Nonprofit, Community-Based Health Plans Continue Outperforming on Critical Health Measures

Washington, D.C. (October 16, 2024) – The Alliance of Community Health Plans (ACHP) member companies continue to lead the nation in key health measures, setting nonprofit, community-based health plans apart from other payers. The National Committee on Quality Assurance’s (NCQA) Health Plan Ratings for 2023-2024 show that across commercial, Medicare and Medicaid products, ACHP member companies continue to outperform the non-ACHP members, especially in areas related to diabetes care and maternal and reproductive health. NCQA accredits and certifies a wide range of health care organizations and manages the evolution of HEDIS®, the most widely used performance measurement tool in health care. 

“This year’s NCQA data recognizes ACHP member companies’ continued success in providing high-quality care across the board,” said ACHP President and CEO Ceci Connolly. “The numbers don’t lie – our members are committed to delivering effective, equitable care to their communities.” 

Commercial 

ACHP member companies make up 26 percent of plans scoring four stars and above, a 6-percentage point increase from 2023. Two members, Kaiser Foundation Health Plan (Mid-Atlantic) and Independent Health, earned five stars for their commercial products, each for the second year in a row.   

Since 2018, ACHP plans have maintained a competitive edge compared to non-ACHP plans, consistently scoring higher on plan quality ratings on average. In 2024, ACHP plans typically scored half a point higher than non-ACHP plans on their overall ratings. On average, ACHP plans outperformed non-ACHP plans on 84 percent of measures, including prenatal care, postpartum care, eye exams for patients with diabetes and blood pressure control for patients with diabetes.   

Seven ACHP members offered thirteen commercial plans that received a rating of 4.5 stars. These plans include Capital District Physicians’ Health Plan (CDPHP), Group Health Cooperative of Eau Claire, Group Health Cooperative of South Central Wisconsin, HealthPartners, Kaiser Foundation Health Plan (Washington, Northern and Southern California), Priority Health and UPMC Health Plan.  

Medicare 

ACHP plans make up 18 percent of 4-star and above rated plans, including AultCare, Capital District Physicians’ Health Plan (CDPHP), Geisinger Health Plan, HAP, Independent Health, Kaiser Foundation Health Plan, Martin’s Point Health Plan, Priority Health, Providence Health, Sanford Health Plan, Security Health Plan, UCare and UPMC Health Plan.    

Of 40 total measures, ACHP plans had a higher average score than non-ACHP plans on 39, meaning that ACHP members outperformed non-members in 98 percent of areas. Particularly high-scoring areas for ACHP member plans include reporting of race and ethnicity of members, prevention and equity and breast cancer screening.   

Medicaid 

ACHP member plans earned a higher average score than non-ACHP plans for 88 percent of all measures, scoring the highest on race and ethnicity of members and blood pressure control for patients with diabetes. ACHP plans outperformed non-ACHP plans by more than 0.9 points on cancer screening, patients with diabetes blood pressure control, cervical cancer screening, prenatal immunizations and appropriate antibiotic use for acute bronchitis/bronchiolitis.  

Six ACHP member plans achieved a rating of at least 4 stars, including Fallon Health, Health New England, Kaiser Foundation Health Plan, Select Health, UCare and UPMC Health Plan.   

NCQA ratings are available on the NCQA website

  

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About ACHP    

The Alliance of Community Health Plans (ACHP) represents the nation’s top-performing nonprofit health companies, which serve tens of millions of Americans across nearly 40 states and D.C. ACHP member plans collaborate with providers on high-quality coverage and care — leading the industry in practical reforms, including MA for Tomorrow, our vision for the future of Medicare Advantage.  

  

ACHP is the voice of a unique payer-provider partnership model advancing proven solutions that deliver better value for patients, employers and taxpayers. Contact us for case studies and data about member innovations and results. 

Making Health Care Better

ACHP is the voice of a unique approach in health care today, one that puts the patient at the center with plans and clinical teams collaborating to improve health outcomes and reduce costs. Our advocacy focuses on providing policymakers with tested solutions, rooted in a model that is proven to deliver better value for patients, employers and taxpayers.

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