Harvard Pilgrim Tops NCQA Rankings for 4th Year

Margaret Dick Tocknell, for HealthLeaders Media , September 25, 2013

Just in time for consumers to assess their coverage opportunities in the soon-to-be-unveiled health insurance exchanges, the National Committee for Quality Assurance has released its annual ranking of health insurance plans.

Just in time for consumers to assess their coverage opportunities in the soon-to-be-unveiled health insurance exchanges, the National Committee for Quality Assurance has released its annual ranking of health insurance plans.

This is the ninth year the NCQA has ranked health plans. For four consecutive years an HMO operated by Wellesley, Mass.–based Harvard Pilgrim Health Care has topped the list of commercial health plans. Harvard Pilgrim has four plans in the 2013 top 10: two PPOs and two HMOs. The health plan serves about 1.2 million members in Massachusetts, Maine, and New Hampshire.

The rankings are compiled by the NCQA, a nonprofit healthcare accreditation and quality measurement group. They are based on the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) performance measures. Each plan receives an overall score between 1 and 100. Prevention and treatment account for 60% of the score, consumer satisfaction for 25%, and NCQA accreditation for 15%.

This year the NCQA ranked 1,020 health plans, including 484 commercial plans, 405 Medicare Advantage plans, and 131 Medicaid HMOs. NCQA accreditation is voluntary and health plans pay for the process.

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