California Health Plans Compared to Health Plans Nationwide

What do the scores mean?

California’s health plans’ quality scores are compared to results of health plans throughout the United States. A set of standard patient experience measures are used to compare the average performance among health plans in California to the health plan national average and to the best performing plans in the country. The 90th percentile results are scores that are better than 90 percent of the plan results nationwide. These scores largely are based on patient care provided in 2019. The California plans’ scores are the average across all California health plans. The nationwide results are from health plans located throughout the United States and were calculated giving equal weight to each plan’s score regardless of its number of enrollees.

What Is the Source?

The National Committee for Quality Assurance (NCQA) collects and reports on CAHPS measures as part of its nationwide health plan accreditation program. These health plan scores include PPO plans as well as several managed healthcare insurance products which are commonly called HMO and POS (Point of Service) health plans. This comparison of California health plans to national scores uses data that was reported in the NCQA 2020 Quality Compass®.
There were concerns about the impact of COVID-19 on CAHPS data collection and response rates, and the potential for response bias because members were asked to reflect on their health care experiences over the previous year while simultaneously living through a pandemic. For this reason, NCQA has withheld individual plan performance rates, but is able to provide a high-level average of California health plan performance reliably.
Scores for the CAHPS® topics are based on the percentage of members who gave high scores or the most positive answers ("always" or "usually" for most questions) to the survey question. For most questions, answers are scored using one of four possible choices ranging from the member “always” had a positive experience to the member “never” had a positive experience.

 

California Average:

California Health Plans

National Average:

Health Plans Nationwide

National 90th Percentile:

Top Health Plans Nationwide
Doctor Communicates with Patients 95% 94% 97%
Getting Appointments and Care Quickly 86% 80% 90%
Getting Doctors and Care Easily 87% 81% 92%
Patient and Doctor Share Decisions NA NA NA
Coordinated Care 84% 83% 89%
Health Care Highly Rated 55% 52% 63%
Health Promotion NA NA NA
Rating of Doctor 71% 67% 77%
Rating of Specialist 69% 67% 75%
Customer Service 90% 87% 96%
Paying Claims 86% 95% 90%
Plan Information on What You Pay NA NA NA
Rate Their Health Plan 44% 47% 58%

 

NA: measure was retired for MY2019 (RY2020)