Mapulani asanu ndi limodzi okha azaumoyo omwe amapeza ziphaso zapamwamba kwambiri mu NCQA Health Insurance Rankings 2022

M’malo azachipatala aku America, palibe gawo lodalirika kuposa inshuwaransi yazaumoyo. Malinga ndi kafukufuku wa 2021 American Board of Internal Medicine Foundation Poll, anthu 33% okha ndi omwe adanena kuti amakhulupirira makampani a inshuwaransi yazaumoyo, poyerekeza ndi 85% omwe adati amakhulupirira madotolo.

Deta yatsopano yochokera ku National Committee for Quality Assurance (NCQA) ikusonyeza kuti chiwerengerochi sichingakhale bwino.

Mu NCQA’s 2022 Health Plan Assessments, yotulutsidwa lero, kukhutitsidwa ndi chisamaliro kwaipiraipira pakati pa mamembala a mapulani azaumoyo ndi Medicaid. Kukhutira kwa membala wamalonda kumatsika ndi mfundo za 4, kuchokera ku 55.9% chaka chatha kufika ku 51.8% chaka chino, ndipo kukhutira kwa membala wa Medicaid kumatsika ndi mfundo za 2, kuchokera ku 58.7% chaka chatha mpaka 56.5% chaka chino. Ngakhale kusinthaku kungawoneke ngati kochepa, ndikofunika kwambiri.

Miyezo yapachaka imawunika mapulani azaumoyo m’magawo onse azamalonda, Medicare, ndi Medicaid. Mapulani amavotera pa 0 mpaka 5 nyenyezi kutengera pafupifupi mavoti 50 a chithandizo cha odwala, zotsatira, zochitika, ndi kukhutira. Mavoti awa amajambula zinthu monga momwe zimakhalira zosavuta kapena zovuta kuti mamembala alandire chisamaliro chomwe akufunikira komanso momwe mamembala amakhutidwira ndi chithandizo chamakasitomala cha dongosolo lawo laumoyo.

Kuwunika kwa 2022 kumaphatikizapo mapulani azaumoyo omwe amatumikira anthu opitilira 200 miliyoni, opitilira 60% ya anthu aku US, malinga ndi NCQA.

Ponseponse, mapulani asanu ndi limodzi okha mwa 1,048 pazaumoyo mu 2022 adalandira nyenyezi 5, zotsatira zabwino kwambiri. Mwa mapulani asanu ndi limodzi omwe ali pamwamba, anayi ndi mapulani azaumoyo a Kaiser Foundation, kuphatikiza Kaiser Foundation Health Plan ya Mid-Atlantic States, yomwe idalandira nyenyezi 5 m’magulu onse atatu a inshuwaransi. Kaiser Foundation Health Plan ku Colorado idalandiranso ziwerengero zapamwamba kwambiri ku Medicare.

Mapulani a Kaiser Foundation Health atha kuchita bwino kwambiri pamasanjidwe awa chifukwa amagwiritsa ntchito njira yophatikizira yomwe imagwirizanitsa chithandizo chaumoyo ndi chithandizo chamankhwala kudzera m’mabungwe osiyanasiyana okhudzana ndi Kaiser Permanente.

Malinga ndi Andy Reynolds, wothandizana nawo wachiwiri kwa purezidenti wa ubale wakunja ku NCQA, njira iyi ingathandize kufotokozera ma alama apamwamba.

“Chofunika ndikugwirizanitsa zolimbikitsa kuti olipira ndi osamalira azitsatira masomphenya omwewo osunga odwala, kupereka chithandizo chozikidwa ndi umboni pamene mamembala akudwala, kuyamikira mamembala monga makasitomala olemekezeka omwe ali oyenerera ndi othandizidwa bwino, ndikukonzekera ntchito yawo m’njira zosiyanasiyana. zomwe zimawonjezera khalidwe pakapita nthawi. “

Kugwiritsa ntchito chitsanzo chophatikizika sikungakhale njira yokhayo yopezera ma 5-star ratings, koma kutulutsa mndandanda wa opambana kwambiri anali mapulani awiri azaumoyo operekedwa ndi Medical Associates Health Plans, bungwe lina lophatikizika la mautumiki / olipira omwe akugwira ntchito ku Iowa, Illinois, ndi Wisconsin. .

Kumbali ina ya sipekitiramu, mapulani 11 adalandira nyenyezi ziwiri zokha, zomwe zidatsika kwambiri zomwe zidalembedwapo. Mapulani atatu a Molina Healthcare kuphatikiza imodzi yoyendetsedwa ndi AmeriHealth ndi UnitedHealthCare anali m’gulu lamakampani omwe adapeza zotsika pamasanjidwe.

Malinga ndi a Reynolds, ogula omwe ali ndi njira zingapo zamadongosolo azaumoyo angafune kusankha mapulani apamwamba kwambiri omwe angatheke. Koma si aliyense amene ali ndi chosankha.

“Timalimbikitsa anthu kuti aziyankha mapulani azaumoyo,” adatero Reynolds. “Kwa anthu omwe alibe chisankho cha ndondomeko zaumoyo, izi zingatanthauze kufunsa abwana anu / ndondomeko / dokotala chifukwa chake zotsatira zabwino za ndondomeko yanu ndizo zomwe iwo ali ndi zomwe angachite kuti asinthe.”

Ponseponse, chiƔerengerocho chinali chochepera 3.4 mwa 5. Reynolds ananena kuti ngakhale kuti khalidweli limasiyanasiyana, limakonda kuwonjezereka pakapita nthawi. Koma izi sizichitika zokha; Zingafunike kulipira kuchokera kwa anthu omwe amagwiritsa ntchito ndikulipira chithandizo chadongosolo laumoyo.

“Odwala ndi olemba anzawo ntchito, omwe amalipira kulipira anthu ambiri omwe ali ndi inshuwaransi, ayenera kugwiritsa ntchito mavoti kuti apitirize kulimbikitsa chisamaliro chabwino,” adatero Reynolds. “Kupititsa patsogolo chithandizo chamankhwala sikunapite patsogolo monga momwe zimakhalira m’mafakitale ena, kotero anthu ayenera kupitiriza kulimbikitsa chisamaliro chabwino ndi ntchito zabwino.”

Kuwonjezera pa kuwunika kwadongosolo lonse la ndondomekoyi, Bungwe la National Council for Quality Assurance limayesa mbali zina za chisamaliro, zomwe zambiri zakhala zikuyenda bwino mu 2022. Mwachitsanzo, miyeso ingapo ya ubwino wa chisamaliro cha mtima ndi mitsempha yakhala ikupita patsogolo, makamaka njira zochepetsera kuthamanga kwa magazi, zomwe zakhala zikuyenda bwino. Bizinesi idakwera ndi 6.9 peresenti kuyambira 2021 mpaka 2022. M’mapulani a Medicare ndi Medicaid, kuwongolera kunali 7.6 points ndi 2.7 point.

Mofananamo, kwa anthu omwe ali ndi matenda a shuga, njira zochepetsera kuthamanga kwa magazi zimakhala bwino ndi 5.5 peresenti pa ndondomeko zamalonda, 2.5 peresenti pa mapulani a Medicare, ndi 2.1 peresenti pa mapulani a Medicaid. Kuwongolera kwa hemoglobin A1c, muyeso wofunikira pa chisamaliro cha matenda a shuga, kunapangitsa kuti 4.1 peresenti ipite patsogolo pamapulani amalonda ndi kungopitirira 3 mfundo zonse za Medicare ndi Medicaid.

Zotsatira za 2022 zidawonetsanso kusiyana kwa magwiridwe antchito okhudzana ndi katemera wa ana, kutengera kuchuluka kwa anthu. M’mapulani amalonda, mitengo ya katemera idakwera ndi 2.2 peresenti koma idatsika ndi 3 mfundo za ana mu mapulani a Medicaid.

Tsatanetsatane wa mavotiwo ukhoza kuwulula nyonga ndi zofooka za mbali zina za umoyo ndi chisamaliro cha mamembala awo. Kusiyanaku kumatha kukhala koyambitsa zokambirana komwe kumakuthandizani kusankha dongosolo loyenera pazosowa zanu, malinga ndi Reynolds.

“Kodi chofunika kwambiri kwa inu, kampani yanu, ndi banja lanu n’chiyani pankhani ya chithandizo chamankhwala? Kodi chisamaliro chabwino ndi chiyani kwa inu, ndipo ndondomeko yotani yomwe ikugwirizana ndi zomwe mumayamikira?” “Mukadziwa zomwe mukuyang’ana, mukhoza kupeza ndondomeko yomwe ingakuthandizeni kwambiri.”

Koma mavoti atha kukhalanso njira yofunikira yopangira mapulani azaumoyo kuti aziyankha pazabwino – ndi mtengo – zomwe amapereka kwa ogula ndi owalemba ntchito.

“Zili kwa anthu omwe amagwiritsa ntchito ndikulipira chithandizo chamankhwala kuti amange muyeso ndi kuwonekera povotera ndi madola awo ndikuvota ndi mapazi awo kuti apereke mphoto kwa anthu ochita bwino komanso kulimbikitsa otsika kuti apite patsogolo,” adatero Reynolds.

Leave a Comment

Your email address will not be published.