UPMC Health Insurance Plan Among Nationwide Top-10

Armen Hareyan's picture

Health Insurance Plan from UPMC

A new report from U.S. News & World Report and the National Committee for Quality Assurance (NCQA) has placed UPMC Health Plan on the prestigious "honor roll" of the top-10 health plans in the country. The report, "America's Best Health Plans," also shows that the Health Plan is the highest ranked plan in Pennsylvania for the second year in a row.

The rankings, which include more than 320 health insurance plans, are based on a combination of clinical performance, member satisfaction, and NCQA Accreditation status. The Health Plan registered the top scores statewide in several measures of care, including women's health (timeliness of prenatal and postpartum care) and children's health (access to primary care physicians for age groups 25 months to 6 years, 7 to 11 years, and 12 to 19 years), and appropriate use of antibiotics and treatment for pharyngitis (sore throat) in children.

UPMC Health Plan is also highest ranked in the state in several behavioral health categories:

  • Antidepressant medication management - optimal practitioner contacts

  • Antidepressant medication management - effective continuation phase treatment

  • Follow-up after hospitalization for mental illness within 30 days.

As released last month, UPMC Health Plan also received the top score nationwide in breast cancer screening, for the third consecutive year. This means Health Plan female members were screened for breast cancer at a greater rate than were members of any other surveyed health plan in the United States. (See "UPMC Health Plan Leads Nation in Breast Cancer Screening for 3rd Year in a Row", Sept. 27 press release.)


"We're so pleased to be among the top-10 health plans in the nation and the highest ranked plan in the state," said Diane P. Holder, president of UPMC Health Plan and the UPMC Insurance Services Division. "In partnership with our providers, we place special emphasis on the high quality of our preventive programs, and it shows in these outstanding results. Our members are receiving the highest caliber of care available, which has a lasting impact on the health of the community."

Here are some examples of how UPMC Health Plan encourages preventive health, which contributed to our exceptional ranking:

  • Taking full advantage of its unique relationship with the University of Pittsburgh Medical Center and the University of Pittsburgh School of Medicine to develop innovative preventive health methodology.

  • Developing and administering health and care management programs in house, departing from the industry trend to outsource these services.

  • Providing a full suite of online tools and information through www.UPMCHealthPlan.com that allows members to track their own health status and research health topics.

  • Offering continuous feedback to its provider network and members to identify gaps in service. Examples include members with diabetes who have not had an annual check-up or screening, and members with asthma in need of medical management. Cardiac programs for coronary artery disease, congestive heart failure, hypertension, and hyperlipidemia are also available.

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 manages the evolution of HEDIS, the tool NCQA uses to measure and report on the performance of the nation's health plans. For more information on NCQA, visit www.ncqa.org

UPMC Health Plan, the second-largest health insurer in Western Pennsylvania, is owned by the University of Pittsburgh Medical Center (UPMC), one of the nation's top-ranked health systems. As part of an integrated health care delivery system, UPMC Health Plan partners with UPMC and community network providers to improve clinical outcomes as well as the health of the greater community. According to the U.S. News & World Report/NCQA's listing of "America's Best Health Plans," UPMC Health Plan is the top-ranked health plan in Pennsylvania and one of the top-10 health plans in the nation. The Health Plan is also the highest-ranked managed care company in the nation for breast cancer screening for the third consecutive year. The integrated partner companies of the UPMC Insurance Services Division - which includes UPMC Health Plan, Work Partners, EAP Solutions, UPMC for You (Medical Assistance), and Community Care Behavioral Health -- offer a full range of group health insurance, Medicare, Children's Health Insurance Program, Medical Assistance, behavioral health, employee assistance, and workers' compensation products and services to over 900,000 members. Our local provider network includes UPMC as well as community providers, totaling more than 80 hospitals and more than 7,000 physicians in a 28-county region.