With the latest NCQA rankings come fresh marketing material and customer satisfaction bona fides, although that doesn't always inoculate them from having to explain coverage controversies in the media.
This year, New England and West Coast insurers are dominating the National Committee for Quality Assurance's rankings of more than 1,000 health plans on the basis of clinical outcomes, prevention and member satisfaction.
Tufts Health Plan HMO in Massachusetts and Rhode Island earned first place, followed by Harvard Pilgrim's HMO in Maine and Massachusetts, and then followed by two of Harvard Pilgrim's PPOs in Massachusetts for third and fourth place.
Kaiser Permanente's health plan in Oregon and Washington, Kaiser Foundation Health Plan of the Northwest, landed fifth place, followed by Kaiser's California plans, Martin's Point of Maine, and Blue Cross and Blue Shield of Massachusetts.
Those insurers are some of the same that led the pack in 2013: Harvard Pilgrim, Tufts, Capital Health Plan in Florida and the Kaiser.
Ahead of the next open enrollment period, those and other insurers have another marketing tool to convince individuals, businesses and government payers to sign up -- or to stay, even when a competitor dangles a lower premium.
Earning a consistently high NCQA rating since the program's inception, Tufts Health Plan is already making good use of the ranking on its website.
"While it's satisfying to be acknowledged as the best health plan, our core focus remains on the member and ensuring we provide them with an exceptional experience and care that is high caliber and affordable," said Paul Kasuba, MD, senior vice Tufts president and chief medical officer, in a media release.
The rankings do not necessarily mean smooth sailing for top rated plans. For instance, Harvard Pilgrim and several other insurers were recently highlighted in The New York Times for the use of non-preferred generic drug pricing in its formularies.
Researchers in the American Journal of Managed Care studied the formularies of six plans, including Harvard Pilgrim, to gauge availability and cost-sharing requirements of guideline-recommended generic medications that treat 10 conditions, including hypertension, diabetes and epilepsy. While Premera Blue Cross and Aetna had preferred generic drugs for each of the 10 conditions and others had at least a few of the conditions covered, Harvard Pilgrim did not have any lower-cost generics in the 10 categories.
Harvard Pilgrim maintains that its higher out-of-pocket requirements are due to the rising cost of a number of generics, and that overall its members pay less than the industry average. Still, as the Boston-based nonprofit tries to expand in New Hampshire and Connecticut, it will face some additional challenges to live up to its high NCQA rating and adapt to employers and individuals.
Back to the ratings, in the list of the top 20 were Geisinger Health Plan in Pennsylvania, Kaiser's Mid-Atlantic plan, Group Health Cooperative in Wisconsin, HealthSpan Integrated Care in Ohio, Kaiser's Hawaii and Georgia plans and UPMC Health Plan.