The National Committee for Quality Assurance (NCQA) published its 2024 health plan ratings, prompting health care payers and insurance companies to take a good hard look at the results and see where they stand. These ratings aren’t just some abstract numbers – they have a real impact on your bottom line.
What’s the Big Deal About NCQA Ratings?
For those unfamiliar, the NCQA ratings give health plans a score from 1 to 5 stars (with 5 being the best) based on a mix of factors:
- Clinical Quality: How well do plans perform on measures like preventive screenings and disease management? This is measured using HEDIS (Healthcare Effectiveness Data and Information Set).
- Patient Experience: How satisfied are members with their care and communication from their plan? This comes from CAHPS (Consumer Assessment of Healthcare Providers and Systems) surveys.
- NCQA Accreditation: Bonus points are awarded to plans that have achieved NCQA Accreditation, showing a commitment to meeting rigorous quality standards.
What Can Payers Do with This Information?
- Attract and Retain Members: Consumers are savvy shoppers. They use these ratings to compare plans, and high ratings can be a powerful magnet for new members (and help you keep the ones you have).
- Pinpoint Areas for Improvement: Don’t just focus on the overall score. Dive deep into the data. Where are you excelling? Where are you falling short? This granular view helps you target specific areas for improvement, whether boosting preventive screenings or improving communication with members.
- Boost Your Value-Based Care Strategy: Value-based care is all about quality outcomes and patient satisfaction. By focusing on the factors that drive those ratings, you’re setting your health plan up for success in a value-driven health care world.
- Gain a Competitive Edge: In a crowded market, differentiation is critical to staying ahead of your competition. High NCQA ratings are a powerful differentiator, showcasing your commitment to high-quality patient-centered care.
Increase Your Quality Rating
Analyze your CAHPS data to identify specific areas where member satisfaction can be improved. If members are frustrated with wait times or unclear communication, take the necessary steps to address these issues head-on. Investing proactively in programs that can directly improve HEDIS and CAHPS scores is critical. Lean on the top performers in your provider networks to identify new ways to increase preventive screenings, improve medication adherence, and enhance patient communication.
The Bottom Line
NCQA ratings are a valuable resource for health care payers. By understanding the data and taking strategic action, you can improve quality, enhance member satisfaction, and, ultimately, strengthen your bottom line.
Learn More
To learn more about how quality scores impact your bottom line, take five minutes to read about how Medicare Advantage changed its quality score algorithm.