UPMC Health Plan earns High Ratings from NCQA for 2023

Pittsburgh (Sept. 28, 2023) – UPMC Health Plan announced that the National Committee for Quality Assurance (NCQA) awarded 4.5 out of 5 Stars to select plans that are part of UPMC Health Plan’s suite of insurance products, making these plans among the highest NCQA rated plans in Pennsylvania. UPMC for You, is among the top-rated Medicaid plans in the nation with a 4.5 out of 5 in NCQA’s Medicaid Health Plan Ratings for 2023, an increase from 4 out of 5 in prior years.

"These high-quality ratings across our plans reflect UPMC Health Plan's unwavering commitment to clinical quality improvement and the betterment of health care outcomes for the patients and communities we passionately serve," said Carrie Whitcher, UPMC Health Plan's Chief Quality Officer and Vice President for Quality Performance. "This commitment to quality ensures our members—whether covered by our Medicare, Medicaid or Commercial plans—have access to the care they need, when they need it."

NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance.

Nine of UPMC Insurance Services Division’s entities received NCQA Health Plan Ratings. Highlights include the following:

• UPMC for You Inc. is one of only two Medicaid plans in Pennsylvania to receive an overall rating of 4.5 out of 5 Stars in NCQA's Medicaid Health Plan Ratings 2023.
• UPMC Benefit Management Services is the highest-performing Commercial EPO/PPO in Pennsylvania with a rating of 4.5 out of 5 Stars in NCQA's Commercial Health Plan Ratings 2023.
• UPMC Commercial HMO products (Benefits Management Services Inc., UPMC Health Coverage Inc., and UPMC Health Plan Inc.) are among the top-rated Commercial HMO plans in Pennsylvania with a rating of 4.5 out of 5 Stars in NCQA’s Commercial Health Plan Ratings 2023.

NCQA Health Plan Accreditation and Health Plan Ratings
UPMC Health Plan is NCQA Health Plan Accredited across its Commercial, Medicaid, and Medicare product lines. NCQA Health Plan Accreditation evaluates how well a health plan manages all parts of its delivery system—physicians, hospitals, other providers, and administrative services—to continuously improve the quality of care and services provided to its members.

How Plans are Rated
NCQA accredits and certifies a wide range of health care organizations, and it manages the evolution of Healthcare Effectiveness Data and Information Set (HEDIS®), the performance measurement tool used by more than 90 percent of the nation’s health plans. Health plans are rated in three categories: private/commercial plans in which people enroll through work or on their own; plans that serve Medicare beneficiaries in the Medicare Advantage program (not supplemental plans); and plans that serve Medicaid beneficiaries. NCQA ratings are based on three types of quality measures: measures of clinical quality from HEDIS; measures of patient experience using the Consumer Assessment of Healthcare Providers and Systems (CAHPS®); and results from NCQA’s review of a health plan’s health quality processes (NCQA Accreditation). NCQA rates health plans that choose to report measures publicly.

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About NCQA

NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS) is the most widely used performance measurement tool in health care. In recognition for its leadership in diversity, equity and inclusion, NCQA has won the Excellence in Diversity Award from the Chesapeake Human Resources Association. NCQA's website (ncqa.org) contains information to help consumers, employers and others make more-informed health care choices. NCQA can be found online at ncqa.org, on Twitter @ncqa, and on LinkedIn at linkedin.com/company/ncqa.

About UPMC Insurance Services

UPMC Insurance Services serves nearly 4.5 million members and is owned and operated by UPMC, a world-renowned health care provider and insurer in Pittsburgh, Pennsylvania. UPMC Insurance Services provides commercial products through UPMC Health Plan for both groups and individuals. Its commercial products also include workers' compensation and employee assistance from nationally known Workpartners^®. Government products include Medicare Advantage plans (UPMC for Life); special needs plans for those who are eligible for Medicare and Medical Assistance (UPMC for Life Complete Care and UPMC Community HealthChoices); a Medical Assistance plan (UPMC for You); and Children's Health Insurance Program plans (UPMC for Kids). Community Care Behavioral Health Organization—one of the nation's largest nonprofit managed care behavioral health organizations—is also part of the Insurance Services Division. Community Care offers a full range of services to commercial and Medical Assistance members. For more information, visit upmchealthplan.com.