Understanding the NCQA Health Plan Ratings

2015 Performance and TrendsSeptember 22, 2015

Presenting: Adam Zavadil, Market Strategy and Analysis Director Stephen Cox, Business Improvement Programs Manager Chloe Stier, Business Analyst

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Outline

− NCQA’s 2015 Health Plan Ratings background and methodology

− Rankings to ratings transition implications− 2015 ratings commercial performance and

trends− ACHP resources

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NCQA’s 2015 Health Plan Ratings:

Background and Methodology

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2015 NCQA Health Plan Ratings− NCQA released its 2015 health plan ratings on

September 17.

− Consumer Reports will again carry the ratings. They will appear in the November issue of their print magazine, and be displayed on their website in late September.

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2015 NCQA Health Plan Ratings

− NCQA releases measures and description of methodology

− ACHP models the methodology using data on publicly reporting plans from NCQA’s Quality Compass®

− The NCQA and ACHP model include 46 HEDIS and CAHPS measures for the commercial product line:− 18 clinical treatment measures− 19 access and prevention measures− 9 member satisfaction measures

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Changes for 2015 NCQA Commercial Ratings

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New Measures− Cervical Cancer Screening− Child Immunization Combo 10− Non-Recommended Cervical Cancer

Screening

Removed Measures− ADHD Treatment – Continuation− Alcohol/Drug Treatment – Engagement− Antidepressant Medication Mgmt-

Continuation Phase− Anti-Rheumatic Drug Therapy− Child Immunization Combo 2− Cholesterol Management Screening*− Cholesterol Management LDL <100*

− Diabetes – Blood Pressure Control (<140/80)*

− Diabetes – HbA1c Screening− Diabetes – LDL-C Screening*− Diabetes – LDL-C Controlled <100*− Monitoring of Persistent Medications− Shared Decision Making− Spirometry Use with COPD

*Retired HEDIS measure.

Changes for 2015 NCQA Medicare Ratings

New Measures− Coordination of Care

Removed Measures− Alcohol/Drug Treatment – Engagement− Antidepressant Med Mgmt – Continuation− Anti-Rheumatic Drug Therapy− Cholesterol Management LDL <100*− Cholesterol Management Screening*− Diabetes – Blood Pressure Control (<140/80)*− Diabetes – HbA1c Screening− Diabetes – LDL-C Screening*− Diabetes – LDL-C Controlled <100 mg/dL*

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− Glaucoma Screening− Health Outcomes – Mental (HOS index)− Health Outcomes – Physical (HOS index)− How Well Doctors Communicate− Monitoring of Persistent Medications− Spirometry Use with COPD

*Retired HEDIS measure.

Changes for 2015 NCQA Medicaid Ratings

New Measures− Adherence to Antipsychotic Meds for Schizophrenia− Cervical Cancer Screening− Child Immunization Combo 10− Frequency of Ongoing Prenatal Care− Non-Recommended Cervical Cancer Screening

Removed Measures− ADHD Medication – Continuation− Alcohol/Drug Treatment – Engagement− Antidepressant Med Mgmt – Continuation− Anti-Rheumatic Drug Therapy− Child Immunization Combo 2− Cholesterol Management LDL <100*− Cholesterol Management Screening*− Diabetes – Blood Pressure Control (<140/80)*

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− Diabetes – HbA1c Screening− Diabetes – LDL-C Screening*− Diabetes – LDL-C Controlled <100 mg/dL*− How Well Doctors Communicate− Lead Screening in Children− Monitoring of Persistent Medications− Shared Decision Making− Spirometry Use with COPD

*Retired HEDIS measure.

2015 HEDIS Measure Revisions

− Controlling High Blood Pressure− Osteoporosis Management− Plan All-Cause Readmissions

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Scores for these measures cannot be trended due to significant measure specification changes.

Changes to the Methodology

− Between 2014 and 2015 NCQA transitioned from a rankings to a ratings methodology.

− Plans are rated from 1 to 5 in half-point increments based on the weighted averages of individual measures and accreditation site visit scores.

− Individual measures are rated in whole numbers 1-5 based on national percentile thresholds (10th/33rd/66th/90th).

− Individual measures have a weight of 1x, 1.5x, or 3x depending on their class (process, experience, or outcome).

− Accreditation can add up to 0.5 points.

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Calculating the Overall Rating

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MeasuresPlan’s Score

National Percentile Threshold(10th / 33rd / 66th / 90th)

RatingMeasure Weight

Measure Impact

Access to Care 7Yrs to 11Yrs 92.56 85.49 / 90.08 / 93.7 / 97.16 3 1 3

Care Coordination 88.02 76.79 / 80.13 / 83.57 / 87.25 5 1.5 7.5

Diabetic HbA1C Control (< 8.0) 63.55 43.8 / 53.54 / 61.52 / 67.54 4 3 12

Management of COPD Bronchodilator

68.36 70.15 / 76.6 / 81.82 / 87.5 1 1 1

Total 3.62 6.5 23.5

Measure Impact = Measure Rating * Measure Weight

Overall Rating = Sum of Impact / Sum of Weight

Example:

How Does Accreditation Factor In?

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Plan X reports all 46 commercial measures. Overall Rating (pre-accred) = 4.216 Accreditation Score = 49/50

Accreditation Points = (total accred. score / possible score) * 5 * 10% of total measure weight

(49/50) * 5 * (0.10 * 62.5) = 0.98 * 5 * 6.25 = 30.625

Overall Rating Including Accreditation = (sum of measure impact + accreditation points) / sum of measure weight

(263.5 + 30.625) / 62.5 = 294.125 / 62.5 = 4.706

Plan X receives an overall rating of 4.5

Sum of Measure Impact = 263.5 Sum of Measure Weight = 62.5

Multiple Reporting Products− NCQA allows plans that are accredited multiple times

on the same set of quality metrics to be rated separately.

− This leads to larger differences between ACHP’s ranking/percentile predictions and the final magazine values.− 11 commercial plans received a rating of 5. However

three had multiple listings meaning that only eight are unique plans.

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Rankings to Ratings Transition Implications

Drivers of Change in New Methodology

− Measure Weighting− Measure Inclusion

− New Measures− Removed measures− Removal of “nested” measures

− CAHPS survey changes

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Measure Weighting

− Under the rankings methodology, a plan’s overall score was determined 85% by HEDIS and CAHPS measures and 15% by accreditation.

− CAHPS measures had a relative weight of 0.417x whereas all HEDIS measures had a weight of 1x.

− Now, with experience measures weighted 1.5x, CAHPS has significantly more influence on a plan’s overall rating.

− Accreditation now accounts for just over 9% of the plan’s overall rating.

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Measure Weighting (Cont.)

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Measure TypeMeasure Source

Weight CategoryNumber of Measures

Total Weight

Weighted % of Total

Clinical Treatment

HEDIS Process (1x) 15 15

34.9% Outcomes (3x) 3 9

Access & Prevention

HEDIS Process (1x) 16 16

36.4% Outcomes (3x) 3 9

Satisfaction CAHPS Experience (1.5x) 9 13.5 19.6%

Accreditation 6.25 9.1%

20152014

2015 NCQA Commercial Measures

New Measures - Cervical Cancer Screening2015 Commercial All Plan Distributions

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ACHP Avg = 97.23

ACHP Avg = 79.6

Cervical Cancer Screening

Non-Recommended Cervical Cancer Screening

ACHP plans on average fall in the 68th percentile.

ACHP plans on average fall in the 71st percentile.

New Measures - Child Immunization Measure Swap2015 Commercial All Plan Distributions

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Combo 2 Combo 10

Measure% of Commercial ACHP Plans at Each Rating Level

Median ACHP PercentileNR 1 2 3 4 5

Combo 2 3% - 9% 14% 34% 40% 86.1

Combo 10 3% - 3% 17% 46% 31% 83.2

− Outcomes measure with a weight of 3x− Not a large difference in median ACHP percentile, but fewer ACHP

plans at the top and bottom of the distribution with Combo 10

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45 54

63

61

7581

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Removed Measures

Several measures were removed from the commercial methodology.

− ACHP plans generally have higher performance on the Monitoring of Persistent Medications measure.

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Measure

% of Commercial Plans at Each Rating Level*Median

ACHP PercentileND 1 2 3 4 5

Anti-Rheumatic Drug Therapy 6% - 9% 37% 29% 20% 66.15

Monitoring of Persistent Medications - 9% 9% 17% 35% 31% 81.36

Shared Decision Making 6% 9% 9% 43% 26% 9% 58.47

Spirometry Use with COPD 6% 6% 11% 31% 17% 29% 65.06*Percentiles for these measures are calculated by ACHP based on publicly reporting plans. **Does not include measures that were retired from HEDIS.

Removal of “Nested” Measures

Several measures were removed from the methodology in order to avoid overemphasis of certain areas in the ratings (e.g., Mental Health, Diabetes).

− Removal of Mental/Behavioral Health 2nd gate measures helped most ACHP members− Removal of Diabetes hurt most ACHP members

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Measure

% of Commercial ACHP Plans at Each Rating Level* Median

ACHP PercentileND 1 2 3 4 5

ADHD Tmt – Continuation 34% 9% 11% 9% 20% 17% 73.9

Alcohol/Drug Tmt – Engagement 3% 20% 20% 31% 20% 6% 39.1

Antidepressant Med Mgmt – Continuation - - 20% 34% 29% 17% 62.3

Diabetes – HbA1c Screening - - 3% 23% 29% 46% 88.0* Percentiles for these measures are calculated by ACHP based on publicly reporting plans.

CAHPS Supplemental Question Policy Change

− Plans may only include up to 12 supplemental questions per CAHPS survey:

− Must be placed at the end of the survey− Must be approved annually by NCQA− Must be specific, clear, and neutral− Cannot refer to or reference another CAHPS item− Cannot put an undue burden on the respondent− Each part of a multi-part question counts toward

12 question limit

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2014-15 Commercial CAHPS Measure NCQA Ratings Cut-Point Changes

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CAHPS Measure2014-15 National Percentile Change

10th 33rd 66th 90th

Rating of Health Care -0.5 -0.4 -1.0 -2.4

Rating of Health Plan -0.7 -0.9 -2.7 -6.3

Rating of PCP 0.9 0.1 -1.0 -3.4

Rating of Specialist 0.1 -0.1 -1.3 -4.7

Claims Processing -0.5 -0.4 0.0 -0.8

Health Promotion & Educ. 0.1 -0.7 -0.6 0.1

Getting Care Quickly -2.5 -1.1 -0.8 -0.5

Getting Needed Care -1.3 0.1 0.1 -0.1

Care Coordination 3.0 1.0 0.7 1.0

– Care Coordination was the only measure for which the national distribution shifted higher.

– The Ratings questions appear to be the most affected by this change, particularly at the higher performance levels.

2014-15 CAHPS Commercial Ratings Questions All Plan Distribution Change

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Rating of Health Care Rating of Health Plan

Rating of PCP Rating of Specialist

2015 Ratings Performance and Trends

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2015 Commercial Distribution of All Plans on Unrounded, Pre-Accreditation Overall Ratings

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Even after the 0.5 additional points accreditation can add, only a small handful of plans will achieve an overall rating of 5.

Distribution of ACHP Member Organizations’ Unrounded NCQA Rating 2011 - 2015

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2011 2012 2013 2014 20151.5

2

2.5

3

3.5

4

4.5

The box shows the 25th to 75th percentile range; the middle line is the median ACHP rating. Previous years’ methodologies have been updated to approximate a rate for 2011-2014.

2015 NCQA Commercial Ratings Summary

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NCQA Rating ACHPNon-ACHP

Total Contracts

ACHP Percent of Total

Rating Level Percent of Total

5 8 3 11 72.7% 2.2%4.5 22 24 46 47.8% 9.4%4 3 70 73 4.1% 14.9%

3.5 5 133 138 3.5% 28.1%3 2 126 128 1.6% 26.1%

Below 3 2 93 95 3.2% 19.3%

5 Rating 4.5 Rating 4 Rating 3.5 Rating 3 Rating Less than 3 Rating

0

20

40

60

80

100

120

140

160

Non-ACHP ACHP

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2015 Commercial Performance by Measure Domain

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Measure DomainOverall Average Rating Product Average Rating

ACHP Non-ACHP HMO PPO

Clinical Treatment 3.8 2.8 3.2 2.8

Prevention & Access 3.9 2.9 3.3 2.7

Satisfaction 3.3 3.0 3.2 2.9

– ACHP plans rate higher on all domains but have a particular advantage on HEDIS measures; CAHPS performance is closer to non-ACHP plans.

– HMO plans rate higher than PPOs on all domains but the gap has narrowed since 2014.– Performance is closest on satisfaction measures and furthest

apart on prevention/access measures.

Commercial Clinical Treatment Scores by NCQA Rating Band Across ACHP Plans Over Time

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Commercial Prevention and Access Scores by NCQA Rating Band Across ACHP Plans Over Time

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Commercial Satisfaction Scores by NCQA Rating Band Across ACHP Plans Over Time

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2015 Commercial Performance by Measure Category

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Measure CategoryOverall Average Rating Product Average Rating

ACHP Non-ACHP HMO PPO

Process 3.8 2.9 3.2 2.7

Experience 3.3 3.0 3.2 2.8

Outcomes 4.0 2.7 3.2 2.4

– ACHP plans rate higher on all categories but have a particular advantage on Outcomes measures.– There are 6 Outcomes measures that comprise about 26% of

the ratings. – Process measures also help to differentiate ACHP plans, which

comprise about 45% of the ratings. – HMO plans have a slight advantage over PPOs among all categories.

ACHP Performance on Individual Measures

− ACHP members continue to achieve top scores on measures included in the NCQA methodology.

− Of the 46 measures included in the 2015 NCQA commercial ratings, an ACHP member is the #1 plan on 30 of those measures (65%).

− This is up from 53% in 2014 and 44% in 2013.

− ACHP members hold the top two spots on 23 measures (50%) in 2015.

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Top ACHP Performers – Best in Nation

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ACHP Member Measure2015 Commercial

Score

Tufts (PPO) Access to Care 7Yrs to 11Yrs 99.2

Kaiser - Mid-Atlantic Acute Bronchitis in Adults 74.4

Capital Health Plan ADHD Followup Initiation 70.0

Kaiser - Georgia Adult BMI Assessment 99.0

Martin's Point (ME) Asthma Medication Compliance 75% (Total) 72.3

Kaiser - Mid-Atlantic Breast Cancer Screening Total 89.6

Kaiser - Mid-Atlantic Cervical Cancer Screening 94.2

UPMC Health Plan Child Immunization Combo 10 77.3

Kaiser - Georgia Children Counseling for Nutrition (Total) 98.3

Kaiser - Georgia Children Counseling for Physical Activity (Total) 98.3

Kaiser - Northern California Children Screened for BMI Percentile (Total) 99.2

Kaiser - Georgia Chlamydia Screening Overall 80.0

Martin's Point (ME) Claims Processing Satisfaction 98.7

Kaiser - Mid-Atlantic Controlling High Blood Pressure Total 90.8

Kaiser - Mid-Atlantic Diabetic Nephropathy Medical Attention 97.8

Top ACHP Performers – Best in Nation (cont.)

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ACHP Member Measure2015 Commercial

Score

Martin's Point (MA, NH, NY, PA, VT) Getting Care Quickly 95.8

Martin's Point (ME) Getting Needed Care 96.2

Tufts (PPO) Health Promotion and Education Composite 85.7

Kaiser - Hawaii HPV Vaccine for Female Adolescents 34.5

Kaiser - Northwest Mgmt of COPD Bronchodilator 94.0

Security Health Plan of Wisconsin Mgmt of COPD Systemic Corticosteroids 87.9

Tufts (HMO) Mental Illness Hospital 7 Day Follow-up 90.9

Kaiser - Colorado Pers. of Beta Blocker Tmt after Heart Attack 97.8

Kaiser - Mid-Atlantic Pharyngitis Treatment for Children 97.8

Tufts (PPO) Postpartum Care 94.0

Tufts (PPO) Prenatal Care Visit Timeliness 100.0

Martin's Point (ME) Rating of Health Care (9 or 10) 74.1

Martin's Point (ME) Rating of Health Plan (9 or 10) 86.1

Martin's Point (ME) Rating of Specialist (9 or 10) 79.7

Kaiser - Mid-Atlantic Upper Respiratory Treatment for Children 100.0

2015 Top Rated Commercial Measures for ACHP

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Commercial Measure ACHP Average RatingNon-ACHP Average

Rating

Adult BMI Assessment 4.49 2.74

Children Screened for BMI Percentile (Total) 4.37 2.74

Diabetic Nephropathy Medical Attention 4.26 2.86

Diabetic Eye Exams 4.23 2.81

HPV Vaccine for Female Adolescents 4.21 2.83

Children Counseling for Nutrition (Total) 4.20 2.75

Colorectal Cancer Screening 4.20 2.87

Acute Bronchitis in Adults 4.18 2.91

Mental Illness Hospitalization 7 Day Follow-up 4.16 2.90

Children Counseling for Physical Activity (Total) 4.14 2.74

– ACHP plans excel at screening and clinical process measures.– Most top ratings are received on process measures with a weight of 1x.

Average performance on the Controlling High Blood Pressure measure declined, dropping it from the top 10 list this year.

2015 Lowest Rated Commercial Measures for ACHP

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Commercial Measure ACHP Average RatingNon-ACHP Average

Rating

Asthma Medication Compliance 75% (Total) 2.74 3.02

Alcohol and Drug Treatment Initiation 2.85 2.96

Getting Needed Care 2.94 3.02

Health Promotion and Education Composite 3.09 2.96

Asthma Medication Ratio (Total) 3.09 2.96

Getting Care Quickly 3.17 3.01

Claims Processing Satisfaction 3.29 2.98

Rating of Specialist (9 or 10) 3.31 2.99

Rating of PCP (9 or 10) 3.37 2.97

Care Coordination 3.37 2.97

– Other plans outperform ACHP on just 3 measures.– Asthma and CAHPS measures lag the most in the ratings.– The provider rating measures are new to the list this year.

Top ACHP Commercial Improvers 2014-2015

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Several ACHP members were also able to make significant improvements in their performance. Below are ACHP members that saw the greatest average improvement across individual measures.

PlanAvg Measure

Percentile ChangeAvg Measure

Ranking Move

Geisinger PPO 6.2 -22.9

CDPHP HMO 6.1 -19.6

UPMC PPO 5.0 -19.4

Kaiser - Mid-Atlantic 6.6 -18.6

Dean 5.3 -17.2

SelectHealth 5.6 -15.8

UPMC HMO 3.2 -12.3

Martin's Point (MA, NH, NY, PA, VT) 3.9 -10.5

Kaiser - N. California 2.5 -8.5

HealthPartners 2.5 -7.6

Capital 1.9 -5.7

2014-15 Commercial Measures with the Largest Performance Changes

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Measure Name2014-15 NationalAvg Score Change

2014-15 ACHP Avg Score Change

Children Screened for BMI Percentile (Total) 5.7 1.5

Children Counseling for Physical Activity (Total) 3.9 0.7

Children Counseling for Nutrition (Total) 3.8 0.9

Adult BMI Assessment 3.7 2.8

Adolescent Immunization 3.4 2.0

Prenatal Care Visit Timeliness -3.9 -2.9

Postpartum Care -3.8 -1.8

Alcohol and Drug Treatment Initiation -3.8 -0.4

Asthma Medication Compliance 75% (Total) -2.8 -0.5

— Scores on prevention measures continue to improve for plans nationally.— ACHP plans improved by more than three points on the following three

measures: HPV Vaccine, Acute Bronchitis, and Child Immunization.— ACHP plans declined significantly more than other plans on the four

CAHPS Rating measures (between -2.6 and -6.1 points on average).

2014-15 Commercial Measure Performance Trends Across All ACHP Plans

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Change in Performance 2014-15

Performance Improving Performance Decreasing

Relative Performance Improving

45.8% of measures 8.0% of measures

Relative Performance Decreasing

7.1% of measures 39.1% measures

- The largest segment of measures had absolute and relative performance improvements.

- More measures this year than last saw absolute performance declines (47.1% vs. 43.1%).

- More measures this year than last saw relative performance improvements (53.8% vs. 51.4%).

ACHP Commercial Increasing Performance Areas

− There have been both absolute and relative improvements in respiratory health and prevention measures.

− The national distribution on the ADHD measure has stabilized somewhat after a large shift to the right last year.

− From 2013-14 ACHP plans improved scores by 0.6 points but still fell behind more than 7% of plans.

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Commercial MeasureScore Change

Since 2014Percentile Change

Since 2014

ADHD Follow-up Initiation 1.7 10.7

Management of COPD Bronchodilator 1.2 8.1

Management of COPD Systemic Corticosteroids 1.6 7.2

Child Immunization Combo 10 3.8 5.5

Adult BMI Assessment 3.5 4.0

Access to Care 7Yrs to 11Yrs 0.2 3.0

Acute Bronchitis in Adults 3.2 2.9

HPV Vaccine for Female Adolescents 3.8 2.2

Persistence of Beta Blocker Tmt. after Heart Attack 0.5 2.0

2014-15 All Commercial Plan Distribution Change ADHD Follow-up: Initiation

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ACHP was able to pass nearly 11 percent of plans this year as all-plan performance declined slightly (fewer plans at the top, more plans near the bottom).

ACHP Commercial Decreasing Performance Areas

− CAHPS measures saw large absolute and relative declines between 2014 and 2015, potentially as a result of the new policy for supplemental questions.

− Last year, all CAHPS “Rating of …” measures saw absolute improvement but relative decline. This year the decline was both absolute and relative.

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Commercial MeasureScore Change

Since 2014Percentile Change

Since 2014

Rating of PCP (9 or 10) -3.2 -9.4

Flu Shot Immunization -1.6 -6.3

Rating of Specialist (9 or 10) -4.3 -6.2

Rating of Health Care (9 or 10) -2.6 -5.1

Well Child Visits (6 in First 15 months) -2.3 -4.9

Diabetic HbA1C Control (< 8.0) -1.1 -4.6

Rating of Health Plan (9 or 10) -6.1 -4.5

2014-15 All Commercial Plan Distribution Change Rating of PCP (9 or 10)

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About 9 percent of plans passed ACHP this year. The national distribution on this measure narrowed, with performance among the highest scoring plans dropping.

Getting Better but Falling BehindACHP Commercial

− Score increases have not been enough to keep up with improvements among other plans for the care coordination measure and a few pediatric prevention and access measures.

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Commercial MeasureScore Change

Since 2014Percentile Change

Since 2014

Care Coordination 0.5 -3.9

Pharyngitis Treatment for Children 0.0 -3.6

Well Child Visits Between 3 and 6 0.4 -2.3

Upper Respiratory Treatment for Children 1.0 -1.3

Getting Worse but Passing Other PlansACHP Commercial

− Nationally, performance has dropped significantly on the measures above, particularly the Asthma Medication Ratio and Alcohol/Drug Tmt Initiation.

− While ACHP’s performance has also dropped, the decline is modest in relation to others and their relative standing has increased.

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Commercial MeasureScore Change

Since 2014Percentile Change

Since 2014

Asthma Medication Ratio (Total) -0.5 10.0

Alcohol and Drug Treatment Initiation -0.4 9.7

Asthma Medication Compliance 75% (Total) -0.5 3.1

Postpartum Care -1.8 1.9

Questions?

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ACHP Resources

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ACHP Resources

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− HealthPlan Performance Gauge® − NCQA rankings performance

− Benchmarking packets− Gap Analysis & Number Needed to Treat (NNT) tool

− Star Ratings − Gap Analysis & NNT tool− General: ACHP member performance benchmarking; Measure

distribution charts; Cut-point analysis

− Measure national percentiles & distributions− Utilization benchmarking packets− Custom analyses & presentations− Quality Management Systems Inventory

Scheduling a Customized Presentation

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− ACHP is now scheduling customized presentations for member organizations.− NCQA Ratings− CMS Star Ratings− Clinical or Satisfaction Performance Assessment− Utilization Performance Assessment

− If you are interested in getting more information about these presentations or scheduling one, please contact Stephen Cox: scox@achp.org

ACHP Calendar

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− October/November: HPPG® updated with Medicaid and Medicare data

− Early November: Understanding the 2016 CMS Star Ratings webinar

− Late 2015 & into 2016: QM Discussion Forums, Star Ratings Work Group meetings

Contact Us

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Adam Zavadil, Market Strategy and Analysis Directorazavadil@achp.org

Stephen Cox, Manager, Business Improvement Programsscox@achp.org

Chloe Stier, Business Analystcstier@achp.org

All can be reached by calling ACHP main phone line (202) 785-2247

Phone: 202-785-2247

Fax: 202-785-4060

www.ACHP.ORG

1825 Eye Street, NW,Suite 401,Washington, DC 20006

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Appendix

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ACHP’s HealthPlan Performance Gauge

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What is ACHP’s HealthPlan Performance Gauge ®?

− An interactive Microsoft Access database − The ACHP HPPG® uses HEDIS, CAHPS, and

CMS data to look at:− Individual and consolidated measures− Single year, multi-year, and improvement metrics− Ratings, rankings, scores, and percentiles− National, regional, state, and custom comparisons

ACHP-NCQA License Agreement

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− ACHP renewed its license agreement with NCQA.− As part of the license agreement, ACHP plans

must purchase the Quality Compass® with the Data Exporter in order to get the interactive database version of the HPPG®.− Plan must also have access to all years of data

included in the HPPG® (2011 – 2015)

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

Benchmarking Packet Highlights− Plan-specific Dashboard− NCQA Rating Impact and Change− NCQA Rating All-Plan Distribution− Performance Gap Charts− Measure Area Breakdown Trend Charts

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Dashboard Ratings Report

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Ratings Breakdown Chart by Measure

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Ratings Score Change by Measure

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Percentile Range Breakdown Trends by Measure Area

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Performance Gap Charts

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Measures with the Largest Difference between Commercial HMO and PPO Plans

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Measure Name2015 HMO

Mean2015 PPO

MeanDifference

Adult BMI Assessment 77.0 49.5 27.6

Children Screened for BMI Percentile (Total) 62.8 40.2 22.6

Children Counseling for Nutrition (Total) 60.8 40.6 20.2

Children Counseling for Physical Activity (Total) 57.5 38.2 19.2

Adolescent Immunization 71.2 62.1 9.1

Postpartum Care 77.6 69.1 8.5

Asthma Medication Compliance 75% (Total) 44.7 46.1 -1.5

Alcohol and Drug Treatment Initiation 34.8 36.2 -1.4

Getting Needed Care 87.5 88.4 -0.9

Getting Care Quickly 85.6 86.3 -0.7

Antidepressant Medication Acute Phase Treatment 66.1 66.1 -0.1

—HMOs score much higher on many prevention and access while PPOs score slightly higher on mental health measures and the asthma compliance measure.