Rating Iowa's Medicaid health plans

Organization looks at MCOs' performance nationwide

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Since the start of the Medicaid managed-care debate in Iowa, Gov. Terry Branstad repeatedly has pointed to the fact that 39 states and the District of Columbia all have moved portions of their Medicaid populations into managed-care plans.

This is certainly true.

More than 70 percent of the country’s 73 million Medicaid beneficiaries — or about 51.3 million people — received their Medicaid benefits from a private health plan, according to a November 2015 PricewaterhouseCoopers report.

Medicaid managed care is becoming increasingly popular — private plans added 7.8 million Medicaid recipients to their rolls in 2015, while those enrolled in a more traditional fee-for-service plan decreased by 1.4 million.

That’s because Medicaid eats up large portions of a state’s budget, so more governors are moving these expensive programs to private insurers to manage. This includes Branstad, who handed over Iowa’s $5 billion Medicaid program to UnitedHealthcare of the River Valley, Amerigroup Iowa and AmeriHealth Caritas Iowa on April 1.

This nationwide trend has led to Medicaid managed care becoming a multibillion-dollar industry. In 2014, private insurers brought in $115 billion in Medicaid revenue, according to data compiled by health care-industry analytics company Mark Farrah Associates and analyzed by Kaiser Health News.

But what makes a good Medicaid managed-care plan?

That’s where the National Committee for Quality Assurance — a Washington, D.C.-based not-for-profit — comes it. The organization analyzes and rates health plans, scoring more than 1,300 health insurance plans based on clinical quality, member satisfaction and survey results. Plans are scored from 1 to 5.

The state-level ratings provide “digestible” information to consumers who want to compare plans, said Kristine Toppe, NCQA’s director of state affairs.

“There’s lots of data that we get from lots of different places,” Toppe explained. That includes claims and encounter data as well “chart-based data,” or clinical information pulled from providers.

Toppe said that insurers hire nurses to collect the data, and that information is then verified by independent auditors before it is submitted to NCQA.

“We have lots of levels of accountability and checking,” Toppe said. “We only accept data that has a (Healthcare Effectiveness Data and Information Set) compliant audit.”

The plans — commercial, Medicare and Medicaid — are rated based on consumer satisfaction, prevention and treatment. NCQA has ranked about 140 Medicaid plans across the country — but Iowa’s MCOs are not yet included as data has not been collected yet.

Toppe said about a year’s worth of information is needed before a rating can be reported, so it’s likely Iowa’s MCOs will not show up in its system until 2018. However, the state has required the three MCOs to become NCQA accredited.

About 24 states require Medicaid plans to take part in what Toppe called its “gold-standard” accreditation.

The accreditation and ratings data can’t be broken down by Medicaid eligibility categories, Toppe said, though the NCQA launched new Long Term Services and Supports (LTSS) accreditation standards two weeks ago and is in the process of rolling it out to states.

“As more states look to us for accreditation and more states are moving their LTSS populations into managed care, we wanted to make sure states know,” she said. “We’re encouraging state to add the (LTSS standards) ... into their programs.”

Although Iowa MCO ratings won’t be available for some time, The Gazette took a look at how the MCOs selected by the state have performed elsewhere. See the chart at the bottom of this story for a detailed breakdown on how the three MCOs operating in Iowa have done in some other states.


The Gazette pulled the highest-NCQA-rated and lowest-NCQA-rated Medicaid managed-care plans for each of the three insurers that have contracted with the state of Iowa.

All three MCOs provide care in multiple states, but data from all states are not included in this chart. This is why The Gazette also calculated and included the average overall ranking as well as the number of NCQA-rated Medicaid plans.

NCQA does not provide ratings for every state in which an MCO operates — this typically is because only partial or insufficient data were reported.

Included in this chart are the health plans’ overall scores as well as individual breakdowns on consumer satisfaction, prevention and treatment. These three sections have additional measurements listed, but this is not a comprehensive list.

It should be noted that:

l Women’s reproductive health ratings include prenatal checkups, postpartum care and ongoing prenatal care

l Children and adolescents includes well-child visits, access and immunizations

l Cancer screenings include breast and cervical cancer screenings, and Human Papillomavirus vaccines

l Diabetes includes monitoring kidney disease, blood-pressure control and glucose control

l Heart diseases include controlling high blood pressure

l Mental and behavioral health includes follow-ups after a hospitalizations, substance-abuse treatment and appropriate medications adherence.

Information included in the program overview was compiled through a November 2015 PwC report that details Medicaid managed-care trends as well as from Kaiser Family Foundation’s Managed Care Tracker.

For more information and to look more closely at these health plan ratings and others, go to healthinsuranceratings.ncqa.org.


Gazette graphic adapted for web by John McGlothlen

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