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Administration for Community Living 

Tip Sheet 

Assessing Health Plans’ NCQA HEDIS Performance 

Purpose: 

The purpose of this tip sheet is to provide information on how to determine how a 

specific health plan performed on the National Committee for Quality Assurance’s 

(NCQA) Health Effectiveness Data and Information Set (HEDIS) measures. 

Background: 

NCQA administers the HEDIS performance measurement program for health plans. 

HEDIS is a set of performance measures utilized by more than 90% of US health 

plans. HEDIS measures provide a method to directly compare quality and 

performance across health plans. In addition, health plans must maintain a certain 

level of HEDIS performance in order to participate in the Medicare Advantage 

program as well as Medicaid. Health plans that score poorly on HEDIS measures 

and STAR ratings can face financial and contractual penalties that are imposed by 

the Centers for Medicare & Medicaid Services (CMS). 

HEDIS consists of 81 measures across five (5) domains of care. HEDIS measures are 

used to compare how well a health plan performed in the following areas: 

 Quality of care 

 Access to care

 Member satisfaction with the health plan 

Additional measures have been added to the HEDIS data set to measure health plan 

performance in providing preventive care services to their members. 

Procedure: 

1. First, access the NCQA website dedicated to providing health plan report cards 

using the following link: 

http://healthplanrankings.ncqa.org

The following screenshot shows the NCQA webpage at that link: 
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2. The webpage defaults to provide a listing of health plans that are in the Private 

(Commercial) category. 
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3. For a Medicare Advantage plan, select the drop down menu and select the 

“Medicare” option: 

4. Once you select the Medicare option, the list will refresh to remove all plans that 

are not Medicare health plans. You now have the option of searching for a plan 

by name by typing the name of the plan in the Search tool: 
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5. First, type in the name of the plan you are interested in, and a listing of plans 

with that name will be provided. Second, select the health plan you’re interested 

in from that list. In this example, we searched for XYZ Health Plan, and found 

there is one plan by that name, which is located in Florida. 

 

XYZ Health Plan

XYZ Health Plan

1st

2nd

6. The summary report will open when you select the plan, which provides the 

overall score that the health plan obtained for each domain. The scores are rated 

from 1 to 5. 1 is the lowest score and 5 is the highest score. Health plans want to 

move as many scores as possible to the 5 category. Identify areas where the 

health plan scored poorly to target your marketing efforts. 

 
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Administration for Community Living 

XYZ Health Plan

www.xyzhealth.com

FL

XYZ Health Plan

9. In order to obtain the detailed scoring for a specific domain, select the plus (+) 

sign next to that category. That category will expand to list specific measures. 

FL

www.xyzhealth.com
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10. Additional detail shows that this health plan has deficiencies in the area of 

“Managing risk of falls”, among others. 

Utility of the Data: 

Knowing how a plan performed in a specific HEDIS measure can provide a direct 

opportunity to propose an evidence-based intervention to help the plan improve its 

HEDIS score. In this example, their current score in the area of managing risk of 

falls could improve. An evidence-based falls prevention program could be a 

welcome service that the plan may wish to purchase from a community-based 

organization.