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Top 10 Highest Performing Medicare, Medicaid Health Plans

The top highest performing Medicare and Medicaid health plans for 2017-18 earned high marks in consumer satisfaction, preventive care, and treating chronic conditions.

Top peforming Medicare and Medicaid plans ranked by NCQA

Source: Thinkstock

By Thomas Beaton

- The top-performing Medicare and Medicaid health plans for the 2017-18 plan year earned exceptional quality scores based on the plans’ customer satisfaction, preventive care, and treatment outcomes of beneficiaries, according to the most recent National Committee for Quality Assurance (NCQA) rankings.

NCQA determined which plans in the public payer sector performed the best by aggregating HEDIS scores, NCQA accreditations, and consumer assessments. NCQA used a 1-5 scale to rank the plans and ranked the top Medicare and Medicaid health plans in the following order:

Top 5 Medicare health plans

Group Health Plan

  • Overall Rating: 5.0
  • Scores: Consumer Satisfaction 4.5; Prevention 5; Treatment 4.0

Group Health Plan of Minnesota and Wisconsin earned nearly perfect marks within each preventive care category and excelled in diabetes and heart disease treatment. The plan also earned the highest possible scores in member satisfaction and member experience.

Gundersan Health Plan Inc.

  • Overall Rating: 5.0
  • Scores: Consumer Satisfaction 5.0; Prevention 5.0; Treatment 4.5

Gundersan Health Plan earned perfect scores in diabetes and heart disease prevention measures as well as perfect marks in provider satisfaction. Gundersen Health Plan had standout performance in almost every measurement category expect a few lower than perfect scores within treatment measures.

Kaiser Foundation Health Plan - multiple states

  • Overall Rating: 5.0
  • Scores: Consumer Satisfaction 4.0; Prevention 5; Treatment 4.5

Kaiser Foundation Health plans earned consistently high marks in prevention and treatment scores but experienced a varying degree of consumer satisfaction scores. Kaiser Health Plan of Washington earned a 4.5 overall consumer satisfaction score while plans in Hawaii and California earned a 4.0 in the same category.

Medical Associates Health Plan - multiple states

  • Overall Rating: 5.0
  • Scores: Consumer Satisfaction 5; Prevention 4.5; Treatment N/A

Medical Associates Health Plan earned perfect scores in consumer satisfaction measures and received high marks in breast cancer screening and diabetes care. NCQA did not have enough data to determine the plan’s overall treatment scores.

Aetna Life Insurance Company Plans - multiple states

  • Overall Rating: 4.5
  • Scores: Consumer Satisfaction 3.5; Prevention 4.0; Treatment 4.0

Aetna Life Insurance plans consistently earned high performance marks in chronic disease prevention and treatment scores, but had trouble receiving higher scores in consumer satisfaction. Members generally gave health plans low consumer satisfaction ratings.

Top 5 Medicaid health plans

Jai Medical Systems Managed Care Organization

  • Overall Rating: 5.0
  • Scores: Consumer Satisfaction 4.5; Prevention 4.5; Treatment 4.0

Jai Medical Systems Managed Care Organization earned perfect scores for member ratings of primary care providers and member education. The health plan also earned high marks in diabetes treatment, helping members manage their asthma symptoms, and assisting members with controlling their blood pressure levels.

Boston Medical Center Health Plan

  • Overall Rating: 4.5
  • Scores: Consumer Satisfaction 3.5; Prevention 3.5; Treatment 4.0

Boston Medical Center Health Plans earned high marks for various treatment measures such as appropriate imaging testing and hospitalization, but experienced shortcomings in health plan satisfaction. The plan also received consistently high marks for many preventive care measures.

Capital District Physicians’ Health Plan

  • Overall Rating: 4.5
  • Scores: Consumer Satisfaction 4.0; Prevention 4.0; Treatment 4.0

Capital District earned high consumer satisfaction scores in categories including customer service, coordination of care, and delivering care quickly. The plan performed considerably better in diabetes and heart disease treatment than in mental health and asthma treatment.

Kaiser Foundation Health Plan - multiple states

  • Overall Rating: 4.5
  • Scores: Consumer Satisfaction 3.0; Prevention 4.5; Treatment 4.0

Kaiser Foundation Medicaid health plans received high-quality performance scores in several preventive care and treatment categories such as cancer screenings and pediatric care. Notably, Kaiser Foundation Health Plan of Hawaii was able to earn a 4.0 in consumer satisfaction when plans in other states earned a 2.5 rating.

Neighborhood Plan of Rhode Island

  • Overall Rating: 4.5
  • Scores: Consumer Satisfaction 4.0; Prevention 4.5; Treatment 4.0

Neighborhood Plan of Rhode Island earned some of the highest quality scores in preventive pediatric care, cancer screenings, and providing flu shots to members. The plan experienced lower quality scores in appropriate imaging and antibiotic use for adults.  

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