Tufts health plan rated among the best by magazine

A high-profile review of America’s health plans has ranked Tufts Health Plan’s HMO/POS combined product at No. 2 among commercial plans nationwide, giving the Watertown, Mass.-based insurer a nice boost as it begins to offer coverage in Rhode Island again.
Another familiar name, Harvard Pilgrim Health Care, was No. 1 in the rankings of “America’s Best Health Plans,” which were published in the Nov. 17 issue of US News & World Report and produced in collaboration with the National Committee for Quality Assurance (NCQA).
Timed to coincide with open-enrollment season, when millions of U.S. workers select their health plan for the coming year, the rankings cover nearly 700 commercial, Medicare and Medicaid health plans, with detailed data available online at www.usnews.com/healthplans.
The rankings are based on the plans’ scores on more than 100 aspects of prevention, treatment and consumer experience, such as how quickly members receive needed care or how well a plan controls blood sugar levels in individuals with diabetes.
New England-based plans dominated the top ranks of the commercial plans, with Harvard Pilgrim Health Care of New England, in New Hampshire, at No. 3; Health New England, of Connecticut and Massachusetts, at No. 6; Anthem Blue Cross and Blue Shield – Connecticut at No. 7; Blue Cross and Blue Shield of Massachusetts at No. 9 and CIGNA HealthCare of New Hampshire at No. 10.
Three New England insurers made the Top 10 among Medicare plans: Blue Cross and Blue Shield of Massachusetts was No. 4; Blue Cross & Blue Shield of Rhode Island was No. 6, and Tufts was No. 10.
Among Medicaid plans, Fallon Neighborhood Health Plan and Neighborhood Health Plan, both of Massachusetts, were No. 1 and No. 2, respectively, while Neighborhood Health Plan of Rhode Island was No. 4. Blue Cross & Blue Shield of Rhode Island was No. 8 and UnitedHealthcare of New England was No. 10.
This is the fourth year in a row that all three of the RIte Care Medicaid managed care plans have made the Top 10, a point highlighted by RIte Care as the program faces yet more expected cuts to help balance the state budget.
“These rankings remind us of the strong commitment Rhode Island has to delivering quality, affordable health care to those most in need,” said Merrill Thomas, CEO of Providence Community Health Centers, in a news release.
On the commercial side, meanwhile, the state’s two dominant insurers did better than average, but they didn’t shine as much. Blue Cross & Blue Shield of Rhode Island came out at No. 32 (out of 287) , with a score of 86.5, while Harvard-Pilgrim and Tufts both scored 91.2.
Blue Cross got its highest scores for preventive care, especially child and adolescent well visits and women’s reproductive health, as well as for its handling of heart disease. It was somewhat weaker on asthma care, and in a blow to the company, which prides itself on its handling of mental-health issues, it scored poorly – one of five stars – for depressed patients’ short- and long-term adherence to medication, though it got five stars for alcohol and drug- dependence treatment.
In terms of consumer satisfaction, Blue Cross earned four stars for the care received and for satisfaction with physician services, but only three stars for the rating of the plan itself.
UnitedHealthcare of New England was ranked No. 70 in the commercial category, scoring 84.0, but with a dismal one-star customer rating of the plan itself – though the care received and the physicians got three stars each – and three-star scores on most clinical quality measures.
United did best on child and adolescent well-care, with five stars almost across the board. It did worst on postpartum care, earning a single star, vs. Blue Cross’ five.
Tufts, on the other hand, earned five stars for customer satisfaction with the plan itself – though not across the board; customers were less happy (three stars) with how quickly they received care and with the claims processing system.
On clinical measures, meanwhile, Tufts earned five-star ratings in every major category and in many of the subcategories. Among its few relative weaknesses: While it scored five stars on prenatal care, it got only three stars for postpartum care. Its only two-star score was for the appropriate use of antibiotics in adults with acute bronchitis.
Tufts issued a news release celebrating the No. 2 ranking – which it’s gotten for three years in a row. In it, Dr. Allen Hinkle, senior vice president and chief medical officer, noted that Tufts’ programs “are designed to improve the health of our members and to responsibly control costs with the goal of achieving the best value … by balancing quality and cost.”
“Our successful medical-management program is evolving to include more than evidence-based medicine,” he added. &#8226