For the seventh year in a row, Capital Health Plan is near the top of national rankings issued by the National Committee for Quality Assurance. And as usual, it is the only Florida plan to make the top-20 list in the private insurance market.
Capital also made the Medicare plan honor roll. No Florida plan made the Medicaid list.
Capital, a non-profit that operates in seven counties around Tallahassee, made the number 3 slot among private plans. The top ratings went to the Boston-area plans Harvard-Pilgrim and Tufts.
Capital is a familiar name on the NCQA honor roll. It issued a press release quoting Chief Medical Officer Nancy Van Vessem:: "We are extraordinarily proud to be ranked again among the top plans in the country. We are constantly working to improve the quality of our programs, and being recognized by NCQA seven years running is a tremendous honor."
NCQA accredits and certifies health-care organizations, including managed-care plans. Its Healthcare Effectiveness Data and Information Set (HEDIS) is widely used in the industry for measuring clinical performance.
The annual rankings draw on HEDIS scores and consumer opinion surveys.
Capital's announcement of the rankings may confuse the public because the headline says it is "the highest-ranked HMO in the nation," even though Harvard-Pilgrim and Tufts are listed above it on the NCQA list.
A spokeswoman for Capital said that it is a mixed-model HMO, which means some of its doctors work in plan-owned clinics while others work under contract from their own offices. The Boston plans are "point-of-service" HMOs, which have more flexibility for patients who want to go out of network. NCQA categorizes them differently, she said, but then puts them together for the annual list.
Kaiser-Permanente, a non-profit based in Oakland, CA., and its subsidiaries in other states, dominate the lists in every category, every year. Kaiser plans are not available in Florida.
----Health News Florida is journalism for a healthy state. As a part of WUSF Public Media, it provides in-depth coverage of health issues and policy. Question? Comment? Contact Carol Gentry, Editor, at 813-974-8629 or 727-410-3266 or Carol.Gentry@HealthNewsFlorida.org.
