close
close

Florida Medicaid’s managed care plans score middle of the road on new report cards • Florida Phoenix

Posted on by Pranco
Florida Medicaid’s managed care plans score middle of the road on new report cards • Florida Phoenix

Florida Medicaid managed care plans — the coverage provided to millions of low-income residents of the state — scored in the middle on industry report cards that rated the quality of care people receive.

The National Committee for Quality Assurance (NCQA) released its Report Cards 2024 that offer commercial, Medicare, Medicaid, and plans offered on the federal health insurance exchange.

In Florida, no Medicaid managed care plan that contracts with the state earned more than 3.5 stars out of a possible five. website shows.

Four of the 10 Florida Medicaid health care organizations listed in the report scored 3.5 on a scale of five: Aetna Better Health of Florida, AmeriHealth Caritas, Molina Healthcare Florida and UnitedHealthcare of Florida, which operates as UnitedHealthcare Community Plan.

Another four plans scored 3s: Humana Medical Plan Inc., Simply Healthcare Plans, the South Florida Community Care Network (which operates as Community Care Plan) and Sunshine State Health Plan.

Molina Healthcare of Florida (SMI), a special plan for Medicaid beneficiaries with serious mental illnesses, scored a 2.5.

Florida Community Care Plan (unlike South Florida’s health care network) is accredited by the American Association for Ambulatory Health Care. It reported no data to the NCQA and does not have a report card score.

GET THE MORNING CREDITS.


NCQA’s annual report cards score plans from 0-5 in increments of 0.5.

The 2024 plan assessments are based on the weighted average of the results from three data sources. Two of them, the Healthcare Effectiveness Data and Information Set (HEDIS) data reported to NCQA and the Center for Medicare and Medicaid Services’ Health Outcomes Survey (HOS) assess clinical quality. The third data source, the Consumer Assessment of Healthcare Providers and Systems (CAHPS), analyzes patient satisfaction. NCQA awarded bonus points based on accreditation.

Audrey Brown via FAHP

Florida Association of Health Plans President and CEO Audrey Brown said improving health care quality and access remains a top priority for Florida’s contracted Medicaid managed care plans.

“Day in and day out, Florida health plans ensure they provide Floridians with the right service, at the right time, in the right place and in the most appropriate environment. This results in better care for members and delivers value to the state,” Brown said in a written statement. “To this end, health plans are continually implementing programs aimed at improving HEDIS scores in Florida.”

Brown said that while measuring quality is critical, it can also be difficult.

“Methodologies change over time, and the subgroups of populations included in the assessments are changing rapidly. For example, with Medicaid, members do not always remain members for a longer period of time. Quality scores fundamentally reflect a particular perspective at a particular point in time. As such, HEDIS scores alone are not a complete assessment of the quality and delivery of care,” she said.

Look inside at the numbers

UnitedHealthcare outperformed its competitors in Florida in immunizing adults against flu, tetanus, diphtheria, shingles and pneumonia, achieving scores of 2, 3, 3 and 2, respectively.

Four of the plans – Aetna, Simply, Community Care and Sunshine – scored the lowest, earning 1s across the board for adult immunizations against these diseases and viruses.

Scott Olson/Getty Images

Florida-based Molina Healthcare beat other plans in immunizing children. It earned 4 points for compliance with vaccination recommendations for children under two years of age and adolescents.

None of the plans scored higher than 2.5 in the behavioral health coordination category, which tracks follow-up care provided to people admitted to an emergency room or inpatient setting for mental illness or substance abuse.

Likewise, none of the plans scored higher than 2.5 in the women’s reproductive category, which includes information on prenatal care, postnatal care and prenatal immunizations. Four of the plans – Molina, Molina SMI, Simply and Sunshine – scored a 1.5

New Medicaid managed care contracts

Florida requires most Medicaid enrollees to use managed care plans. To ensure that the state receives the best value and care for its beneficiaries, state law requires competitive bidding. Managed care plans compete with each other in hopes of winning six-year contracts worth billions of dollars annually and tens of billions over the life of the contract.

The NCQA released the report cards after the state completed its most recent negotiations with the health plans. The state agreed to contract with all of the above health plans except AmeriHealth Caritas, which earned a 3.5 on the 2024 report card.

The Agency for Health Care Administration, which controls Florida’s Medicaid program, did not immediately respond to a request for comment on the health plans’ performance.

While no Florida-contracted Medicaid health plan earned more than 3.5 stars, that’s not the case elsewhere.

Nationally, 45 Medicaid managed care plans earned 4 stars, and Wisconsin had the most Medicaid plans (seven) earning 4 stars, followed by Pennsylvania (6) and California (5).

FAHP’s Brown cautioned against comparing plans from different states.

“Comparing Florida to other states is apples and oranges. Different states have different quality rating systems, different demographics, geographic areas and more,” Brown said.

She added, “Health plans take HEDIS scores seriously and will continue to work with our state partners to adopt innovative solutions to increase access to care and engage Floridians to continue supporting healthier communities.”

YOU MAKE OUR WORK POSSIBLE.