7:17am

Mon November 19, 2012
Health

Checking Insurance Ratings Can Save Your Life

Coloradans can now add another factor to choosing health insurance plans besides cost alone: Which one will do a better job of keeping you healthy?

Ratings are now available that will let customers know how different insurance plans stack up when it comes to ensuring their health. The data measures factors like controlling high blood pressure and blood sugar, up-to-date immunizations and providing patients the correct drugs after they experience a heart attack.

This year in Colorado, Kaiser Permanente of Colorado has garnered one of the highest rankings in the nation. Rocky Mountain Health Plans, on the Western Slope, has also come in with high rankings.

The performance measurements – like for blood pressure and blood sugar – were chosen because they count things “that science says is good care,” said Andy Reynolds, vice president of the National Committee for Quality Assurance (NCQA), a nonprofit organization that produces one of the rankings. The NCQA accredits and publishes the data that insurance companies have agreed to track and make public as attempt to improve quality.

The ratings will come in useful right now as numerous employers and Medicare are asking clients to choose a health plan in the coming weeks, with a deadline of Dec. 7. Two main ratings plans from the NCQA, and Medicare, mainly review HMOs and PPOs rather than traditional fee-for-service insurance plans.

Medicare is going so far during this year’s enrollment period as to encourage half a million clients nationwide to drop the lowest-rated plans Medicare Advantage plans and switch to high-rated ones on its five-star scale. In Colorado, Medicare is recommending the two Today’s Options plans be dropped from Pyramid Life Insurance/Universal American Corp.

If people do switch to higher-rated plans, “they will be healthier,” said Dr. Glenn Gade, chief of geriatrics for Kaiser Permanente of Colorado.

Kaiser is ranked as the only five-star Medicare Advantage health plan in the state. It is also the top-ranked health plan in Colorado for people of all ages and one of the highest rated in the country on the quality assurance group’s ratings. NCQA ranks Kaiser Permanente of Colorado number 6 out of 508 plans nationwide, and has also garnered top ratings by Medicare.

So what’s the difference in a high-ranked plan? The entire system is geared toward making sure that measures of quality are met. For example, at Kaiser, 82 percent of patients with high blood pressure have it under control, Gade said. The national average is just 46 percent, according to the Million Hearts campaign.

Controlling blood pressure to less than 140/90 is important because “it reduces stroke and heart attack and kidney disease,” Gade said. “It’s one of the most important things you can do to save lives.”

Kaiser has an electronic medical records system that alerts doctors like Gade every month with the names of his patients who need to be called in for a blood pressure check, mammogram or other routine care.

“They don’t fall through the health care system and get lost,” he said.

Kaiser, a combination insurer and health provider, serves the Front Range, having recently moved into Fort Collins and Loveland. It is adding an office in Greeley in 2014.

On the Western Slope, Rocky Mountain Health Plans has been top-ranked for Medicare Advantage, with 4.5 stars.

Even entering into the organization’s accreditation and ranking system is a major step for insurers, because “you are signing on to let the world see your quality scores,” Reynolds said. NCQA’s rankings look at prevention, treatment and consumer satisfaction.

The rankers “even have secret shoppers” who call and check service on the telephone, Gade said.

How to find rankings for your insurance plan:

Medicare

To find ratings on Medicare Advantage plans or Medicare prescription drug plans, go to Medicare.gov and click on the link regarding enrollment ending Dec. 7 or choosing a plan. Enter your ZIP code. You can get cost estimates by answering the questions at the site. If you want to see the ranking only, say “I don’t know” to the first two questions, and “No drugs” to the next question. Then choose whether you are looking for drug plans or Medicare Advantage plans with and without drugs. That will give you a page with the plans in your area, and the rating is in the last column.

The National Committee for Quality Assurance

The NCQA has ratings for private HMO/PPO plans. The page also has a link to its rankings of Medicare and Medicaid plans.