NCQA: Nonprofit Health Plans Provide Better Quality

December 15, 2011

Most top-quality health plans in the U.S. are offered by nonprofit organizations, says Bruce McPherson, president and CEO of Alliance for Advancing Nonprofit Health Care. He bases that claim on 2011 rankings recently released by the National Committee for Quality Assurance (NCQA)

Most top-quality health plans in the U.S. are offered by nonprofit organizations, says Bruce McPherson, president and CEO of Alliance for Advancing Nonprofit Health Care. He bases that claim on 2011 rankings recently released by the National Committee for Quality Assurance (NCQA).

NCQA collects data from hundreds of health plans each year and analyzes each plan’s performance on dozens of measures of enrollee satisfaction, prevention, treatment, and accreditation status. This year rankings were provided on 830 HMOs, POS or PPO plans (390 Private, 341 Medicare, and 99 Medicaid).

McPherson says the Alliance has analyzed the latest rankings and found the quality performance of nonprofit health plans to be impressive. While  29% of the 390 private plans reported as nonprofits, all of the top 20 ranked private plans are nonprofits. Similarly, 31% of the 341 Medicare plans are reported as nonprofit, but 95% of the top 20 ranked Medicare plans are nonprofit. On the Medicaid plan side, 40% of the 99 plans are reported as nonprofit, which make up 75% of the Top 20 ranked plans.

The Alliance is using these findings to support its position that state health insurance exchanges should be required to make readily transparent to consumers whether the various coverage options being made available to them are being provided by not-for-profit or for-profit health plans. It has sent a letter to that effect to The Centers for Medicare & Medicaid Services (CMS).

“We are hearing through informal channels that CMS is seriously considering it, but how they will come out on this is still very uncertain,” McPherson says. “The final regulations, to be released in the weeks ahead, will ultimately tell the tale. We are hoping that the response will be favorable so that we won't need to consider seeking any legislative remedy.

“It was unfortunate that some federal officials didn't avail themselves of consumer views and these types of performance data a couple of years ago, before they started vilifying all private health insurers as greedy and/or incompetent during the federal healthcare reform debates,” McPherson continues.

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