informed health care choices.


National Committee for Quality Assurance
Andy Reynolds,
Brock, 202-955-1739