Kaiser Permanente has once again been ranked No. 1 among Georgia’s commercial health plans by a major accrediting organization.
It’s the eighth consecutive year that Kaiser Permanente Georgia has been rated tops in the state by the National Committee for Quality Assurance (NCQA).
The NCQA, a leading managed care accrediting body, evaluates health plans based on customer satisfaction, treatment and prevention. Kaiser’s Georgia HMO scored an 86.8, placing it 36th among 474 ranked private health plans nationwide, a climb of 16 places in the past year.
The nonprofit has more than 235,000 members and 29 medical facilities in metro Atlanta and in Athens.
NCQA also ranked the three managed care plans covering Medicaid and PeachCare in Georgia. Amerigroup received an 83, and WellCare and Peach State each scored an 81.
The organization rated hundreds of Medicare health plans as well, with Kaiser’s Georgia plan again leader in the state, followed by Aetna’s HMO, UnitedHealthcare’s PPO, Humana’s PPO, Aetna’s PPO, United’s HMO/POS, and Blue Cross HMO.
Consumer Reports, which is publishing the rankings in its November issue and on its website, noted this week that the data are coming out shortly before many consumers will make important health insurance decisions. Open enrollment for private health plans is in October and November, while Medicare open enrollment runs from October 15 to December 7.
To be eligible for NCQA’s rankings, health plans must authorize public release of their performance information and submit enough data for statistically valid analysis.
On a 1 to 5 scale, with 5 being the highest, Kaiser’s Georgia HMO earned a 5 in prevention, a 4 in treatment, and a 4 in consumer satisfaction
“NCQA is the gold standard in measuring care and service,” Kerry Kohnen, president of Kaiser Permanente Georgia, said in a statement Tuesday. “This ranking shows that we are setting the pace for high quality health care in Georgia. The real winners are our members and the communities we serve.”
Dr. Rob Schreiner, executive medical director for Kaiser of Georgia, added, “Our ranking reflects the success of Kaiser Permanente’s coordinated care model, which is enhanced by our electronic medical record system.’’
Among private health plans, Kaiser’s HMO was followed in Georgia by Blue Cross and Blue Shield of Georgia’s HMO/Point of Service plan, with an 82.4 score; Kaiser’s Point of Service plan, at 82.2; then health plans offered by Cigna, Aetna, Humana, and UnitedHealthcare.
“All the insurers in these rankings are commendable for disclosing their quality results,’’ said NCQA President Margaret E. O’Kane in a statement. “If not for that transparency, consumers would be in the dark when they choose a health plan.’’
Consumer Reports found that five of the top 10 national performers in NCQA’s rankings of private plans are “integrated health systems, “which provide insurance while also employing the doctors, and in some cases owning the hospitals, that care for their customers.”
Nancy Metcalf, senior program editor at Consumer Reports, said, “I think we’re going to be hearing a lot more about these systems, which are leading the way in large part because they are avoiding wasteful care.”
Each of the top 10 national private plans is a nonprofit.
Seven indicators of consumer satisfaction tracked by NCQA have improved almost every year since 2007, Consumer Reports said.
But measures designed to track overuse show troubling trends, the magazine said. For example, research shows that imaging tests aren’t helpful for most forms of lower-back pain — and can even be harmful. But insurance plans have failed to rein in imaging claims for back pain in the seven years the NCQA has tracked it, Consumer Reports said.
The national rankings show that Kaiser performs the best of any of the major private insurers, with 75 percent of its private plans in the top 25 percent of rankings, the magazine reported. Plans not affiliated with a major national brand come next, with 53 percent in the top quarter, followed by Blue Cross-Blue Shield plans, with 41 percent.
Consumer Reports noted that plans that don’t have NCQA accreditation or have a lot of missing, undisclosed, or less thorough data tend to be lower in the rankings.
Starting this fall, all private health insurance plans must use a standard “Summary of Benefits and Coverage,” which allows consumers to compare plans side by side.
“It’s like a nutrition label — boiling all of the salient details down to a summary that is very consumer-friendly,’’ Metcalf said. “The key is allowing consumers to compare plans and giving them information that they can actually digest and make sense of.”