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Consumer Reports releases new rankings for hundreds of health plans; just 86 meet “Avoiding Overuse” criteria

Brian Anderson

Consumer Reports has just released its fifth annual rankings of hundreds of health insurance plans across the U.S. with the intention of helping consumers determine which ones may be best for them.

New for 2014, Consumer Reports evaluated private (employer-based) plans in a category called “Avoiding Overuse” that looks at how well plans perform in key areas such as avoiding inappropriate use of antibiotics and limiting imaging tests for lower back pain. These are treatments that when used inappropriately, Consumer Reports says, can expose patients to harm and also drive up costs.

The report is available in the November issue of Consumer Reports and on ConsumerReports.org. The latest health plan rankings areavailable for free online.

The rankings data come from the National Committee for Quality Assurance (NCQA), a respected non-profit quality measurement and accreditation organization. Overall, Consumer Reports and NCQA have information on more than 1,000 private, Medicare Advantage, and Medicaid plans. Consumer Reports used NCQA data to develop the “Avoiding Overuse” designation for private plans.

The higher-ranking health plans provide high-quality care while helping members avoid unnecessary medical care, which can minimize costs and reduce risks that come with all medical tests and treatments. To earn Consumer Reports’ Avoiding Overuse designation (indicated by a checkmark), plans must have sufficient data, score higher in overall quality, and do better in at least three of the following areas:

• Avoiding inappropriate use of antibiotics

• Limiting imaging tests for lower-back pain

• Reducing hospital readmissions

• Avoiding overuse of emergency rooms

• Reducing overuse of invasive heart procedures

Consumer Reports looked at these areas because they are situations in which patients can be overtreated or inappropriately treated, potentially causing harm, and increasing costs.

The analysis of 507 ranked private plans identified 86 plans that got an Avoiding Overuse designation, earning check marks if the plan met the threshold for quality and met CR’s standards in three of the five criteria mentioned above. Many more—168 plans—met the quality threshold alone but did not meet the Avoiding Overuse criteria. And, 219 plans met neither the quality nor the overuse criteria. That could be because they had lower results for these measures or they did not report the data needed for the Avoiding Overuse analysis.

• Have thoughts about the CR rankings? Please share them on this thread

Consumer Reports’ publication of NCQA’s quality rankings of more than 1,000 private, Medicare Advantage, and Medicaid health insurance plans nationwide can be viewed through the lens of coverage via an employer (or through a family member’s employer), through Medicare or Medicaid, or insurance on-your-own through the new health exchange marketplaces.

Online, Consumer Reports also provides NCQA’s quality rankings for Medicare, Medicaid, and private (those you purchase through your employer) plans. For each plan, consumers can find the overall quality of the plan (based on a 1 to 100 scale) that reflects the plan’s performance across many aspects of care. These include cancer screenings, immunizations and other preventative services, and treatments for chronic diseases such as heart disease, osteoporosis, and mental illness. Customer satisfaction and results from NCQA accreditation surveys also contribute to the overall scores.

Consumer Reports has also created a free online tool at http://www.HealthLawHelper.org to help consumers better understand how they may be affected by the Affordable Care Act. Based on responses to a few questions, the tool provides a customized, printable report that identifies what an individual consumer should look for in the insurance marketplace. The tool does not require users to provide their name or other personally identifying information. The tool is also available in Spanish at http://www.AseguraTuSalud.org.

• Have thoughts about the CR rankings? Please share them on this thread

ABOUT CONSUMER REPORTS: Consumer Reports is the world’s largest and most trusted product-testing and consumer advocacy organization. The organization rates thousands of products and services at its 50 labs, auto test center and survey research center. Founded in 1936, Consumer Reports is a non-profit organization with annual revenues of more than $260 million. Consumer Reports employs almost 600 staff, with more than eight million subscribers to its flagship magazine, website and other publications. In addition, Consumer Reports has achieved substantial gains for consumers through its advocacy on health reform, food and product safety, financial reform, and other consumer issues at the federal, state, and local level. Consumer Reports accepts no advertising, payment or other support from the companies whose products it rates.

ABOUT NCQA: NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care.



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