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 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.
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