The 2007 Rankings Methodology

Let's select a managed care plan at random and conduct an inquiry. How good is it at encouraging members at risk of heart attack to get their bad cholesterol into safe territory and keep it there? If it's a Medicare plan, are physicians effectively steered away from prescribing certain antihistamines, muscle relaxants, and other drugs that could be dangerous to elderly patients? Are doctors alert for kidney disease in diabetic members? Are members happy with claims handling?

To someone trying to pick a health plan, answers to these kinds of nuts-and-bolts questions are useful. And November kicks off "open season," when millions of families decide whether to stick with their current plan or move to a different one.

So for a third year, U.S. News and the National Committee for Quality Assurance, managed care's leading accrediting and standards-setting body, have joined forces to rank health plans based on just such questions.

More than 500 HMOs and POS plans, including most large commercial, Medicare, and Medicaid plans and many smaller ones, have been evaluated, using data submitted annually to NCQA. Their performances in 50 measures for commercial plans, 28 for Medicare plans, and 35 for Medicaid plans were scored on a scale of 1 to 5 and converted to overall scores that determined their rankings.

Inside the measures. Some results came from a consumer survey asking members how satisfied they were, for example, with how well their doctors communicated with them and how quickly care was provided. The rest were medical, divided between prevention (such as whether members were screened for colorectal cancer) and treatment (such as whether asthmatic children from 5 to 9 years old got the right medication).

Plan performance in dozens of individual measures can be found at the Web address provided. It is the first time we've shown such fine detail; in the past, we displayed results only for some measures, although all of the data went into the final scores. The measures can be used to search, sort, and compare plans.

Health plans that couldn't be ranked because of insufficient data are grouped below ranked plans, with scores for measures they did submit. Plans that submitted no data at all, or did but refused to make it public, are listed at the bottom of the rankings. Sometimes there's a good reason—a plan is being phased out, say. Most of the time, however, that's not a place where you want to see your plan, or one that might interest you.