Table 2.
Associations Between Insurer Type and Summary Ratings
| Clinical quality management | Enrollee experience | Plan efficiency, affordability, and management (plan administration) | ||||
|---|---|---|---|---|---|---|
| Coefficient*(95% CI) | P | Coefficient*(95% CI) | P | Coefficient*(95% CI) | P | |
| Insurer type | ||||||
| NFP | 0.30 (0.10 to 0.51) | 0.004 | 0.07 (− 0.14 to 0.28) | 0.51 | 0.24 (0.05 to 0.42) | 0.01 |
| PSHP | 0.36 (0.11 to 0.62) | 0.005 | 0.27 (0.03 to 0.50) | 0.03 | 0.17 (− 0.10 to − 0.44) | 0.22 |
| MMCO | − 0.11 (− 0.35 to 0.12) | 0.34 | − 0.38 (− 0.63 to − 0.13) | 0.003 | − 0.44 (− 0.73 to − 0.15) | 0.003 |
| Blue | 0.12 (− 0.14 to 0.39) | 0.37 | 0.06 (− 0.19 to 0.30) | 0.64 | − 0.48 (− 0.75 to − 0.22) | < 0.001 |
| PPO | − 0.04 (− 0.26 to 0.18) | 0.70 | 0.26 (0.05 to 0.47) | 0.02 | − 0.33 (− 0.55 to − 0.11) | 0.003 |
| Market controls | ||||||
| Rurality | − 0.72 (− 1.70 to 0.25) | 0.15 | 0.74 (− 0.15 to 1.63) | 0.10 | − 1.20 (− 2.17 to − 0.23) | 0.02 |
| Competition | − 0.06 (− 0.20 to 0.09) | 0.43 | − 0.10 (− 0.24 to 0.04) | 0.17 | − 0.04 (− 0.23 to 0.16) | 0.71 |
| Mean (SD) | 3.20 (0.86) | 3.05 (0.86) | 3.46 (0.84) | |||
| R-squared | 0.58 | 0.59 | 0.43 | |||
| N | 378 | 356 | 359 | |||
Data are from Centers for Medicare and Medicaid Services Quality Rating System 2019 and 2020 databases. Insurer types are identified with the 2016 National Association of Insurance Commissioners report and the Robert Wood Johnson Foundation’s Marketplace insurer-type data. Among five insurer types, only Medicaid focus (Medicaid-managed care organization or MMCO) and Blue Cross affiliate are mutually exclusive. More details can be found in Appendix Table A2. Insurer type is classified by insurer’s non-profit ownership, Blue Cross Blue Shield affiliation, Medicaid focus, preferred provider organization status, and whether the plan is vertically integrated with a provider organization (“provider-sponsored health plan” or PSHP). Reported coefficients were estimated from multivariate linear regression models of quality scores that included insurer-product type indicators, market controls, and state fixed effects; standard errors were clustered by insurer. Market competition is measured by number of competitors in each insurer’s geographic market, and rurality data are obtained from the Health Resources and Services Administration’s Area Health Resources File. Both market competition and rurality are weighted by county population. Sample sizes vary as a quality score is not calculated by CMS when insurer product provides insufficient data according to the QRS rating methodology. More details can be found in the 2020 and 2021 QRS and QHP enrollee survey technical guidance documents
*Coefficients represent the absolute difference in mean quality scores associated with belonging to a given insurer-product type. For example, a coefficient of 0.36 for PSHP indicates that insurer products that are of the PSHP type are associated with a quality score that is 0.36 points higher, on average, than insurer products that are not of the PSHP type