Newly published data from the federal government shows that some of the health insurers enrolling the most people in coverage on the Affordable Care Act insurance exchanges have quality ratings below the national average.
Most 2019 exchange plans, or about 64% of 195 plans listed in the CMS data, received an overall quality rating of four or five stars, with five being the highest rating, according to Modern Healthcare’s analysis of CMS data released last week. Another 26.2% of plans received a 3-star rating. The rest—about 10 health plans—received a 1- or 2-star rating.
Across all plans, the average rating was 3.8 stars.
“It should encourage plans to try to address issues that are leading them to have lower star ratings,” said Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation.
The CMS said overall quality ratings are based on 38 different measures that have to do with medical care quality management, member experience and plan administration, with the agency giving a heavier weight to medical care. The plans listed in the CMS data had an average rating of 3.5 and 3.6 stars for medical care and plan administration categories respectively, but the average member experience rating was lower at 3 stars.
Some of the dominant health insurers on the public insurance exchanges had star ratings below the national average.
Centene Corp., the ACA kingpin with 1.9 million exchange members, scored an overall quality rating of 3.3 stars across its plans in different states. Centene also came up short of the national average in each of the three subcategories, scoring 3.1 stars for medical care, 2.5 for member experience and 3.2 for plan administration. Centene did not comment on the scores by deadline.
National health insurer Anthem’s exchange plans had an average 3.6-star rating, also short of the national average. Anthem, which declined to comment, retreated from the ACA exchanges in 2018 after losing money, but still sells plans in at least seven states and has said it will continue to participate where the market is stable. The insurer doesn’t publicly report its ACA exchange membership, but its on- and off-exchange individual membership totaled 741,000 on June 30.
Molina Healthcare, which covers 308,000 exchange members, had an overall star rating of 2.7, with similar scores for medical care and plan administration. But the Long Beach, Calif.-based plan scored a 2-star rating for member experience. Molina, which is in the middle of a push to overhaul its company under a new management team, said in an emailed statement that the star ratings “offer valuable insight on areas where we are doing well and where we can improve.”
On the flipside, other big ACA exchange players had star ratings above the national average. One of those was Blue Cross and Blue Shield of Florida, which covers more than 1 million exchange members and received a 4-star rating for each of its two plans in the state.
Kaiser Foundation Health Plan had a 4.8-star rating. Of the 36 5-star plans, Kaiser owns eight, CMS data shows.
Three plans received one star. Those included New Mexico’s Christus Health, Meridian Health Plan of Michigan, which was acquired by WellCare Health Plans, and Montana Health Cooperative’s Idaho plan.
The New Mexico Superintendent of Insurance this week barred Christus Health, which covers about 1,100 individual insurance members, from selling exchange plans in 2020 for failure to get certified as a qualified health plan. A spokeswoman for the superintendent said the 1-star rating was not a factor.
The insurance industry’s lobbying group America’s Health Insurance Plans said it couldn’t weigh in on specific plans’ star ratings, but said the expansion of quality measures “is a positive step to help consumers review and select a plan that fits their needs for the year.”
Following pilots in a handful of states, the federal government will start posting these star ratings, updated for 2020, for all exchange plans on HealthCare.gov when shoppers search for plans during open enrollment for 2020 coverage starting Nov. 1. State-run exchanges will also be required to post star ratings. The point, the agency said, is to help people make informed decisions and compare plans when shopping, while also encouraging health insurers to improve their quality.
It’s the latest in the CMS’ string of initiatives meant to bring more transparencyto healthcare and it comes when the ACA marketplace has stabilized enough to concentrate on things like quality ratings instead of just keeping the market afloat.
Many insurers that once fled the exchanges for fear of financial losses started crawling back to sell plans during open enrollment for 2019, and even more are returning to sell plans next year. Premium increases for 2020 are looking modest and there are also some plans requesting decreases in rates, Robert Wood Johnson Foundation’s Hempstead explained.
The CMS’ plan to post star ratings would allow shoppers to compare plans based on quality in addition to price, but it’s unclear if shoppers will take advantage of that. If they do, health insurers could be pressured to improve their ratings and the value they offer to customers.
A similar star ratings program exists in Medicare Advantage, but evidence shows seniors don’t focus on those ratings when choosing a plan, said Richard Lieberman, chief data scientist at Mile High Healthcare Analytics. Still, he said seniors opt for plans that offer extra benefits, like eyeglasses and non-emergency transportation. Plans that offer extra perks are those that received bonuses from the CMS for having four or more stars.
There’s no indication the CMS will reward ACA exchange plans for high quality scores, so it’s unlikely high scorers will offer extra benefits. That said, the exchange population of younger people who are used to comparing product quality on websites like Amazon and Yelp are more likely to take health plan star ratings into account.
“The question is: Will the plans advertise to try to move people around? If they do, younger people tend to be more sensitive to quality advertising,” Lieberman said.
In a region with a clear star winner, for example, a 5-star plan could lure customers by advertising its rating compared to its competitors.’ Lieberman cautioned that Medicare Advantage plans have learned to manipulate their star ratings; it’s possible exchange plans will do the same.
Other experts said displaying quality scores will provide little benefit in areas of the U.S. that lack competition.
“A lot of people don’t have much choice, whether it’s because of cost or where they live,” said Cynthia Cox, vice president at the Kaiser Family Foundation. “If someone is coming to the exchange to shop for coverage and sees their only option has two stars, I don’t know what the consumer is supposed to do with that information.”
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