U.S. News released its annual Health Plan rankings of hundreds of commercial, Medicare, and Medicaid managed-care plans. Managed-care providers have to turn over data describing their performance in a host of clinical and member-satisfaction measures to the National Committee for Quality Assurance, managed care’s major accrediting and standards-setting body. They also have to agree to make the information public. Most HMOs and point of service plans—the two plan types evaluated—did comply this year, but 126 plans declined. Also this year, 94 plans turned in too little data to be ranked.
Several plans, including Blue Cross and Blue Shield of Texas, the largest commercial health plan to opt out, were NCQA-accredited until 2006. They then chose to be accredited by URAC, whose requirements for data collection and reporting are less resource-intensive. The question is whether lack of NCQA accreditation points to a subpar performer. The answer, writes US News, based on data from states and large corporate purchasers of coverage, is that on balance, unaccredited plans do underperform accredited ones. This is not always true, and differences in quality often are trivial. But some are not. Many of the measures in which unaccredited commercial HMO and POS plans as a group do far worse, and Medicaid plans not much better, reflect diligence at keeping children’s immunizations on track.
The same laggard performance in childhood immunizations is true of plans that provided data to NCQA for benchmarking purposes but stipulated that nothing could be made public. US News writes that studies such as one in the Journal of the American Medical Association in September of 2002 suggest that plans tend to hide their data when performance drops. Public reporting, in other words, is skewed toward good performers.
In another JAMA study from October 2007, researchers found that members of Medicaid health plans got worse care than commercial plan members did.