Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Value-Based Care News

Top 10 Highest Performing Medicare Advantage Health Plans

These ten Medicare Advantage health plans exceeded industry standards for member engagement, chronic disease management, and customer satisfaction.

Ten Medicare Advantage health plans exceed industry standards for member engagement, chronic disease management

Source: Thinkstock

By Thomas Beaton

- Medicare Advantage (MA) plans are growing in popularity as an aging consumer population seeks comprehensive coverage for acute and chronic care needs.

A competitive, lucrative market for high-performing plans has emerged, giving payers an incentive to craft quality offerings at reasonable prices.  

As the MA environment heats up, insurance companies are also feeling pressure to deliver friendly and efficient customer services that engage beneficiaries, prioritize retention, and proactively educate members about how to stay as healthy as possible.

The top performing Medicare Advantage plans achieve all these goals - and more. They are rewarded with four or five stars on CMS’s consumer-friendly star ratings scale, indicating exceptional performance within several key categories. Currently, there are only 24 Medicare Advantage health plans and prescription drug-only plans that earned a five-star overall rating. 

The major performance domains include improving member outcomes, addressing chronic disease management, providing high-quality customer service, and offering comprehensive prescription drug benefits.

READ MORE: How Payer Philanthropy Can Address Social Determinants of Health

Medicare Advantage star ratings are also weighted by the plan’s ability to engage with members and resolve consumers’ issues with plan benefits.

As of 2018, these are the top ten highest performing Medicare Advantage health plans as rated by CMS. Each health plan has earned a five-star overall rating and is listed in order of CMS’s rankings of five-star plan performance. The following list does not factor in newer Medicare Advantage plans with limited performance data or prescription drug-only health plans. 

KelseyCare Advantage

KelseyCare earned five stars in almost every member engagement and customer service domain while also scoring four or more stars for long-term chronic disease management. The health plan earned five stars in customer service domains related to its drug benefit plan. KelseyCare serves 30,000 beneficiaries across four counties in Texas, including Fort Bend, Harris, Montgomery, and Galveston.

Kaiser Permanente

Six Kaiser Permanente Medicare Advantage plans earned five stars for preventive care and chronic disease management.

Kaiser MA plans earned an average of four stars for efficiently updating members about health plan changes and resolving member complaints for members in California, Colorado, Georgia, Hawaii, Oregon, Washington, the District of Columbia, and certain counties in Maryland.

Tufts Health Plan, Tufts Associated HMO

READ MORE: Medicare Advantage Star Ratings Tied to Member Socioeconomic Strata

Tufts MA health plan earned five stars for chronic disease care, preventive care, and member engagement with drug plans. The only performance domains where the plan didn’t earn five stars include prescription drug plan customer service and drug pricing. Tufts MA plans serves beneficiaries in Eastern and Central Massachusetts.

Blue Cross Blue Shield of Minnesota

BCBS of Minnesota’s Medicare Advantage plan secured a five-star overall rating for medical and prescription drug plan customer service within 55 of the state’s 87 counties. The plan also earned five stars for resolving health plan issues and four stars for chronic disease management performance.

Capital District Physicians’ Health Plan Medicare Choices PPO (CDPHP)

CDPHP’s MA plan secured an overall five-star rating while performing particularly well in the customer service categories. The plan earned four stars in both the preventive care and the long-term chronic disease management categories. The health plan currently serves members in 21 counties across New York state.

Medical Associates Clinic Health Plan of Wisconsin

The Wisconsin-based Medical Associates Clinic Health Plan achieved a five star-rating for customer service performance in its four-county market. The plan achieved a four-star rating for chronic disease management, but scored a three star rating for preventive care.

Gundersen Health Plan

Gundersen’s MA plan earned its five-star overall rating by earning five stars in medical and drug health plan customer service. The health plan earned four stars for chronic disease management performance within its three-state market of Iowa, Wisconsin, and Minnesota.

HealthSun Health Plans, Inc.

READ MORE: How Payers Can Add More Value to Medicare Advantage Health Plans

Florida-based HealthSun earned five-star ratings in several domains, including preventive care, long-term chronic disease management, and drug safety. The plan also earned five stars for creating high-quality health plan experiences for its 40,00 beneficiaries in the Miami-Dade and Broward County areas.

Optimum HealthCare, Inc.

The Optimum MA health plan stood out by earning five stars in beneficiary drug safety and drug plan customer service. The plan also earned a five-star rating for resolving consumer complaints with prescription drug benefits. Optimum provides its MA offerings to beneficiaries in 25 counties across Central and Southern Florida.

Anthem Health Plans Of New Hampshire, Inc., Anthem BCBS

Anthem’s Medicare Advantage plans in New Hampshire earned five-star ratings for both preventive care and longer-term chronic disease management. Anthem’s MA plans also earned at least four stars in customer service categories, including member experience.

Editor's Note: The article has been updated to explain that the list was categorized by the five-star overall Medicare Advantage plans with the highest available performance data and explains that the list does not include prescription drug-only MA health plans.


Sign up for our free newsletter:

Our privacy policy

no, thanks

Continue to site...