Comparative Reports on Health Plans

The following reports are examples of comparative information on the quality of health plans. These examples include reports sponsored by Federal agencies, State agencies, private organizations, and purchasing coalitions.

Report Title: Health Plan Report Card

Web Site: http://reportcard.ncqa.org/plan/external/. Accessed November 4, 2015.

Developer: National Committee for Quality Assurance (NCQA)

Developer Type: Quality organization

Location: United States

Synopsis: NCQA’s Health Plan Report Card compares the performance of NCQA-accredited health plans across the United States. The Web site is an interactive tool that allows consumers to create their own comparative report. Each report includes information about the plan type and scores (in the form of one to four stars) that reflect how well the health plan provides members with access to needed care and good customer service; ensures the quality of doctors; and helps members stay healthy, recover from illness, and manage chronic illness.

A link to this report is also provided by Consumer Reports in its article about choosing health plans: Health Insurance Plan Rankings (Accessed October 28, 2015).

Report Title: Medicare Plan Finder

Web Site: https://www.medicare.gov/find-a-plan/questions/home.aspx. Accessed November 16, 2015.

Developer: Centers for Medicare & Medicaid Services (CMS)

Developer Type: Federal government

Location: United States

Synopsis: This Web site provides comparative information on health plans available to Medicare beneficiaries across the United States, with the option to complete a general or personalized search for a health insurance and prescription drug plan. Medicare Plan Finder uses star ratings to indicate how well a plan performs overall and in different categories. The Overall Star Rating combines scores for multiple aspects of health plan quality: how well the plan helps members stay healthy and manage chronic conditions, member experience with the health plan, member complaints and changes in the health plan’s performance, and health plan customer service. Additional topics are included in the rating for plans that cover prescription drugs. In addition to the Star Ratings, beneficiaries can find general information on each plan, as well as information on benefits, premiums and other out-of-pocket costs, drug costs and coverage, and medication therapy management programs for plans that offer Medicare prescription drug coverage.

Report Title: Health Plan Report Card

Web Site: http://etf.wi.gov/members/IYC2016/et-2107rc.asp. Accessed December 4, 2015.

Developer: Wisconsin Department of Employee Trust Funds

Developer Type: State government (employees)

Location: Wisconsin

Synopsis: The Health Plan Report Card provides information on the quality of health plans available to State employees and retirees in Wisconsin. This Web site reports a summary score for overall performance plus measures of clinical quality, care coordination, grievances, and overuse of services (e.g., controlling high blood pressure, preventing readmissions, and avoiding overuse of antibiotics). Health plan performance on these measures is presented as star ratings, with four stars as the highest rating and one star as the lowest rating. Performance ratings are presented in a table form; the plans can be sorted by star rating or in alphabetical order.

Report Title: Health Plan Comparison in New York State

Web Site: https://www.health.ny.gov/health_care/managed_care/reports/eqarr/2015/index.htm. Accessed December 4, 2015.

Developer: New York State Department of Health

Developer Type: State government

Location: New York

Synopsis: This report provides information on managed care plan performance with respect to primary and preventive health visits, health care for acute illness, behavioral health, and medical management of select chronic diseases. The New York State Department of Health uses a public reporting system called the Quality Assurance Reporting Requirements (QARR), which is largely based on HEDIS and CAHPS measures of quality. The report organizes the results of health plan performance to facilitate comparisons of specific measures among health plans of the same type. Measures are organized into general domains to make it easier to focus on results in a given area. For each plan, the report also provides information on the regions of the state it serves, the types of managed care products it provides, how to contact member services departments, and other information about enrollment and national accreditation status. The report is published online and in PDF format.

Report Title: 2015 Health Plan Quality Checkup—A Guide to Michigan Medicaid Health Plans

Web Site: http://www.michigan.gov./documents/QualityCheckupJan03_59423_7.pdf. Accessed November 17, 2015.r4

Developer: Michigan Department of Community Health

Developer Type: State government (Medicaid)

Location: Michigan

Synopsis: This guide to Michigan Medicaid health plans includes ratings in five separate categories of health plan performance: Doctors Communication and Service, Getting Care, Keeping Kids Healthy, Living with Illness, and Taking Care of Women. The guide also has information about accreditation status. Health plan performance ratings are shown using a red apple symbol: four apples indicate above average performance, three apples indicate average performance, and two apples signify below average performance. The report is published online in PDF format so that it can be printed and distributed as a trifold pamphlet.

Report Title: California Health Care Quality Report Cards

Web Site: http://www.opa.ca.gov/pages/reportcard.aspx. Accessed December 8, 2015.

Developer: State of California Office of Patient Advocate

Developer Type: State government

Location: California

Synopsis: This Web site presents star ratings for commercial insurance provided by large Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) in California. Clinical performance and patient experience ratings are represented by one to four stars, with four stars for excellent performance and one star for poor performance. The score for clinical performance is based on meeting HEDIS standards for delivering recommended care. The scores for patient experience with health plans use CAHPS rating and composite measures. This site also presents quality ratings for medical groups that contract with the commercial health plans.

Report Title: Maryland Health Care Quality Reports—Health Benefit Plans

Web Site: https://www.marylandqmdc.org/Article/View/9f87be10-4c38-42f8-9936-7fdb114194b5?Type=Health%20Insurance%20Plan%20Guide. Accessed November 17, 2015.

Developer: Maryland Health Care Commission (MHCC)

Developer Type: State government

Location: Maryland

Synopsis: Each year, MHCC publishes a Comprehensive Quality Report on the health plans in the state, as well as a consumer-friendly version. The Health Benefit Plans Report has both consumer ratings and clinical ratings of health plans. Consumer ratings are based on members’ experiences with their health plans; clinical ratings compare health plans on the quality and performance on measures such as care for chronic conditions, how well plans help members with language challenges, whether the plan supports the cultural health needs of members, provision of timely prenatal care and postpartum care, medication management etc. The reports are available online in PDF format.

Report Title: Colorado Health Matters—Colorado Health Plans Quality Report

Web Site: http://www.cbghealth.org/publications/quality-reports/. Accessed December 4, 2015.

Developer: Colorado Business Group on Health

Developer Type: Employer-led non-profit organization

Location: Colorado

Synopsis: The Colorado Health Matters Quality Report provides information on the quality of care provided by health plans in Colorado. Health plan quality information that is provided in the report includes network quality, customer service, provision of preventive care services, and care coordination. For each clinical quality measure, the report provides additional information to educate consumers about the measure, important issues that consumers should discuss with their physicians, as well as resources for more information. The report also provides basic information such as accreditation status, plan coverage, and tips to help consumers navigate health care pricing. Health care quality information in this report is presented in comparative, graphical and numeric format. The report is published online in PDF format.

Other Examples

Several comparative reports on health plans are published by well-known media and market research organizations. These include:

  • The Health Insurance Guide by U.S. News & World Report, which offers information on how to buy health insurance and publishes plan ratings for every state. (Available at http://health.usnews.com/health-insurance. Accessed October 28, 2015)
  • The Member Health Plan Study by J.D. Power and Associates, which presents ratings based on a survey of a representative sample of consumers who have been members of the health plan. (Available at http://www.jdpower.com/ratings/industry/healthcare. Accessed October 28, 2015)
Page last reviewed December 2016
Page originally created December 2016
Internet Citation: Comparative Reports on Health Plans. Content last reviewed December 2016. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/cahps/consumer-reporting/rcc/health-plans.html