Consumer Reports Health publishes rankings of 227 HMOs, POS plans

Consumer ReportsOct 5 2010

With open enrollment season now underway, consumers with employer-based health insurance can take advantage of the once-a-year opportunity to switch plans.  To help consumers compare health insurance plans, Consumer Reports Health is today publishing rankings of 227 HMOs and Point of Service (POS) plans.  The Rankings are produced by the non-profit National Committee for Quality Assurance (NCQA), the main U.S. group that sets measurement standards for health insurance, accredits plans, measures the quality of care they achieve, and publicly reports the findings.  

The rankings are based mainly on 49 measures that take into account specific treatments and preventive care services as well as consumer satisfaction.  The measures include treatment for high blood pressure and high cholesterol, colon-cancer screening, diabetes care, mental-health care, and immunizations.  

"When most of us think about health insurance we tend to focus on cost.  But it's just as important for consumers to take stock of the quality of care and service that a health plan delivers.  The plan you pick can make a big difference in the care you get," said Steven Findlay, M.P.H., senior health policy analyst, Consumers Union.

The rankings represent the newest addition to a growing suite of tools available online at www.ConsumerReportsHealth.org for navigating the complex world of health insurance.  Rankings of the 227 plans are available in the November issue of Consumers Reports and online at ConsumerReportsHealth.org.  The magazine is publishing two editions -- one for readers in the East, Midwest, and South, and one for the rest of the nation.  Subscribers to ConsumerReportsHealth.org can access more detailed information on plans and their performance, with the ability to compare up to five at a time.  Consumer Reports Health will publish NCQA's rankings of Medicare Advantage plans and HMOs serving the Medicaid market on its web site in November.    

"Choosing a health insurance plan is one of the most important decisions a consumer makes each year," said NCQA President Margaret E. O'Kane. "These rankings empower consumers with the information they need to choose wisely -- based on which plans have demonstrated the highest levels of care and service."

This year, NCQA has identified top-rated HMO and POS plans nationwide, but with many concentrated in the Northeast and on the West coast -- led by #1 ranked Harvard Pilgrim Health Care in Maine and Massachusetts, followed by Tufts Associated Health Maintenance Organization (#2) in Massachusetts, New Hampshire, and Rhode Island, and Harvard Pilgrim Health care of New England (#3).  

The rankings also find that many HMOs that submit to the voluntary ratings are owned by the major health insurance companies, including Aetna, Cigna, Humana, Kaiser Permanente, United Healthcare, and Wellpoint.  But, as Consumer Reports notes, plans with the same brand names can vary in quality, with some plans ranked high on the list and some ranked low.  The same goes for Blue Cross and Blue Shield plans, which are independently owned and operated but might be mistakenly construed as affiliated.  

"Consumers shouldn't enroll in a plan based on its brand name," said Findlay.   "We advise consumers to take a variety of factors into account, including these rankings.  Plans that are reporting to NCQA have made a commitment to quality improvement and public transparency.  As a result, we tend to think people should be skeptical of enrolling in a plan that is not on the NCQA list at all or has submitted its data but declined to have that data made public."   The report notes that while most of the 25 top-ranked individual HMOs are fairly large, some, like ConnectiCare in Massachusetts and Grand Valley Health Plan in Michigan, have fewer than 40,000 enrollees.