Turning NCQA 2025 Health Plan Ratings into a Roadmap for Improvement
The 2025 NCQA Health Plan Ratings are out. For health plans, these results are more than just numbers — they’re a public reflection of quality, experience, and performance.
This year’s ratings highlight progress, new measures that raise the bar, and sharper contrasts between top performers and those falling behind. The challenge is clear: ratings are not only a benchmark; they’re a competitive differentiator.
At
Advent Advisory Group, an
NCQA-licensed organization, we help plans make sense of their results, identify opportunities, and implement changes that drive measurable gains.
What's New in 2025:
- Language Diversity of Membership (LDM): Plans must now report on members’ preferred spoken and written languages.
- CAHPS still critical: Member experience remains a top driver of ratings.
- Chronic condition gains: Improvements in diabetes management and care transitions.
- Coordination matters: Smooth transitions remain a differentiator — gaps still exist.
Why Ratings Matter
High NCQA ratings build trust with members, competitive positioning, and credibility with regulators and purchasers. Accreditation also earns bonus points, directly boosting scores.
Common Struggles
- Reporting readiness: Many plans aren’t fully prepared for reporting of descriptive measures, like LDM and Race/Ethnicity Diversity of Membership (RDM)
- Gaps in data: Sunsetting of the hybrid methodology presents new data challenges
- CAHPS performance: Member experience continues to drag down ratings.
- Inconsistent results: Strong in one area, weak in others — uneven performance.
The Bottom Line
As Betsy Seals, CEO of Alerion Advisors, recently noted: “Transparency and accuracy are now key differentiators in the Medicare Advantage market.”
Humana borrows UnitedHealth’s Medicare Advantage playbook - Modern Healthcare
At Advent, we don’t just react to ratings — we help you get ahead. Let’s turn your NCQA into a blueprint for stronger quality, compliance, and growth.
How Advent Helps
With NCQA licensing and deep HEDIS audit expertise, Advent provides:
- Compliance audit support to validate measures and correct discrepancies.
- Gap analysis across metrics impacting ratings.
- Support for new measures, from data to process.
- Benchmarking and competitive insight for market positioning.
Advent Advisory Group Insights
