CHA News Article

Covered California Announces Release of Quality Rating System
Will expand information on hospital, medical group and physician quality in future versions of QRS

Covered California announced today that it recently added a quality rating system (QRS) to its website to aid consumers in their selection of health plans. The QRS gives a rating of one to four stars, with four stars being the highest. The scores, from the nationally recognized Consumer Assessment of Healthcare Providers and Systems (CAHPS), are based on reported experiences of members about access to care, including getting doctor appointments, tests and treatments; customer service; and medical care. The ratings are based on consumer surveys for the most recent year they are available — in most cases, from 2011. The surveyed members were reporting on care received before the launch of Covered California. In future years, plans will be rated by members enrolled in Covered California plans.

To assign the star rating, each health plan is compared with results for health plans across the western U.S. region. A four-star rating means a plan placed in the top 25 percent of all rated plans. Three stars are given for those that landed in the 50- to 75-percent band, while a two-star plan scored in the 25- to 50-percent band of all plans. One star is given for those plans scoring in the bottom 25 percent. The California plans are compared to regional results for PPO (Preferred Provider Organization) network, because they most mirror the types of plans offered throughout Covered California. 

The QRS is in place ahead of the 2016 federal mandate and will be improved over the next two years as the exchange gets more comprehensive performance ratings for health plans. Covered California reports it anticipates expanding its rating system to integrate the national standards when they are available, adding information on hospital, medical group and physician quality. The clinical performance scores will be based on claims data and patient records, in addition to member surveys about exchange plan services starting in 2014.

Consumers may access the quality ratings when they visit www.CoveredCA.com and browse health insurance plan options. The scores are displayed on the summary for each plan. Consumers can review QRS scores in their regions by visiting www.CoveredCA.com/hbex/insurance-companies/qrs.html

The QRS scores by region are also included here:

For background information on the Covered California QRS, see the Oct. 24, 2013, Board Recommendation Brief.

 

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