Optima Health Achieves 4 Out of 5 Rating for Commercial Health Plan

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NCQA awards 4 out of 5 rating to Optima Health for commercial health plan in Virginia. Optima Health the only company in VA’s top three serving Hampton Roads and Central VA. NCQA recognized as national leader in healthcare performance measurement.

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NCQA Rating Seal for Optima Health Private Plan

Our high NCQA ratings affirm the tremendous dedication of Optima Health in providing innovative prevention and treatment services to improve the health of our members.

Out of 17 commercial health plans in Virginia, Optima Health Plan rated among the top three in the National Committee for Quality Assurance (NCQA) Private Health Insurance Plan Ratings 2016-2017, with an overall rating of 4 out of 5. This is the second year in a row Optima Health has rated among Virginia’s top three, since NCQA initiated its current rating methodology in 2015. Optima Health is the only company in Virginia’s top three that serves the Hampton Roads and Central Virginia markets.

Based on clinical quality, member satisfaction and NCQA Accreditation Survey results, the NCQA Health Insurance Plan Ratings are listed for Private (commercial), Medicare and Medicaid health insurance plans. NCQA rates more than 1,000 health plans to compile the report. The organization is widely recognized as the national leader in healthcare performance measurement.

“Our high NCQA ratings affirm the tremendous dedication of Optima Health in providing innovative prevention and treatment services to improve the health of our members,” said Michael Dudley, CEO of Optima Health. “We are working hard every day to provide greater value for our members, through clinical partnerships, enhanced wellness programs and exceptional customer service.”

Optima Health received a rating of 4 out of 5 for both Women’s Reproductive Health and Cancer Screening in the Prevention subcategory. The company also achieved scores of 4 out of 5 in the Treatment subcategory for asthma control; eye exams and glucose control for members with diabetes; providing beta blockers for heart-attack patients; and ensuring first-line psychosocial care for youth on antipsychotic medications.

The Optima Health model of managed care features a clinically integrated network approach, to raise the bar of performance for effective member care and health outcomes. “A great example of how our partnerships are helping to improve the health of our members, and therefore our NCQA ratings, is our colorectal cancer screening program, where we use at home testing to screen members,” said Dr. Sam Basta, Senior Medical Director, Clinical Integration at Optima Health. “When using home testing, we were able to improve our screening rates for colon cancer by 10%, translating to early detection and ultimately, saved lives.”

The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) (1) 5.0 survey, one of the measures used to determine NCQA ratings, also revealed a score of 4 out of 5 in the subcategory of Customer Satisfaction for Optima Health claims processing. Scores from the CAHPS, along with the Healthcare Effectiveness Data and Information Set (HEDIS®) (2) and NCQA Accreditation standards provide the basis for NCQA Health Insurance Plan Ratings.

For 18 consecutive years, Optima Health has received NCQA Accreditation for its commercial HMO/POS health plans, as well as for its Medicaid HMO product. Since 2015, the company has achieved accreditation for its Marketplace HMO plans. (3)

NCQA Ratings and Accreditation measurements provide evidence-based information for consumers and employers in identifying well-managed, high quality health care organizations.

About the National Committee for Quality Assurance
National Committee for Quality Assurance (NCQA) is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and recognizes clinicians in key clinical areas. NCQA's HEDIS® is the most widely used performance measurement tool in health care. NCQA's Web site (http://www.ncqa.org) contains information to help consumers, employers and others make more informed health care choices.

About Optima Health Optima Health, based in Virginia, provides health insurance coverage to approximately 450,000 members. With 30 years of experience in the health insurance arena, Optima Health offers a suite of commercial products including consumer-directed, employee-owned and employer-sponsored plans, individual health plans, employee assistance programs and plans serving Medicare and Medicaid enrollees. Our provider network features 26,000 providers including specialists, primary care physicians and hospitals across Virginia. Optima Health offers programs to support members with chronic illnesses, customized wellness programs and integrated clinical and behavioral health services, as well as pharmacy management – all to help our members improve their health. Our goal is to provide better health, be easy to use and offer services that are a great value. To learn more about Optima Health, visit http://www.optimahealth.com. (4)

(1) CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
(2) HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).
(3) NCQA Accreditation Letters, 1998-2016.
(4) The membership figure includes total membership in all group and individual insured products, Medicare Managed Care Plans, Medicaid and Famis Plans, and self-funded health plans issued or administered by Optima Health. Total Medical Membership based on Membership History Report, June 2016. Includes members from all Optima Health Licenses, products, Medicare and Medicaid products. Optima Health is the trade name of Optima Health Plan, Optima Health Insurance Company, and Sentara Health Plans, Inc. Optima PPO plans, and Medicare Managed Care Plans are underwritten or administered by Optima Health Insurance Company. Optima Vantage HMO plans, Medicaid, and Famis products are underwritten or administered by Optima Health Plan. Sentara Health Plans provides administrative services to self-funded plans but does not underwrite benefits. Employee Assistance Programs (EAP) are administered by Optima Behavioral Health Services, Inc. Wellness programs are administered by Sentara Health Plans. Source for provider network is Optima Health, Provider Status Report, February 2016.

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Pamela Walters
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