URBANA – Health Alliance Medical Plans has been ranked one of the nation's top 10 health plans in a study just released by U.S News & World Report.
An Urbana managed care company owned by Carle Clinic, Health Alliance was ranked 10th best in the nation for its Health Maintenance Organization (HMO) and Point of Service plans on a list of 257 commercial health plans nationwide.
Point of Service plans are modified HMOs, in which members pay more for care obtained outside their local provider network.
Jeff Ingrum, Health Alliance's chief executive, said about 150,000 of his company's 250,000 members are in HMOs, and the rest are in Point of Service or Preferred Provider Organization (PPO) plans, with PPOs excluded from the ratings.
Champaign-based PersonalCare – which is part of Coventry Health Care of Bethesda, Md. – was ranked 52nd in the nation for its HMO.
Fewer than 10 percentage points separated the ranking of the top 100 plans, with total scores for the top 100 falling between 87 for 100th-ranked United Healthcare of New England and 94.2 for top-ranked Harvard Pilgrim Health Care.
Health Alliance scored a total 91.5 in the rankings, and PersonalCare scored 88.8.
Ingrum said there are about 600 commercial health plans nationwide, but the others weren't ranked because they don't submit themselves to the scrutiny of the National Committee for Quality Assurance, the major accrediting body for managed care plans. U.S. News & World Report collaborated with the National Committee for Quality Assurance to compile the rankings.
Information was collected on such quality-of-care measurements as how diligently the plans provide preventative tests and immunizations and how appropriately they monitor and medicate a variety of diseases, the magazine said.
Plans were given between one and five stars in each of the categories – access to care, overall member satisfaction, prevention and treatment – with five stars being the best.
Health Alliance received five stars in member satisfaction and four stars each for access to care, prevention and treatment measures.
PersonalCare, whose officials couldn't be reached for comment, received three stars in member satisfaction and four stars in each of the other three categories.
Ingrum said Health Alliance received the top score – 87.8 percent out of 100 – among all 257 plans on the list for how satisfied members are with the care they get from their doctors and nurses. The average score was 77.6.
Being a local community plan, the company has put a lot of emphasis on having enough staff handling customer service, Ingrum said. For example, Health Alliance installed a new Voice over Internet Protocol telephone system a few years ago to make sure customer service employees can provide the answers members need while they're still on the line.
On individual quality measures, both Health Alliance and PersonalCare were ranked above average in providing access to care for children and adolescents, member satisfaction, providing regular mammograms for women, overall diabetes care, managing high blood pressure, providing cholesterol checks and providing appropriate medication for asthma.
Health Alliance was above average in providing appropriate medication for depression and PersonalCare was just a hair below average in that measurement.
How much stock should managed care members place in these rankings?
Accreditation by the National Committee for Quality Assurance is one measure of health plan quality – but it's not the only one – said Cathy Eddy, president of Irving, Texas-based Health Plan Alliance, an organization that represents provider-sponsored health plans.
Health plans that lack NCQA accreditation aren't necessarily bad ones, she said, but "it's one thing I think is important."
Not only does it reflect a certain level of quality and accomplishment, Eddy said, the process of achieving it requires a discipline and commitment to improvement on the part of the health plans.
"It's something they spend a lot of effort on, and take very seriously," she added.