The Top Performing Health Plans

Three plans garnered the top overall performing spots this year, according to the National Business Coalition on Health (NBCH): Kaiser Permanente Southern California and Kaiser Permanente Northwest for HMO; and Cigna Pennsylvania for PPO. Plans the achieved the highest scores (benchmark) for specific modules include: Cigna in California, Colorado, New Jersey, Tennessee and Washington; and Tufts Health Plan Massachusetts for PPO; Kaiser Permanente in Southern and Northern California, Colorado, and Northwest; Group Health Cooperative in Washington; and Cigna Colorado for HMO.

Health plans are asked to document their activities in support of purchasers, members, and providers including: how they works with employers to promote safe and effective care; tools available for consumer engagement; physician performance measurement and payment reform; pharmaceutical management; prevention and health promotion; and behavioral health and chronic disease management. The information is then verified, and scores are tabulated so that purchasers can compare their health plans against previous year’s activities as well as against regional and national benchmarks.

There is wide variation among plans reporting C-section rates with a high of just over 40% to a low of 19%. With an overall mean C-section rate of 30%, much can be done to educate consumers and reduce the rate of unnecessary C-sections in the market.

Plans are working to identify gaps in diabetes care using a variety of methods. Most plans track patient adherence to diabetes medications (87%) and recommended diabetes services, such as retinal exams (97%) and foot exams (62%).

Just over half of plans provide publicly available comparative reports on physician performance related to diabetes care; 37% of plans provide comparative performance on perioperative care; and 47% provide comparative performance reports on patient experience.

Over 80% of plans are able to report data on hospital readmissions, but only 34% report that readmissions measures are used to determine financial incentives.

Eighty-one percent of plans use financial incentivessteer to steer users to better-performing physicians. However, plan have been slow to offer incentives for consumer engagement activities, with only 16% providing consumer financial incentives for web consultation and 34% rewarding the use of a personal health records. For additional information visit: www.nbch.org.

Last Updated 7/11/2017

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