Executives at both plans said clinical integration and a focus on quality improvement were key to achieving the top rating.
NCQA ratings are based on clinical measures, the plans’ accreditation status and efforts made to keep improving. The group rated a total of 624 MA plans in 2024.
Menasha, Wisc.-based Network Health was one of the MA plans earning five stars for 2025. The insurer is owned by Froedert-ThedaCare Health.
Integration with the Froedtert-ThedaCare is the “secret sauce” to quality outcomes, Coreen Dicus-Johnson, CEO of Network Health, told Becker’s.
The insurer collaborates with providers to identify areas for clinical improvement and funds these initiatives, Ms. Dicus-Johnson said.
“There’s a level of experimentation that facilitates not only our relationship, but being able to move the needle on these measures,” she said. “Once a provider tries it, we share best practices with the other provider systems. Our focus is that all boats will rise from this.”
Network Health achieved the five-star rating for the first time this year by zeroing in on areas such as comprehensive diabetes care and follow-up care for members visiting the emergency department for substance use, Ms. Dicus-Johnson said.
Kaiser Permanente Colorado was the only other Medicare Advantage plan to earn a five-star rating from NCQA this year.
Wendolyn Gozanksky, MD, vice president and chief quality officer for Colorado Permanente Medical Group, told Becker’s Kaiser Permanente’s integrated care and coverage platform is key to high-quality outcomes.
“We have those personal connections with patients, and we also can look at the bigger population. Bringing those two things together, I think, is the secret sauce that allows us to get really high-quality outcomes that meet members where they are.”
Kaiser Permanente Colorado has worked to increase the number of Medicare members receiving annual total health assessments, which identifies health conditions alongside social determinants of health and other factors, Dr. Gozansky said.
“That allows us to have a better picture of our Medicare members, and to tailor care to truly meet their needs as a whole person,” she said.
Both plans identified data as a key to success. Network Health has built out its own data warehouse over the past eight years, Ms. Dicus-Johnson said, and has focused on making sure the data it collects is useful to providers. Network Health surveys providers for feedback on its data.
“It starts with us collecting [data], understanding it, knowing what to do with it, making sure it’s actionable,” she said. “It’s just as important to share that information with our provider partners, who can ensure it’s being utilized appropriately.”
Network Health has more than 70,000 Medicare Advantage members. Though the plan is smaller, its team operates with a “mindset of abundance,” Ms. Dicus-Johnson said.
“We’re a small health plan, but we know how to utilize the resources that we have in a way that differentiates us from our competitors,” Ms. Dicus-Johnson said. “We can get in our cars and drive to the places where we can be face-to-face, and sit down with the data shoulder-to-shoulder with our provider partners. Quite frankly, that’s where innovation happens.”
Getting buy-in from staff at Kaiser Permanente is the easy part when it comes to high quality, Dr. Gozansky said.
“Everyone wants to be able to provide high-quality care,” she said. “We know the highest-quality care is the most affordable. That means more people are going to be able to get access to our care, and we’re going to be able to improve health outcomes for our communities. So it is really easy to get buy-in.”
