NCQA Rankings: Performance Trends and Updates

ACHP Medical Directors Meeting

Presenting: Adam Zavadil, Market Strategy and Analysis DirectorSeptember 21, 2011

Outline

• NCQA’s 2011 Health Plan Rankings methodology

• Anticipated rankings, performance and trends

• ACHP resources

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NCQA’s 2011 Health Plan Rankings:

Background and Methodology

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2011 NCQA Rankings• NCQA released its 2011 health plan rankings

on September 20, 2011.• Consumer Reports will again carry the

rankings this year. They will appear in the November issue of their print magazine, and be displayed on their website on October 4th. – ACHP hosted a WebEx with NCQA and

Consumers’ Union last week. • Ranking methodology remains similar with

some changes in measure and plan inclusion.

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2011 NCQA Rankings (cont.)• PPO plans are included in the rankings this year.

However, they tend to perform lower than HMO/PPO plans.– Displayed in several ways, including lists of only HMOs

and only PPOs. Displays will show only the results from the combined rankings. For example, if the top-ranked PPO is ranked second in the combined rankings, the only number that will appear next to that plan’s name in any display is 2.

• 386 plans publicly reported data in 2011. 170 were PPOs.• More information available at:

www.ncqa.org/tabid/1329/Default.aspx

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2011 NCQA Health Plan Rankings

• NCQA released measures and description of method• ACHP models the methodology using publicly

available data from NCQA’s Quality Compass® tool• The NCQA and ACHP model include 55 measures for

the commercial product line:– 29 clinical treatment measures– 17 access and prevention measures– 9 member satisfaction measures

• Measures weighted a quarter, third, half or full point

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NCQA Ranking Methodology in Brief• Roughly: The average scores of all plans is converted to

0 for every measure– Better than average is positive; lower than average is negative

• Multiply each positive or negative score by its assigned measure weight

• Apply additional weighting of Effectiveness of Care versus Service scores

• Add converted, weighted scores across measures.• Factor in NCQA Accreditation (data not publicly

available)• Change to 100 point scale for the magazine publication

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Changes for 2011 NCQA Commercial Rankings

• Added Measures– Immunization for adolescents (Prevention)– Weight assessment and counseling for nutrition and

physical activity• Adolescent BMI percentile (Prevention)• Counseling on nutrition (Prevention)• Counseling on physical activity (Prevention)

– Flu shots for adults ages 50 to 64 (Prevention)– Adult BMI (Prevention)– Use of Imaging Studies for Low Back Pain (Treatment)

• Removed Measures– Blood pressure control (<130/80) (Treatment)

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How Does Each Domain Effect Overall Quality?Commercial 2010 to 2011

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Domain2010

Measures

Points

% of Total2010

2011 Measur

es

Points

% of Total2011

Clinical Treatment 29 17 47% 29 17 42%

Prevention & Access

11 10 28% 17 14 34%

Satisfaction 9 9 10% 9 9 9%

Total 49 36 85% 55 40 85%

2010 2011

2011 Anticipated Rankings, Performance and Trends

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2011 NCQA Ranking Estimates ACHP Member Organizations in the Top 50

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Plan Name

ACHPEstimated Rank

(without Accrd.)

Preliminary NCQA Rank

ACHP Summed Z- Score

Tufts HMO 2 2 48.8Kaiser – Colorado 3 6 44.8Capital Health Plan 4 3 43.6

Group Health Coop. of South Central Wisconsin 5 7 43.5Tufts (PPO) 6 4 40.5Geisinger Health Plan 7 8 40.1Fallon Community Health Plan 9 13 37.4

Kaiser – Southern California 10 12 37.3Kaiser – Northern California 12 14 36.9Kaiser – Northwest 16 21 33.0

Geisinger Health Plan (PPO) 19 17 30.6Martin’s Point 21 Not Accred. 29.8HealthPartners 22 24 29.6Capital District Physicians’ Health Plan 24 22 29.2

UPMC Health Plan 25 18 29.1Independent Health 28 28 27.1Kaiser – Mid-Atlantic States 30 33 26.9Kaiser - Hawaii 32 37 25.9

Priority Health 34 41 23.9Security Health Plan 36 38 23.4

Distribution of ACHP Member Organizations Overall NCQA Rank 2007-2011 (ACHP Modeling)

122007 2008 2009 2010 2011

The line represents the 50th Percentile and the box shows the 25th to 75th percentile range

Performance Trends 2010 - 2011• HMO/POS performance improved slightly across

measure domains:– Clinical Treatment: +0.8 points per measure– Access and Prevention: +1.3 points per measure– Satisfaction: +0.9 points per measure

• PPO plans showed the stronger improvement trends:– Clinical Treatment: +2.0 points per measure– Access and Prevention: +3.8 points per measure– Satisfaction: +0.6 points per measure

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Score Change by Domain Across ACHP

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2010 – 2011Average ACHP

Percentage-PointChange*

2010 – 2011Percentile Rank

Change*

Clinical Treatment Measures +1.0 +3.0

Access & Prevention Measures +2.7 +4.7

Service Measures +2.2 +4.0

*Includes existing, trend able Measures

• ACHP plans improved on an absolute and relative basis compared to other health plans last year.

• Prevention and access gains were the most pronounced among ACHP members.

NCQA Rankings - Impact

• What measures hurt ACHP member organizations in the 2011 rankings?

• What measures help ACHP member organizations?

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Commercial Clinical Treatment Scores by Percentile Range Across ACHP Over Time

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Commercial Prevention and Access Scores by Percentile Range Across ACHP Over Time

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Commercial Satisfaction Scores by Percentile Range Across ACHP Over Time

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Measures that Hurt ACHP in the 2011 Rankings

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MeasureAverage Weighted

Z-Score 2011Average Weighted

Z-Score 2010

Doctor Communication -0.27 0.06

Getting Needed Care -0.21 -0.10

Getting Care Quickly -0.18 -0.01

Claims Processing Satisfaction -0.08 0.13

Asthma Appropriate Medication Use (5 to 11) -0.07 0.08

Alcohol and Drug Treatment Initiation -0.04 -0.10Asthma Appropriate Medication Use (12 to 50) 0.00 0.11

• CAHPS® performance improved this year, but it still represents the area of lowest performance for ACHP member plans as a whole.

Measures that Help ACHP in the 2011 Rankings

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MeasureAverage Weighted

Z-Score 2011Average Weighted

Z-Score 2010

Children Screened for BMI Percentile (Total) 1.46 0.83

Adult BMI Assessment 1.36 0.78Children Counseling for Physical Activity (Total) 1.27 0.57

Children Counseling for Nutrition (Total) 1.20 0.48

Cervical Cancer Screening 1.15 0.80

Breast Cancer Screening Total 1.15 1.05

Adolescent Immunization Combo 1 1.08 NA 

• ACHP plans performed particularly well on the new obesity-related measures.

• Screening performance is also a differentiator

ACHP Plans Continue to be Top Performers

• For every measure except one (Claims Processing), an ACHP member organization scores best in the country or above the 95th percentile.– Of the 55 measures included in the

NCQA rankings, an ACHP member is the top plan on 28 of those measures (over 50 percent.)

– This is up from 20 measures in 2010.

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Top ACHP Performers – Best in Nation

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ACHP Member Measure2011 Score

Kaiser - Northern California Antidepressant Medication Acute Phase Treatment 86.9

Kaiser - ColoradoAntidepressant Medication Continuation Phase Treatment 75.2

Kaiser - Southern California Diabetic Nephropathy Medical Attention 95.9

Martin's Point Doctor Communication 97.6

Geisinger Health Plan (PPO) Mental Illness Hospitalization 7 Day Follow-up 93.3

Martin's Point Getting Care Quickly 94.9

Martin's Point Getting Needed Care 94.8

Capital Health Plan Breast Cancer Screening Total 84.7

Kaiser - Colorado Diabetic Cholesterol LDL < 100 73.9

Fallon Community Health Plan Alcohol and Drug Treatment Engagement 46.5

Kaiser - Georgia Chlamydia Screening Overall 78.7

GHCSCW Cervical Cancer Screening 89.5

Geisinger Health Plan (PPO) Upper Respiratory Treatment for Children 98.5

Kaiser - Mid-Atlantic States Pharyngitis Treatment for Children 96.1

Top ACHP Performers – Best in Nation (cont.)

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ACHP Member Measure 2011 Score

Capital Health Plan Colorectal Cancer Screening 87.4

Geisinger Health Plan Persistence of Beta-Blocker Treatment 96.4

Tufts Associated HMO Access to Care 7Yrs to 11Yrs 99.0

Martin's Point ADHD Follow-up Initiation 60.9

Martin's Point Monitoring of Long-Term Meds Combined Rate 88.8

Capital Health Plan Use of Spirometry to Diagnose COPD 68.1

Martin's Point Rating of Health Care (9 or 10) 75.2

Martin's Point Rating of Health Plan (9 or 10) 84.6

Martin's Point Asthma Appropriate Medication Use (5 to 11) 100.0

UPMC Health Plan Adolescent Immunization Combo 1 88.8

Kaiser - Northwest Children Counseling for Physical Activity (Total) 96.5

Kaiser - Northwest Children Counseling for Nutrition (Total) 96.5

Kaiser - Southern California Children Screened for BMI Percentile (Total) 97.3

GHCSCW Appropriate Use of Low Back Imaging 89.4

ACHP Plans are Top Improvers Too• Often the best way to learn how to improve

performance is to ask those who have recently improved.

• Among ACHP member organizations there are recent substantial improvers in many measures.– On 37 of the trend able HEDIS® measures there is at

least one ACHP member organization that has improved at least 5 points within the last year.

– On every CAHPS® measure there is at least one ACHP member organization that has improved their national rank by at least 100 places within the last two years.

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From 2010-11 Top Plans Tended to Improve Faster than Lower Ranked Plans

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2011 Rankings, Performance and Trend Summary

• Ranking changes with respect to new measures and PPOs had a mixed effect on ACHP plans.– Many of the top ranked PPOs were run by ACHP

member plans– ACHP plans tended to have disproportionately

high performance in obesity-related measures• Overall ACHP plans have improved in absolute

performance, relative performance and national rankings from 2010-2011.

• This year staying at the top was harder because top plans are improving faster than other plans.

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ACHP Resources

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Resources

• 2011 HealthPlan Performance Gauge®

• ACHP Web site• Individual plan chart packs• Number Needed to Treat analysis• Custom performance improvement

presentations

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ACHP’s HealthPlan Performance Gauge®

• What is ACHP’s HealthPlan Performance Gauge®?– An interactive Microsoft Access database– At least Access 2003

• The ACHP HealthPlan Performance Gauge® – Uses Quality Compass® and CMS HEDIS® and

CAHPS® data– Individual and consolidated measures– Single year, multi-year and improvement metrics– Rankings, scores and percentiles– National, regional, state and custom comparison

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NCQA License Agreement

• ACHP renewed its license agreement with NCQA this year.

• It was determined as part of the license agreement, that ACHP plans must purchase the Data Exporter, in addition to Quality Compass®, in order to get the interactive database version of the HPPG™.

• Plans that just purchase Quality Compass® can get reports, analyses and presentations from ACHP and a first come, first serve basis.

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Obtaining the HPPGTM

• Because we will be creating different versions of the HealthPlan Performance Gauge® this year, we have sent the files to individuals based on your organization’s NCQA purchasing status.

• To get the HPPG™ send an e-mail to Stephen Cox at scox@achp.org. Please indicate in what version of Access you would like the files (2002, 2007 or 2010).

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ACHP Website – www.achp.org

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Password

“community2011”

Customized Packet Highlights• Plan-specific Dashboard• NCQA Ranking Impact and Change• NCQA Ranking Performance Distribution• Performance Gap Charts• Measure Area Breakdown Trend Charts

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Dashboard

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Measure Breakdown Chart - 2011

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Measure Score Change Chart 2010 - 2011

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Performance Gap Charts

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Measure Area Breakdown Trend

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Upcoming ACHP Events & Analyses

• October 5: Understanding Rankings• Early October: HPPGTM updated with

Medicaid and Medicare data• Late 2011 – 2012: Star rating

improvement best practices

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Contact UsAdam Zavadil

Director, Market Strategy and AnalysisAlliance of Community Health Plansazavadil@achp.org202.785.2247

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Phone: 202-785-2247

Fax: 202-785-4060

www.ACHP.ORG

1825 Eye Street, NW,

Suite 401,Washington, DC

20006