Medicare Advantage PPOs are catching up with MA HMOs on quality, based on a new analysis by the National Committee for Quality Assurance (NCQA). And NCQA President Peggy O’Kane, while acknowledging that the bonuses now attached to CMS’s star ratings have been a “huge motivator” for quality in all MA plans, says the PPOs’ catch-up with the tighter-network HMOs on quality results from “no magic — just hard work.”

The findings for MA plans parallel those for commercial-market PPOs and HMOs in NCQA’s State of Health Care Quality report released last month. Quality expectations were lower for PPOs than for HMOs in the past, O’Kane tells MAN in an interview, but that has changed now in both the commercial and MA markets, with all plans, regardless of network structure, needing to get “better performance out of the delivery system” and “engage patients more” in such areas as medication adherence.

In a special analysis of its data conducted for MAN, NCQA developed lists of the top 10 MA PPOs and the most improved in two categories of quality related to cardiovascular conditions and diabetes. Both categories are ones in which MA PPOs are catching up with MA HMOs in screening rates, NCQA data for 2010 show.

The top 10 MA PPOs in ranked order for eye exams for diabetics, according to NCQA, are (1) United Healthcare of Ohio; (2) Humana Insurance Co. (Kentucky); (3) UnitedHealthcare Insurance Co. – Idaho; (4) UnitedHealthcare Insurance Co. – Pennsylvania Evercare; (5) Humana Insurance Co. (Iowa, Missouri and Nebraska); (6) Humana Insurance Co. (Hawaii); (7) QCC Insurance Co. (Personal Choice); (8) UnitedHealthcare Insurance Co. – Hawaii; (9) United Healthcare Insurance Co. – Midwest; and (10) Aetna Life Insurance Co. (Texas).

The top 10 in LDL (i.e., “bad” cholesterol) screening for cardiovascular care are (1) UnitedHealthcare Insurance Co. (Texas and New Mexico); (2) QCC Insurance Co. (Personal Choice); (3) UnitedHealthcare Insurance Co. of New York; (4) Anthem Blue Cross Life and Health Insurance Co.; (5) UnitedHealthcare Insurance Co. – Midwest; (6) Humana Insurance Co. (Ohio); (7) Anthem Health Plans Kentucky, Inc.; (8) Humana Benefit Plan of Illinois; (9) Presbyterian Insurance Co.; and (10) UPMC Health Plan.

NCQA, which accredits plans, also developed lists of the most improved MA PPOs in the same two categories, with “most improved” defined as plans that had a rate at least as high as the mean for all MA plans measured plus had a degree of improvement that ranked in the top 10.

In the eye-exam category, they are (1) UnitedHealthcare of Ohio, Inc.; (2) Blue Cross and Blue Shield of Massachusetts; (3) MVP Health Care, Inc. (New York – contract H3346); (4) ODS Health Plan, Inc.; (5) MVP Health Care, Inc.; (New York – H9615; (6) UPMC Health Plan; (7) HealthNow New York, Inc.; (8) Independent Health Association, Inc.; (9) UnitedHealthcare Insurance Co. (Massachusetts/Rhode Island); and (10) Priority Health.

For the LDL screening category, NCQA said the most improved MA PPOs are (1) Empire HealthChoice HMO, Inc.; (2) Blue Cross and Blue Shield of Massachusetts; (3) UnitedHealthcare Insurance Co. – Pennsylvania Evercare; (4) UnitedHealthcare Insurance Co. –Texas and New Mexico; (5) UnitedHealthcare Insurance Co. – Hawaii; (6) Aetna Life Insurance Co. (Texas); (7) QCC Insurance Co. (Personal Choice); (8) UnitedHealthcare Insurance Co. of New York; (9) Anthem Blue Cross Life and Health Insurance Co.; and (10) UnitedHealthcare Insurance Co. – Midwest.

© 2012 by Atlantic Information Services, Inc. All Rights Reserved.

AIS is celebrating our 25th anniversary with special discounts of 25% off our most popular publications – including a $130 discount on a one-year subscription to Medicare Advantage News. Click here to see the deals and save!