New England, Great Lakes Perform Best at HEDIS Quality Measures
Health plans from New England and the Great Lakes had the highest HEDIS quality measure scores on the NCQA 2016 Health Insurance Plan Ratings.
By - More than 90 percent of commercial health insurance companies throughout the country adhere to HEDIS quality measures in order to show consumers and surveillance agencies their overall performance with regard to prevention, treatment, and patient satisfaction. Yesterday, the National Committee for Quality Assurance (NCQA), which collects HEDIS quality measures, announced in a press release the 2016 Health Insurance Plan Ratings.
The 2016 Health Insurance Plan Ratings includes more than 1,000 different health plans throughout the nation and compares quality and services based on HEDIS quality measures. Alongside with NCQA, the health information services company WebMD will be publishing the ratings due to a new partnership.
The data will be published on the WebMD.com website as well as directly on the NCQA website. The NCQA rated a total of 1,012 health plans which encompassed 503 commercial plans, 338 Medicare plans, and 171 Medicaid health plans.
The way HEDIS quality measures are used in comparing these health plans is by bringing more focus toward patient health outcomes and overall satisfaction. The results show that health plans in New England and the Great Lakes performed best.
The three specific areas graded in the Health Insurance Plan Ratings include consumer satisfaction, prevention, and treatment. Satisfaction relates to consumer survey scores regarding doctors, care quality, and customer service. Prevention relates to screenings and immunizations while treatment relates to how effectively a health plan cares for chronic and acute conditions.
HEDIS quality measures have a strong focus on data-driven results such as patient outcomes regarding whether blood pressure or diabetics’ blood sugar levels are kept at safe and recommended levels, the NCQA reported in the press release.
The states that had 4.5 or five out of five scores included Massachusetts, Rhode Island, Wisconsin, Maine, New Hampshire, Minnesota, Vermont and New York. The states Hawaii and Iowa also landed in the top 10 for the best health plans in the country.
Low performers were found to be rare with only 3 percent landing in scores of 1.5 to 2.0. Additionally, only 10 percent of health plans had scores of 4.5 or 5.0, which shows that the majority of health plans ended up falling somewhere in the middle. The number of top-rated plans was also similar between private and public health payers.
According to NCQA’s Health Insurance Plan Ratings Methodology, both HEDIS quality measures along with CAHPS measure ratings are used to determine the overall scores. CAHPS measures are related to patient experience and uses the information found in patient surveys.
At this particular time, there are 81 HEDIS quality measures across five domains available for health plans to assess their performance. This type of data tracking and reporting will be a vital part of health plans and providers transitioning toward value-based care reimbursement, as the healthcare industry moves away from fee-for-service payment systems.
More payers such as Humana and Blue Cross Blue Shield of Rhode Island are working toward incorporating value-based care reimbursement and improving their HEDIS quality measures. Nancy Mamo, AVP/Managing Director of Population Health Analytics at Blue Cross Blue Shield, discussed in an interview how she had developed ways to close gaps in care by incentivizing providers financially to meet a subset of measures.
“First, I wanted to create a very substantial pay-for-performance program where our providers are our partners in closing gaps in care. It’s all about closing gaps in care for HEDIS,” Mamo told HealthPayerIntelligence.com.
“So we put in place a very robust pay-for-performance program in the millions of dollars that we rolled out to our providers. It has a subset of measures in each product line where they could earn substantial amount of money by closing gaps in care. The second thing we did was work with MedeAnalytics, a cloud-based analytics platform, to build a population health registry,” Mamo added. “That tool has all the clinical measures, the HEDIS measures, and all the pay-for-performance information. Every provider can go in and see the listed members who are high risk.”
In a separate interview, HealthPayerIntelligence.com spoke with NCQA’s Vice President for Performance Measurement Mary Barton who provided details on how health plans could help their provider network improve their HEDIS scores.
“Many HEDIS measures are focused on population health topics, so the approach to keeping people healthy using cancer screenings apply to a large number of people. All men and women over age 50 should get colorectal screenings, for example. All women over 50 should get mammography every other year,” Barton explained.
“What could the health plan do to support their practice partners? There is a laundry list of activities that a plan could engage in. They could use their data of who has and hasn’t gotten these tests to provide lists back to the providers of quality care gaps. They could take that information themselves and send postcard reminders to patients about the fact that they need to get these services,” Barton concluded. “They could make it easier for providers to get these services done by the way that they pay for the claims or the way they make the services accessible to providers.”
To view the 2016 Health Insurance Plan Ratings, click here.
Dig Deeper:
HEDIS Quality Performance Measures Assist Consumers, Insurers
Top 3 Ways to Meet HEDIS Quality Measures, Improve Performance
