Some health plans excel at helping you get high quality medical care. Some excel at helping you avoid costly care. And some plans do both. For the first time in the four years, we’ve published rankings of health insurance plans we’ve identified Best Value plans—those that give the biggest bang for your health care dollar.
The Best Value designation is based on how well plans help people with diabetes manage their condition. We are focusing on diabetes for several reasons.
First, the disease has reached epidemic proportions, affecting about 26 million Americans and projected to reach a third of U.S. adults by 2050. So even if you don’t have diabetes now, you might want a plan that manages it effectively in case you or someone in your family develops it later.
In addition, managing diabetes requires good, basic care—for things such as high blood pressure, cholesterol, and blood glucose levels—and coordination among providers. That means plans that get diabetes right are likely to do a lot of things well.
Finally, treating diabetes is expensive, especially if basic care is neglected, so plans that provide good diabetes care for less money should have more resources available to cover other conditions or to reduce premiums. And that’s important for everyone. (See our advice on how to prevent and manage diabetes.)
The data for the rankings and the Best Value designation come from the National Committee for Quality Assurance (NCQA), a nonprofit health care quality measurement group. It is financed mainly by fees from health plans for accreditation, by government research contracts, and by sales of other products and services. Overall, we have some information on 997 private and Medicare plans, and full data on quality and cost for diabetes care for 472 of them. (See a list of NCQAs rankings of Medicaid plans.)
The information is part of an effort to better track and control health care spending, and to make the data available to consumers. “Many people assume that the more money that’s spent on health care, the better health care will be,” said John Santa, M.D., medical director of Consumer Reports Health. “But as these rankings show, that is not always the case.”
In fact, our analysis of the data found no connection between cost and quality. Plans that avoided costly care were just as likely to provide high quality care as those that spent more lavishly.
NCQA identified Best Value plans by studying how well they performed on several key diabetes measures and how often and how long diabetic patients were hospitalized. Then NCQA compared similar plans covering the same region.
The quality measures include how well plan members have their glucose, blood pressure, and cholesterol measured and controlled, how well their kidney function is monitored, and whether they get regular screenings for eye disease.
NCQA focused on hospitalization to identify plans that avoid costly diabetes care. Hospitalization is by far the most expensive kind of care. And with a disease such as diabetes, it’s often avoidable.
Plans that do well in managing diabetes tend to do a good job of helping members stay out of the hospital. Keeping you out of the hospital helps keep your medical bills down—and it can help insurance companies control their costs, too. After all, it costs more to hospitalize a diabetic patient for a heart attack than it does to provide the care that can prevent heart attacks in the first place.
Our analysis shows that 114 plans got a Best Value designation, earning check marks for providing high quality care and avoiding costly care. Many more—402 plans—got a check mark for one but not both of those measures. And 481 plans didn’t get a check mark for either. That could be because they had poor results for those measures or they did not report the data needed for this analysis.
Doing poorly on either measure is obviously worrisome, but not sharing results publicly can be just as bad.
“If plans don’t measure and disclose information about quality and resource use, it’s hard for consumers to have all the information they need,” said the NCQA president, Margaret E. O’Kane. “And without that information, it’s also hard for plans to know where they need to improve.”
Not surprising, plans with a Best Value designation also tended to do better in other measures that are included in our rankings. Specifically, Medicare plans with a Best Value check mark did better in consumer satisfaction, and private plans with a Best Value check mark had higher average overall scores.
And use the complete health insurance rankings to get additional information on those plans and on Medicaid plans.
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How big plans fared
We looked at large insurers that offer multiple health plans to see how they compare when it comes to making sure that their members with diabetes get higher quality care and avoid costly care. The table shows the number of plans for each insurer, and the percentage that earned a Best Value check mark. Note that 20 percent of unaffiliated plans also got a Best Value check mark.
Confused by the new health care law?
Our free tool HealthLawHelper.org can cut help you make sense of it. (The tool is in Spanish at AseguraTuSalud.org.) Answer basic questions about your age, household size, income, and where you get insurance now, and it will tell you what you have to do (if anything). It won’t tell you which insurance plan to buy, but for help deciding, turn to our rankings of health plans based on quality and value.
In the health insurance rankings published in the November 2013 issue of Consumer Reports magazine (where this article appeared), Group Health Cooperative in Washington state should have been shown as accredited and should have received an overall score of 88, not 73, making it the second-ranked Medicare plan in the state and the 12th-ranked Medicare plan nationally, not the 214th. The errors were due to inaccurate data from NCQA.
Consumer Reports has no relationship with any advertisers or sponsors on this website. Copyright © 2007-2013 Consumers Union of U.S.
