Rank: Based on score. Commercial, Medicare, and Medicaid health plans are separately evaluated and ranked.
Score: From 0 to 100 points. Scores are based on performance relative to other plans in consumer satisfaction, prevention, and treatment, as well as accreditation by the National Committee for Quality Assurance. Forty-nine measures were evaluated for commercial plans, 42 for Medicare plans, and 39 for Medicaid plans.
State: Where the plan has members.
Type: HMO (health maintenance organization)—a primary care physician provides routine care and a network of specialists provides other care. Members pay out of pocket for care received outside the network. POS (point-of-service plan)—the plan pays some of the cost of out-of-network care.
NCQA accreditation: Accreditation by the National Committee for Quality Assurance (NCQA), the major accrediting body for U.S. managed-care organizations, indicates the health plan follows established quality practices. Score value is 15 points.
I: Insufficient data.
NA: Not applicable: Benefit is not offered or number of affected members is small, or the plan was not required to submit the data (Medicare only).
NR: Not reported: A plan did not calculate a measure or calculated it but did not report it.
Commercial Plan Terms
Performance was measured relative to other plans, not against independent standards.
Consumer Assessment
Summary of members' views, based on surveys, of plan's ability to provide care and of their satisfaction with the physicians and services.
Getting care
Getting needed care: Proportion of surveyed members who said they could easily get appointments, preventive care, tests, and treatment.
Getting needed care quickly: Proportion of surveyed members who said they could easily get appointments, preventive care, tests, and treatment promptly.
Satisfaction with physicians
How well doctors communicate: Proportion of surveyed members who gave plan doctors a high rating in communication skills.
High rating of personal doctor: Proportion of surveyed members who gave their personal physician a high overall rating.
High rating of specialists: Proportion of surveyed members who gave the plan's specialists a high overall rating.
High rating of care received: Proportion of surveyed members who gave the healthcare they received a high overall rating.
Satisfaction with health plan services
Claims processing: Proportion of surveyed members satisfied with the handling of their claims
High rating of health plan: Proportion of surveyed members who gave the overall level of plan services a high rating.
Customer service: Proportion of surveyed members who gave the overall level of customer service a high rating.
Prevention
Sums up a plan's performance in providing preventive services such as immunizations, cancer screening, and regular pediatric visits.
Children and adolescents
Well-child visits (birth to 15 months): Proportion of children who had at least six well-child visits from birth to 15 months old.
Well-child visits (3-6 years old): Proportion of children ages 3, 4, 5, and 6 who had at least one well-child visit.
Access for children (7-11 years old): Proportion of children ages 7 to 11 who had a visit with a primary-care physician.
Adolescent well-care visits: Proportion of members ages 12 to 21 who had at least one comprehensive well-care visit.
Immunizations
All immunizations at age 2: Proportion of children who got all recommended immunizations by their second birthday.
Women's reproductive health
Timeliness of prenatal checkups: Proportion of women who gave birth and had a prenatal visit during the first trimester.
Postpartum care: Proportion of women who had a postpartum visit between three and eight weeks after delivery.
Cancer screening
Breast cancer screening: Proportion of women ages 40 to 69 who had a mammogram.
Cervical cancer screening: Proportion of women ages 21 to 64 who had a Pap test.
Colorectal cancer screening: Proportion of members ages 50 to 80 who were screened for colorectal cancer.
Other preventive services
Chlamydia screening: Proportion of women ages 16 to 25 who were tested for chlamydia.
Treatment
Sums up a plan's performance in treating various conditions such as asthma and diabetes.
Asthma
Medicate appropriately (5-9 years old): Proportion of asthmatic children ages 5 to 9 receiving appropriate medication.
Medicate appropriately (10-17 years old): Proportion of asthmatic children ages 10 to 17 receiving appropriate medication.
Medicate appropriately (18-56 years old): Proportion of asthmatic adults ages 18 to 56 receiving appropriate medication.
Diabetes
Blood pressure control (130/80): Proportion of members ages 18 to 75 with type 1 or 2 diabetes whose most recent blood pressure reading was lower than 130/80.
Blood pressure control (140/90): Proportion of members ages 18 to 75 with type 1 or 2 diabetes whose most recent blood pressure reading was lower than 140/90.
Retinal eye exams: Proportion of members ages 18 to 75 with type 1 or 2 diabetes who had a retinal exam.
Glucose testing: Proportion of members ages 18 to 75 with type 1 or 2 diabetes who had a blood glucose test.
Glucose control: Proportion of members ages 18 to 75 with type 1 or 2 diabetes whose blood glucose level was maintained at or below 9 percent.
LDL cholesterol screening: Proportion of members ages 18 to 75 with type 1 or 2 diabetes whose LDL cholesterol was checked.
LDL cholesterol control: Proportion of members ages 18 to 75 with type 1 or 2 diabetes whose LDL cholesterol was maintained below 100 milligrams/deciliter.
Monitoring kidney disease: Proportion of members ages 18 to 75 with type 1 or 2 diabetes whose kidney function was checked.
Heart disease
Staying on beta blocker after heart attack: Proportion of members ages 35 and above who had a heart attack and received treatment with a beta blocker for at least six months after discharge.
Controlling high blood pressure: Proportion of members ages 18 to 85 who were diagnosed with hypertension and whose most recent blood pressure reading was below 140/90.
LDL cholesterol screening: Proportion of members ages 18 to 75 with heart disease whose LDL cholesterol was checked.
LDL cholesterol control: Proportion of members ages 18 to 75 with heart disease whose LDL cholesterol was maintained below 100 milligrams/deciliter.
Mental and behavioral health
Depression—appropriate follow-up after diagnosis: Proportion of members ages 18 and above who were newly diagnosed with depression, prescribed medication, and had at least three visits with a practitioner during the next 12 weeks.
Depression—adhering to medication for 12 weeks: Proportion of members ages 18 and above who were newly diagnosed with depression, prescribed medication, and remained on the drug during the next 12 weeks.
Depression—adhering to medication for 6 months: Proportion of members ages 18 and above who were newly diagnosed with depression, prescribed medication, and remained on the drug for at least six months.
Follow-up after hospitalization for mental illness: Proportion of members ages six and above who were hospitalized because of mental illness and were seen for follow-up care within a week and again within a month of discharge.
Alcohol or drug dependence treatment initiated: Proportion of members ages 13 and above who were diagnosed with alcohol or drug dependence and treated as inpatients or outpatients.
Alcohol or drug dependence treated for 30 days: Proportion of members ages 13 and above who were diagnosed with alcohol or drug dependence and received at least two related services within 30 days of the initial treatment.
Follow-up after ADHD diagnosis: Proportion of children ages 6 to 12 initially diagnosed with attention deficit hyperactivity disorder who were prescribed medication and had a visit with a practitioner within 30 days.
Continued follow-up after ADHD diagnosis: Proportion of children ages 6 to 12 initially diagnosed with attention deficit hyperactivity disorder who were treated with medication for seven months and had three follow-up visits within nine months.
Other treatment measures
Appropriate antibiotic use, adults with acute bronchitis: Proportion of adults ages 18 to 64 who were not prescribed an antibiotic within three days of a diagnosis of acute bronchitis.
Appropriate testing and care, children with pharyngitis: Proportion of children ages 2 to 18 who were diagnosed with a sore throat, prescribed an antibiotic, and tested for strep.
Medication for rheumatoid arthritis: Proportion of members ages 18 and above who were diagnosed with rheumatoid arthritis and were prescribed an appropriate drug.
Monitoring key long-term medications: Proportion of members ages 18 and above who received a six-month supply of any of the following drugs and were being clinically monitored: ACE inhibitors, angiotensin receptor blockers (ARBs), digoxin, diuretics, or anticonvulsants.
Spirometry testing for COPD: Proportion of members ages 40 and above whose diagnosis of chronic obstructive pulmonary disease was confirmed with a spirometry test.
Appropriate antibiotic use, children with URI: Proportion of children from 3 months to 18 years old who were not prescribed an antibiotic for up to three days after being diagnosed with a common cold.
Medicare Terms
Performance was measured relative to other plans, not against independent standards.
Consumer assessment
Summary of members' views, based on surveys, of plan's ability to provide care and of their satisfaction with the physicians and services.
Getting care
Getting needed care: Proportion of surveyed members who said they could easily get appointments, preventive care, tests, and treatment.
Getting needed care quickly: Proportion of surveyed members who said they could easily get appointments, preventive care, tests, and treatment promptly.
Satisfaction with physicians
How well doctors communicate: Proportion of surveyed members who gave plan doctors a high rating in communication skills.
High rating of personal doctor: Proportion of surveyed members who gave their personal physician a high overall rating.
High rating of specialists: Proportion of surveyed members who gave the plan's specialists a high overall rating.
High rating of care received: Proportion of surveyed members who gave the healthcare they received a high overall rating.
Satisfaction with health plan services
High rating of health plan: Proportion of surveyed members who gave the overall level of plan services a high rating.
Prevention
Sums up a plan's performance in providing preventive services such as cancer and glaucoma screening and immunizations.
Breast cancer screening: Proportion of women up to age 69 who had a mammogram.
Colorectal cancer screening: Proportion of members up to age 80 who were screened for colorectal cancer.
Glaucoma screening: Proportion of members who were screened for glaucoma.
Evaluating mental health status: Proportion of members whose mental health status was assessed at the beginning and end of a two-year period.
Evaluating physical health status: Proportion of members whose physical health status was assessed at the beginning and end of a two-year period.
Flu shots for older adults: Proportion of members who received an influenza vaccination.
Pneumonia shots for older adults: Proportion of members who received a pneumococcal vaccination.
Treatment
Sums up a plan's performance in treating various conditions such as diabetes and heart disease.
Diabetes
Blood pressure control (130/80): Proportion of members up to age 75 with type 1 or 2 diabetes whose most recent blood pressure reading was lower than 130/80.
Blood pressure control (140/90): Proportion of members up to age 75 with type 1 or 2 diabetes whose most recent blood pressure reading was lower than 140/90.
Retinal eye exams: Proportion of members up to age 75 with type 1 or 2 diabetes who had a retinal exam.
Glucose testing: Proportion of members up to age 75 with type 1 or 2 diabetes who had a blood glucose test.
Glucose control: Proportion of members up to age 75 with type 1 or 2 diabetes whose blood glucose level was maintained at or below 9 percent.
LDL cholesterol screening: Proportion of members up to age 75 with type 1 or 2 diabetes whose LDL cholesterol was checked.
LDL cholesterol control: Proportion of members up to age 75 with type 1 or 2 diabetes whose LDL cholesterol was maintained below 100 milligrams/deciliter.
Monitoring kidney disease: Proportion of members up to age 75 with type 1 or 2 diabetes whose kidney function was checked.
Heart disease
Staying on beta blocker after heart attack: Proportion of members who had a heart attack and received treatment with a beta blocker for at least six months after discharge.
Controlling high blood pressure: Proportion of members up to age 85 who were diagnosed with hypertension and whose most recent blood pressure reading was below 140/90.
Advising smokers to quit: Proportion of smoking members who were advised by a practitioner to stop.
LDL cholesterol screening: Proportion of members up to age 75 with heart disease whose LDL cholesterol level was checked.
LDL cholesterol control: Proportion of members up to age 75 with heart disease whose LDL cholesterol level was maintained below 100 milligrams/deciliter.
Mental and behavioral health
Depression—appropriate follow-up after diagnosis: Proportion of members who were newly diagnosed with depression, prescribed medication, and had at least three visits with a practitioner during the next 12 weeks.
Depression—adhering to medication for 12 weeks: Proportion of members who were newly diagnosed with depression, prescribed medication, and remained on the drug during the next 12 weeks.
Depression—adhering to medication for 6 months: Proportion of members who were newly diagnosed with depression, prescribed medication, and remained on the drug for at least six months.
Follow-up after hospitalization for mental illness: Proportion of members who were hospitalized because of mental illness and were seen for follow-up care within a week and again within a month of discharge.
Alcohol or drug dependence treatment initiated: Proportion of members who were diagnosed with alcohol or drug dependence and treated as inpatients or outpatients.
Alcohol or drug dependence treated for 30 days: Proportion of members who were diagnosed with alcohol or drug dependence and received at least two related services within 30 days of the initial treatment.
Other treatment measures
Managing risk of falls: Proportion of members who fell or had problems with balance or walking and were seen by their practitioner and received fall risk intervention.
Avoiding harmful drug and disease interactions: Proportion of members who have evidence of an underlying disease, condition, or health concern and did not receive an ambulatory prescription for a contraindicated medication at time of diagnosis or after.
Avoiding high-risk medications: Proportion of members who did not receive medications considered potentially harmful in this age group.
Medication for rheumatoid arthritis: Proportion of members who were diagnosed with rheumatoid arthritis and were prescribed an appropriate drug.
Monitoring key long-term medications: Proportion of members who received a six-month supply of any of the following drugs and were being clinically monitored: ACE inhibitors, angiotensin receptor blockers (ARBs), digoxin, diuretics, or anticonvulsants.
Testing for osteoporosis: Proportion of women who reported having received a bone density test to check for osteoporosis.
Managing osteoporosis in women after fracture: Proportion of women ages 67 and above who had a fracture and either had a bone mineral density test or were prescribed an appropriate drug during the next six months.
Spirometry testing for COPD: Proportion of members whose diagnosis of chronic obstructive pulmonary disease was confirmed with a spirometry test.
Discussing urinary incontinence: Proportion of members whose physicians discussed a urine leakage problem with them during the past six months.
Medicaid Terms
Performance was measured relative to other plans, not against independent standards.
Consumer Assessment
Summary of members' views, based on surveys, of plan's ability to provide care and of their satisfaction with the physicians and services.
Getting care
Getting needed care: Proportion of surveyed members who said they could easily get appointments, preventive care, tests, and treatment.
Getting needed care quickly: Proportion of surveyed members who said they could easily get appointments, preventive care, tests, and treatment promptly.
Satisfaction with physicians
How well doctors communicate: Proportion of surveyed members who gave plan doctors a high rating in communication skills.
High rating of personal doctor: Proportion of surveyed members who gave their personal physician a high overall rating.
High rating of specialists: Proportion of surveyed members who gave the plan's specialists a high overall rating.
High rating of care received: Proportion of surveyed members who gave the healthcare they received a high overall rating.
Satisfaction with health plan services
High rating of health plan: Proportion of surveyed members who gave the overall level of plan services a high rating.
Customer service: Proportion of surveyed members who gave the overall level of customer service a high rating.
Prevention
Sums up a plan's performance in providing preventive services such as immunizations, cancer screening, and regular pediatric visits.
Children and adolescents
Well-child visits (birth to 15 months): Proportion of children who had at least six well-child visits from birth to 15 months old.
Well-child visits (3-6 years old): Proportion of children ages 3, 4, 5, and 6 who had at least one well-child visit.
Access for children (7-11 years old): Proportion of children ages 7 to 11 who had a visit with a primary-care physician.
Adolescent well-care visits: Proportion of members ages 12 to 21 who had at least one comprehensive well-care visit.
Immunizations
All immunizations at age 2: Proportion of children who got all recommended immunizations by their second birthday.
Women's reproductive health
Timeliness of prenatal checkups: Proportion of women who gave birth and had a prenatal visit during the first trimester.
Postpartum care: Proportion of women who had a postpartum visit between three and eight weeks after delivery.
Cancer screening
Breast cancer screening: Proportion of women ages 40 to 69 who had a mammogram.
Cervical cancer screening: Proportion of women ages 21 to 64 who had a Pap test.
Other preventive services
Chlamydia screening: Proportion of women ages 16 to 25 who were tested for chlamydia.
Treatment
Sums up a plan's performance in treating various conditions such as diabetes and heart disease.
Asthma
Medicate appropriately (5-9 years old): Proportion of asthmatic children ages 5 to 9 receiving appropriate medication.
Medicate appropriately (10-17 years old): Proportion of asthmatic children ages 10 to 17 receiving appropriate medication.
Medicate appropriately (18-56 years old): Proportion of asthmatic adults ages 18 to 56 receiving appropriate medication.
Diabetes
Blood pressure control (130/80): Proportion of members ages 18 to 75 with type 1 or 2 diabetes whose most recent blood pressure reading was lower than 130/80.
Blood pressure control (140/90): Proportion of members ages 18 to 75 with type 1 or 2 diabetes whose most recent blood pressure reading was lower than 140/90.
Retinal eye exams: Proportion of members ages 18 to 75 with type 1 or 2 diabetes who had a retinal exam.
Glucose testing: Proportion of members ages 18 to 75 with type 1 or 2 diabetes who had a blood glucose test.
Glucose control: Proportion of members ages 18 to 75 with type 1 or 2 diabetes whose blood glucose level was maintained at or below 9 percent.
LDL cholesterol screening: Proportion of members ages 18 to 75 with type 1 or 2 diabetes whose LDL cholesterol was checked.
LDL cholesterol control: Proportion of members ages 18 to 75 with type 1 or 2 diabetes whose LDL cholesterol was maintained below 100 milligrams/deciliter.
Monitoring kidney disease: Proportion of members ages 18 to 75 with type 1 or 2 diabetes whose kidney function was checked.
Heart disease
Controlling high blood pressure: Proportion of members ages 18 to 85 who were diagnosed with hypertension and whose most recent blood pressure reading was below 140/90.
Advising smokers to quit: Proportion of smoking members ages 18 and above who were advised by a practitioner to stop.
Discussing stop-smoking strategies: Proportion of smoking members ages 18 and above who discussed methods or strategies for quitting with a practitioner.
Discussing stop-smoking medications: Proportion of smoking members ages 18 and above who discussed medications for quitting.
LDL cholesterol screening: Proportion of members ages 18 to 75 with heart disease whose LDL cholesterol was checked.
LDL cholesterol control: Proportion of members ages 18 to 75 with heart disease whose LDL cholesterol was maintained below 100 milligrams/deciliter.
Other treatment measures
Appropriate antibiotic use, adults with acute bronchitis: Proportion of adults ages 18 to 64 who were not prescribed an antibiotic within three days of a diagnosis of acute bronchitis.
Appropriate testing and care, children with pharyngitis: Proportion of children ages 2 to 18 who were diagnosed with a sore throat, prescribed an antibiotic, and tested for strep.
Monitoring key long-term medications: Proportion of members ages 18 and above who received a six-month supply of any of the following drugs and were being clinically monitored: ACE inhibitors, angiotensin receptor blockers (ARBs), digoxin, diuretics, or anticonvulsants.
Appropriate antibiotic use, children with URI: Proportion of children from 3 months to 18 years old who were not prescribed an antibiotic for up to three days after being diagnosed with a common cold.
