Health Insurance Plans That Hide Their Data

No data, no rank. To appear in the annual U.S. News Best Health Plans rankings, managed-care providers have to turn over data describing their performance in a host of clinical and member-satisfaction measures to our rankings partner, the National Committee for Quality Assurance. They also must agree to make the information public.

Most HMOs and point of service plans—the two plan types evaluated—did comply this year. But 126 others, some of which have hundreds of thousands of members (see table), declined. More was at stake than absence from the rankings. Publicly disclosing performance data is a requirement for accreditation by NCQA, managed care's major credentialing and standards-setting body.

Blue Cross and Blue Shield of Texas, the largest commercial health plan to opt out, was NCQA-accredited until 2006. Then it chose to be accredited by URAC, whose requirements for data collection and reporting are less resource-intensive. "It was a cost-saving move," says company spokesperson Margaret Jarvis. "Senior management decided that NCQA accreditation did not create a market advantage."

Missing shots. The question for families picking a health plan is whether lack of NCQA accreditation points to a subpar performer. The answer, based on data from states and large corporate purchasers of coverage, is that on balance, unaccredited plans do underperform accredited ones. This is not always true, and differences in quality often are trivial. But some are not. Parents take note: Many of the measures in which unaccredited commercial HMO and POS plans as a group do far worse, and Medicaid plans not much better, reflect diligence at keeping children's immunizations on track.

The same laggard performance in childhood immunizations is true of plans that provided data to NCQA for benchmarking purposes but stipulated that nothing could be made public. Studies such as one in the Journal of the American Medical Association in September of 2002 suggest that plans tend to hide their data when performance drops. Public reporting, in other words, is skewed toward good performers.

"That's no surprise, as any kid knows who's ever hidden a report card from parents," says NCQA President Margaret O'Kane, who calls disclosure a form of accountability. She identifies Medicaid plans as the worst at holding themselves accountable. "There is still a point of view that cheap coverage is good enough for poor people," says O'Kane. "It's hard to say, but there it is." Another JAMA study, this one from October 2007, backs her up. Researchers found that members of Medicaid health plans got worse care than commercial plan members did.

If comparing plans, any information is better than none. This year, 94 plans turned in too little data to be ranked. What they did report is available at health.usnews.com/healthplans.