Blue Cross Blue Shield of Massachusetts boasts one of the highest-quality health plans in the nation, beating out more than 1,000 other products across every insurance market.
In September, the National Committee for Quality Assurance named the best-rated health plans of 2024 based on nearly 50 factors that include patient experience and clinical quality.
Plans were rated on a zero- to five-star scale, with five being the highest rating. In total, 1,019 plans received a rating, and only five health plans received the highest score. Among those five, only three commercial plans received five stars, including the PPO plan from BCBS Massachusetts.
"It's definitely a big deal for us," Mark Friedberg, MD, senior vice president of performance measurement and improvement at BCBSMA, told Becker's.
"We've been a 4.5 star plan for many years on both HMO and PPO but never hit five for our PPO plan, so this is a first for us," he said. "This has been a decade-long effort focused on putting quality and experience first for our members. Hundreds of people across our organization were involved, from those working with our provider partners to improve the quality of care our members receive, to those involved in contracts and providing support to ensure members have access to high-quality care."
A key factor behind the high rating is BCBSMA's Alternative Quality Contract, which launched in 2009 and helped set the stage for the development of accountable care organizations before the Affordable Care Act. The AQC emphasizes quality and patient experience within its incentive structure, alongside managing total medical expenses, to incentivize affordable care.
Since its inception, the program has been continually upgraded to meet the evolving needs of BCBSMA members. The most recent enhancement includes the addition of an equity component, making the company the first health plan in the nation to incorporate specific equity measures into an ACO-type payment model.
"Our biggest challenge has been navigating the aftermath of the pandemic, especially in Massachusetts, where many medical services were delayed due to shutdowns," Dr. Friedberg said. "This created a backlog of necessary care, such as screening colonoscopies. We've had to work closely with our provider community to offer alternative screening options, like fecal immunochemical testing and Cologuard, to ensure members receive timely, evidence-based care despite the delays."
BCBSMA's data submission efforts to the NCQA are focused on two primary areas: technical quality measures and member experience surveys. The first area involves monitoring prevention and chronic disease management through data collected from billing claims, such as mammograms for breast cancer screening, and clinical data exchanges with provider partners to track conditions like blood pressure throughout the year. That data is submitted annually to the NCQA, which conducts audits to ensure the accuracy and validity of the information.
The second area of focus is the CAHPS survey, which evaluates member experience. The survey is administered by an NCQA-authorized vendor, which maintains the integrity of the process by managing all aspects of survey distribution and data collection. Payers receive only aggregated scores, ensuring that individual member responses remain confidential and do not influence their service or care.
"Ultimately, maintaining high-quality care requires a strong internal quality management program, good relationships with providers, and a team dedicated to supporting our members directly and through provider interactions," Dr. Friedberg said.