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: Medi-Cal Managed Care Health Care Options

Website: https://www.healthcareoptions.dhcs.ca.gov/learn/health-plan-materials?location=138. Accessed July 13, 2022.

Developer: California Department of Health Care Services

Developer Type: State government

Location: California

Synopsis: The California Department of Health Care Services’ website on Medi-Cal managed care health care options allows users to view plan materials by county in California and compare the quality of care and service. Quality ratings are presented in the form of stars, with two of the three stars indicating an average performance on the measure. These star ratings are provided for both adults and children. The website also offers details about benefits and services, a directory of providers working within the medical plan, a formulary list of drugs the medical plan covers, tips on choosing a plan, and methods for enrollment.

Report Title: Health Plan Report Card

Website: https://reportcards.ncqa.org/health-plans. Accessed December 20, 2022.

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 website is an interactive tool that allows consumers to see an overall rating and detailed ratings (in the form of one to five stars) for different types of plans. The scores 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.

Report Title: Medicare Plan Finder

Website: https://www.medicare.gov/find-a-plan/questions/home.aspx. Accessed July 13, 2022.

Developer: Centers for Medicare & Medicaid Services (CMS)

Developer Type: Federal government

Location: United States

Synopsis: This national website provides comparative information on health plans available to Medicare beneficiaries across the United States, with the option to include prescription drug plans. 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 Quality 2022

Website: https://etf.wi.gov/its-your-choice/2022/health-plan-quality. Accessed July 13, 2022.

Developer: Wisconsin Department of Employee Trust Funds

Developer: State government

Location: Wisconsin

Synopsis: The Wisconsin Department of Employee Trust Funds’ Health Plan Quality website provides quality resources for users to make informed decisions about selecting a health plan, including National Committee for Quality Assurance (NCQA) ratings.

Report Title: It's Your Choice 2019: Decision Guide

Website: https://etf.wi.gov/its-your-choice/2019-27/direct. Accessed December 20, 2022.

Developer: Wisconsin Department of Employee Trust Funds

Developer Type: State government (employees)

Location: Wisconsin

Synopsis: The Decision Guide provides step-by-step guidance for State employees and retirees choosing a health plan in Wisconsin, including a breakdown of costs, benefits, supplemental benefits, quality ratings, and availability by geographical location.

Report Title: Managed Care Regional Consumer Guides

Website: https://www.health.ny.gov/health_care/managed_care/consumer_guides/. Accessed July 13, 2022.

Developer: New York State Department of Health

Developer Type: State government

Location: New York

Synopsis: The Managed Care Regional Consumer Guides help consumers in New York State choose a plan that meets their needs by providing information about quality of care, including consumers’ experiences with care and services. Users can filter by region and payer to produce a table that displays an overall score as well as ratings for quality of care provided to members with illness, preventive and well-care for adults and children, and member experience with access and service. Ratings are depicted by a five-star scale, with more stars signifying better performance.

Also available: 2020 Health Plan Comparison in New York State. The NY Department of Health also publishes a report in PDF format that compares quality and satisfaction performance results for health plans. Website: https://www.health.ny.gov/health_care/managed_care/reports/docs/health_comp_report/health_comp_report_2020.pdf

Report Title: 2016 Health Plan Quality Checkup—A Guide to Michigan Medicaid Health Plans

Website: https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Folder1/Folder15/QualityCheckupJan03.pdf?rev=614fba4a358b4cf9a24fc33bf357357f. Accessed July 13, 2022.

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

Website: http://reportcard.opa.ca.gov/rc/HMO_PPOCombined.aspx. Accessed July 13, 2022.

Developer: State of California Office of Patient Advocate

Developer Type: State government

Location: California

Synopsis: This website 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 five stars, with five 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 Quality Reporting

Website: https://healthcarequality.mhcc.maryland.gov/HealthPlan/Suggestione. Accessed July 13, 2022.

Developer: Maryland Health Care Commission (MHCC)

Developer Type: State government

Location: Maryland

Synopsis: The MHCC’s website on quality reporting provides a guide for finding a health plan and comparing health plans, as well as reports to learn more about the overall performance of Maryland health plans. The Health Plan Guide includes:

• consumer ratings based on members' experiences with their health plans,
• clinical ratings,
• provider network ratings, and
• overall performance ratings.

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 July 13, 2022.)
• The Commercial Member Health Plan Satisfaction Study by J.D. Power and Associates, which presents ratings of plans by state based on a survey of a representative sample of consumers who have been members of the health plan. (Available at https://www.jdpower.com/business/ratings/industry/insurance. Accessed July 13, 2022)