NCQA has just released its 2023 health plan ratings. These ratings are based on health plans that publicly report their quality measures (via the Healthcare Effectiveness Data and Information Set – HEDIS®) and represents about two thirds of the entire US population.
Overall, there is a slight improvement in performance from health plans versus 2022 – especially around health equity – where 92% of plans reported the direct race and ethnicity measure – scoring maximum points on this measure.
Two commercial plans received 5-star ratings – Kaiser Foundation Health Plan of the Mid-Atlantic States and Independent Health Association (which is up from 1 plan last year). No Medicare or Medicaid plans received 5 stars this year.
With these ratings now released, we will eagerly anticipate the October release of 2023 Stars ratings to see if drop in performance last year was a “blip”, with recovery this year or if more plans will see the post covid impact on their ratings.
Regardless of overall trends, if you are a health plan looking maximize your ratings, my strong advice is that you turn to technology and AI solutions to ensure you are reporting accurately – and not being penalized for care gaps that exist on paper but not in practice.
How do you do this? With AI assisted medical record review – as a health plan, you can increase the volume and accuracy of supplemental data or electronic data you review and submit as part of your quality reporting. This use of such technology has seen health plans and ACOs increase efficiency of medical record reconciliation and review by over 10x.
As we approach HEDIS® season – it's not too late to make the boost you need with NLP.
If this is of interest to you – then please get in touch.