1. NCQA Rankings: Performance Trends and Updates ACHP Medical Directors Meeting Presenting: Adam Zavadil, Market Strategy and Analysis Director September 21, 2011

2. Outline NCQA’s 2011 Health Plan Rankings methodology Anticipated rankings, performance and trends ACHP resources 2

3. NCQA’s 2011 Health Plan Rankings: Background and Methodology 3

4. 2011 NCQA Rankings NCQA released its 2011 health plan rankings on September 20, 2011. Consumer Reports will again carry the rankings this year. They will appear in the November issue of their print magazine, and be displayed on their website on October 4 th. –ACHP hosted a WebEx with NCQA and Consumers’ Union last week. Ranking methodology remains similar with some changes in measure and plan inclusion. 4

5. 2011 NCQA Rankings (cont.) PPO plans are included in the rankings this year. However, they tend to perform lower than HMO/PPO plans. –Displayed in several ways, including lists of only HMOs and only PPOs. Displays will show only the results from the combined rankings. For example, if the top-ranked PPO is ranked second in the combined rankings, the only number that will appear next to that plan’s name in any display is 2. 386 plans publicly reported data in 2011. 170 were PPOs. More information available at: www.ncqa.org/tabid/1329/Default.aspx www.ncqa.org/tabid/1329/Default.aspx 5

6. 2011 NCQA Health Plan Rankings NCQA released measures and description of method ACHP models the methodology using publicly available data from NCQA’s Quality Compass ® tool The NCQA and ACHP model include 55 measures for the commercial product line: –29 clinical treatment measures –17 access and prevention measures –9 member satisfaction measures Measures weighted a quarter, third, half or full point 6

7. NCQA Ranking Methodology in Brief Roughly: The average scores of all plans is converted to 0 for every measure –Better than average is positive; lower than average is negative Multiply each positive or negative score by its assigned measure weight Apply additional weighting of Effectiveness of Care versus Service scores Add converted, weighted scores across measures. Factor in NCQA Accreditation (data not publicly available) Change to 100 point scale for the magazine publication 7

8. Changes for 2011 NCQA Commercial Rankings Added Measures –Immunization for adolescents (Prevention) –Weight assessment and counseling for nutrition and physical activity Adolescent BMI percentile (Prevention) Counseling on nutrition (Prevention) Counseling on physical activity (Prevention) –Flu shots for adults ages 50 to 64 (Prevention) –Adult BMI (Prevention) –Use of Imaging Studies for Low Back Pain (Treatment) Removed Measures –Blood pressure control (<130/80) (Treatment) 8

9. How Does Each Domain Effect Overall Quality? Commercial 2010 to 2011 9 Domain 2010 Measures Points % of Total 2010 2011 Measures Points % of Total 2011 Clinical Treatment291747%291742% Prevention & Access111028%171434% Satisfaction9910%999% Total493685%554085% 2010 2011

10. 2011 Anticipated Rankings, Performance and Trends 10

11. 2011 NCQA Ranking Estimates ACHP Member Organizations in the Top 50 11 Plan Name ACHP Estimated Rank (without Accrd.) Preliminary NCQA Rank ACHP Summed Z- Score Tufts HMO2248.8 Kaiser – Colorado3644.8 Capital Health Plan43 43.6 Group Health Coop. of South Central Wisconsin57 43.5 Tufts (PPO)64 40.5 Geisinger Health Plan78 40.1 Fallon Community Health Plan91337.4 Kaiser – Southern California101237.3 Kaiser – Northern California121436.9 Kaiser – Northwest162133.0 Geisinger Health Plan (PPO)191730.6 Martin’s Point21Not Accred.29.8 HealthPartners222429.6 Capital District Physicians’ Health Plan242229.2 UPMC Health Plan251829.1 Independent Health28 27.1 Kaiser – Mid-Atlantic States303326.9 Kaiser - Hawaii323725.9 Priority Health344123.9 Security Health Plan363823.4

12. Distribution of ACHP Member Organizations Overall NCQA Rank 2007-2011 (ACHP Modeling) 12 2007 2008 2009 2010 2011 The line represents the 50 th Percentile and the box shows the 25 th to 75 th percentile range

13. Performance Trends 2010 - 2011 HMO/POS performance improved slightly across measure domains: –Clinical Treatment: +0.8 points per measure –Access and Prevention: +1.3 points per measure –Satisfaction: +0.9 points per measure PPO plans showed the stronger improvement trends: –Clinical Treatment: +2.0 points per measure –Access and Prevention: +3.8 points per measure –Satisfaction: +0.6 points per measure 13

14. Score Change by Domain Across ACHP 14 2010 – 2011 Average ACHP Percentage-Point Change * 2010 – 2011 Percentile Rank Change * Clinical Treatment Measures+1.0+3.0 Access & Prevention Measures+2.7+4.7 Service Measures+2.2+4.0 *Includes existing, trend able Measures ACHP plans improved on an absolute and relative basis compared to other health plans last year. Prevention and access gains were the most pronounced among ACHP members.

15. NCQA Rankings - Impact What measures hurt ACHP member organizations in the 2011 rankings? What measures help ACHP member organizations? 15

16. Commercial Clinical Treatment Scores by Percentile Range Across ACHP Over Time 16

17. Commercial Prevention and Access Scores by Percentile Range Across ACHP Over Time 17

18. Commercial Satisfaction Scores by Percentile Range Across ACHP Over Time 18

19. Measures that Hurt ACHP in the 2011 Rankings 19 Measure Average Weighted Z-Score 2011 Average Weighted Z-Score 2010 Doctor Communication-0.270.06 Getting Needed Care-0.21-0.10 Getting Care Quickly-0.18-0.01 Claims Processing Satisfaction-0.080.13 Asthma Appropriate Medication Use (5 to 11)-0.070.08 Alcohol and Drug Treatment Initiation-0.04-0.10 Asthma Appropriate Medication Use (12 to 50)0.000.11 CAHPS ® performance improved this year, but it still represents the area of lowest performance for ACHP member plans as a whole.

20. Measures that Help ACHP in the 2011 Rankings 20 Measure Average Weighted Z-Score 2011 Average Weighted Z-Score 2010 Children Screened for BMI Percentile (Total)1.460.83 Adult BMI Assessment1.360.78 Children Counseling for Physical Activity (Total)1.270.57 Children Counseling for Nutrition (Total)1.200.48 Cervical Cancer Screening1.150.80 Breast Cancer Screening Total1.151.05 Adolescent Immunization Combo 11.08NA ACHP plans performed particularly well on the new obesity-related measures. Screening performance is also a differentiator

21. ACHP Plans Continue to be Top Performers For every measure except one (Claims Processing), an ACHP member organization scores best in the country or above the 95 th percentile. –Of the 55 measures included in the NCQA rankings, an ACHP member is the top plan on 28 of those measures (over 50 percent.) –This is up from 20 measures in 2010. 21

22. Top ACHP Performers – Best in Nation 22 ACHP MemberMeasure 2011 Score Kaiser - Northern CaliforniaAntidepressant Medication Acute Phase Treatment86.9 Kaiser - ColoradoAntidepressant Medication Continuation Phase Treatment75.2 Kaiser - Southern CaliforniaDiabetic Nephropathy Medical Attention95.9 Martin's PointDoctor Communication97.6 Geisinger Health Plan (PPO)Mental Illness Hospitalization 7 Day Follow-up93.3 Martin's PointGetting Care Quickly94.9 Martin's PointGetting Needed Care94.8 Capital Health PlanBreast Cancer Screening Total84.7 Kaiser - ColoradoDiabetic Cholesterol LDL < 10073.9 Fallon Community Health PlanAlcohol and Drug Treatment Engagement46.5 Kaiser - GeorgiaChlamydia Screening Overall78.7 GHCSCWCervical Cancer Screening89.5 Geisinger Health Plan (PPO)Upper Respiratory Treatment for Children98.5 Kaiser - Mid-Atlantic StatesPharyngitis Treatment for Children96.1

23. Top ACHP Performers – Best in Nation (cont.) 23 ACHP MemberMeasure 2011 Score Capital Health PlanColorectal Cancer Screening87.4 Geisinger Health PlanPersistence of Beta-Blocker Treatment96.4 Tufts Associated HMOAccess to Care 7Yrs to 11Yrs99.0 Martin's PointADHD Follow-up Initiation60.9 Martin's PointMonitoring of Long-Term Meds Combined Rate88.8 Capital Health PlanUse of Spirometry to Diagnose COPD68.1 Martin's PointRating of Health Care (9 or 10)75.2 Martin's PointRating of Health Plan (9 or 10)84.6 Martin's PointAsthma Appropriate Medication Use (5 to 11)100.0 UPMC Health PlanAdolescent Immunization Combo 188.8 Kaiser - NorthwestChildren Counseling for Physical Activity (Total)96.5 Kaiser - NorthwestChildren Counseling for Nutrition (Total)96.5 Kaiser - Southern CaliforniaChildren Screened for BMI Percentile (Total)97.3 GHCSCWAppropriate Use of Low Back Imaging89.4

24. ACHP Plans are Top Improvers Too Often the best way to learn how to improve performance is to ask those who have recently improved. Among ACHP member organizations there are recent substantial improvers in many measures. –On 37 of the trend able HEDIS ® measures there is at least one ACHP member organization that has improved at least 5 points within the last year. –On every CAHPS ® measure there is at least one ACHP member organization that has improved their national rank by at least 100 places within the last two years. 24

25. From 2010-11 Top Plans Tended to Improve Faster than Lower Ranked Plans 25

26. 2011 Rankings, Performance and Trend Summary Ranking changes with respect to new measures and PPOs had a mixed effect on ACHP plans. –Many of the top ranked PPOs were run by ACHP member plans –ACHP plans tended to have disproportionately high performance in obesity-related measures Overall ACHP plans have improved in absolute performance, relative performance and national rankings from 2010-2011. This year staying at the top was harder because top plans are improving faster than other plans. 26

27. ACHP Resources 27

28. Resources 2011 HealthPlan Performance Gauge ® ACHP Web site Individual plan chart packs Number Needed to Treat analysis Custom performance improvement presentations 28

29. ACHP’s HealthPlan Performance Gauge ® What is ACHP’s HealthPlan Performance Gauge ® ? –An interactive Microsoft Access database –At least Access 2003 The ACHP HealthPlan Performance Gauge ® –Uses Quality Compass ® and CMS HEDIS ® and CAHPS ® data –Individual and consolidated measures –Single year, multi-year and improvement metrics –Rankings, scores and percentiles –National, regional, state and custom comparison 29

30. NCQA License Agreement ACHP renewed its license agreement with NCQA this year. It was determined as part of the license agreement, that ACHP plans must purchase the Data Exporter, in addition to Quality Compass ®, in order to get the interactive database version of the HPPG™. Plans that just purchase Quality Compass ® can get reports, analyses and presentations from ACHP and a first come, first serve basis. 30

31. Obtaining the HPPG TM Because we will be creating different versions of the HealthPlan Performance Gauge® this year, we have sent the files to individuals based on your organization’s NCQA purchasing status. To get the HPPG™ send an e-mail to Stephen Cox at scox@achp.org. Please indicate in what version of Access you would like the files (2002, 2007 or 2010).scox@achp.org 31

32. ACHP Website – www.achp.org 32 Password “community2011”

33. Customized Packet Highlights Plan-specific Dashboard NCQA Ranking Impact and Change NCQA Ranking Performance Distribution Performance Gap Charts Measure Area Breakdown Trend Charts 33

34. Dashboard 34

35. Measure Breakdown Chart - 2011 35

36. Measure Score Change Chart 2010 - 2011 36

37. Performance Gap Charts 37

38. Measure Area Breakdown Trend 38

39. Upcoming ACHP Events & Analyses October 5: Understanding Rankings Early October: HPPG TM updated with Medicaid and Medicare data Late 2011 – 2012: Star rating improvement best practices 39

40. Contact Us Adam Zavadil Director, Market Strategy and Analysis Alliance of Community Health Plans azavadil@achp.org 202.785.2247 40

41. Phone: 202-785-2247 Fax: 202-785-4060 www.ACHP.ORG 1825 Eye Street, NW, Suite 401, Washington, DC 20006