NCQA

Sharp Health Plan

California

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Accredited

Last update: 11/19/2024
Ratings are updated annually (September)

Health Plan Rating

4.0 of 5

Insurance Type

Commercial

Product Type

HMO

Next Review Date

01/14/2025

Members Enrolled

101,648

Evaluation Product

Renewal Survey

Other Accreditations, Certifications, and Distinctions

Plan Detail Ratings

The overall rating score is the weighted average of all measures, not an average of the three composites (Patient experience, Prevention and equity, Treatment).

Note: NCQA used MY 2023 data and percentiles for commercial and Medicaid HEDIS/CAHPS and Medicare HEDIS. NCQA used MY 2022 data and percentiles for Medicare CAHPS and the Health Outcomes Survey. Several reasons could contribute to a plan having a non-numerical rating (Partial Data Reported, No Data Reported). For details about the Health Plan Ratings display rules, visit the 2024 Health Plan Ratings methodology on the 2024 HPR page.

Getting care

Getting care easily

Did members get appointments, preventive care, tests and treatment easily?

Getting care quickly

Did members get appointments, preventive care, tests and treatments promptly?

Satisfaction with plan physicians

Rating of primary care doctor

Did members rate their primary care doctors high overall?

Rating of specialists

Did members rate specialists high overall?

Coordination of care

Were members satisfied with how their primary provider coordinated care with other providers?

Satisfaction with plan and plan services

Rating of health plan

Did members rate their plan services high overall?

Rating of care

Did members rate their care high overall?

Children and adolescent well-care

Childhood immunizations

Did children receive all recommended immunizations by age 2?

Adolescent immunizations

Did children receive all 3 recommended immunizations by age 13?

BMI percentile assessment

Did members ages 3 to 17 have their BMI assessed?

Women’s reproductive health

Prenatal checkups

Did members who gave birth have a prenatal visit in their first trimester or shortly after enrolling in a health insurance plan?

Postpartum care

Did members who gave birth have a postpartum visit on or between 7 and 84 days after delivery?

Prenatal immunizations

Did members who gave birth receive both recommended immunizations by their delivery date?

Equity

Race and ethnicity of members

Did health plans have information about their members’ race and ethnicity in order to provide appropriate services?

Cancer screening

Breast cancer screening

Did members ages 50 to 74 who are recommended for routine breast cancer screening get a mammogram every 2 years?

Colorectal cancer screening

Were members ages 45 to 75 screened for colorectal cancer?

Cervical cancer screening

Did members ages 21 to 64 who are recommended for routine cervical cancer screening receive it?

Other preventive services

Chlamydia screening

Did members ages 16 to 24 who are recommended for chlamydia screening get tested?

Influenza immunizations for adults

Did members ages 19 and older receive recommended influenza immunizations?

Td/Tdap immunizations for adults

Did members ages 19 and older receive recommended Td/Tdap immunizations?

Zoster immunizations for adults

Did members ages 50 and older receive recommended zoster immunizations?

Pneumococcal immunizations for adults

Did members 66 and older receive recommended pneumococcal immunizations?

Respiratory

Asthma control

Did members, ages 5 to 64, with persistent asthma have an appropriate ratio of asthma medications to help control their symptoms?

Appropriate testing and care for a sore throat

Were members ages 3 years and older with a sore throat given strep tests and appropriately prescribed antibiotics?

Appropriate antibiotic use for colds

Were members ages 3 months and older with colds not prescribed antibiotics up to 3 days after their diagnosis, as recommended?

Appropriate antibiotic use for acute bronchitis/bronchiolitis

Were members ages 3 months and older with acute bronchitis not prescribed antibiotics in the 3 days after their diagnosis, as recommended?

Steroid after hospitalization for acute COPD

Did members ages 40 and older who were hospitalized or had an ED visit for chronic obstructive pulmonary disease receive systemic corticosteroids within 14 days of discharge?

NA

Bronchodilator after hospitalization for acute COPD

Did members ages 40 and older who were hospitalized or had an ED visit for chronic obstructive pulmonary disease receive a bronchodilator within 30 days of their discharge?

NA

Diabetes

Patients with diabetes—blood pressure control (140/90)

Did members ages 18 to 75 with diabetes have their blood pressure below 140/90 at their last visit?

Patients with diabetes—eye exams

Did members ages 18 to 75 with diabetes have a retinal or dilated eye exam?

Patients with diabetes—glucose control

Did members ages 18 to 75 with diabetes maintain their blood sugar level below 8 percent?

Patients with diabetes—received statin therapy

Did members ages 40 to 75 with diabetes who do not have cardiovascular disease receive a statin medication?

Patients with diabetes—statin adherence 80%

Did members ages 40 to 75 with diabetes who do not have cardiovascular disease stay on statin therapy as prescribed?

Patients with diabetes—kidney health evaluation

Did members ages 18 to 85 with diabetes receive a kidney health evaluation?

Heart disease

Patients with cardiovascular disease—received statin therapy

Did males ages 21 to 75 and females ages 40 to 75 with cardiovascular disease receive a high or moderate-intensity statin medication?

Patients with cardiovascular disease—statin adherence 80%

Did males ages 21 to 75 and females ages 40 to 75 with cardiovascular disease stay on high or moderate-intensity statin therapy as prescribed?

Controlling high blood pressure

Did members ages 18 to 85 with hypertension have their blood pressure controlled (<140/90 mm Hg)?

Behavioral health—care coordination

Follow-up after hospitalization for mental illness

Were members ages 6 and older hospitalized with a mental illness followed up with, within a week after discharge?

Follow-up after ED for mental illness

Were members ages 6 and older with an ED visit for mental illness followed up with, within a week of their visit?

Follow-up after ED for substance use disorder

Were members ages 13 and older with an ED visit for a diagnosed substance use disorder followed up with, within a week of their visit?

Follow-up after high-intensity care for substance use disorder

Were members ages 13 and older with an inpatient visit, residential treatment visit, or medically managed withdrawal event for a diagnosed substance use disorder followed up with, within a week of their visit or discharge?

Behavioral health—medication adherence

Adherence to antipsychotic medications for individuals with schizophrenia

Did members ages 18 and older with schizophrenia or schizoaffective disorder stay on antipsychotic medications as prescribed?

Patients with a new episode of depression—medication adherence for 6 months

Did members ages 18 and older with a new episode of depression take a prescribed antidepressant medication for at least 6 months?

Patients with opioid use disorder—medication adherence for 6 months

Did members ages 16 and older with a new episode of opioid use disorder treatment stay on recommended medications for at least 6 months?

Behavioral health—access, monitoring and safety

Cholesterol and blood sugar testing for youth on antipsychotic medications

Did members ages 1 to 17 who were on 2 or more antipsychotic medications have their blood sugar and cholesterol tested?

First-line psychosocial care for youth on antipsychotic medications

Did members ages 1 to 17 who had a new prescription for an antipsychotic medication have documentation of psychosocial care as first-line treatment?

NA

Continued follow-up after ADHD diagnosis

Did children ages 6 to 12 who were on ADHD medication for at least 210 days have at least 2 follow-up visits within 9 months?

Substance use disorder treatment engagement

Did members ages 13 and older with a new episode of substance use disorder engage in treatment within 34 days?

Risk-adjusted utilization

Acute hospital utilization

For members ages 18 and older, how many acute inpatient and observation stays occurred during the year compared to the expected?

Plan all-cause readmissions

For members ages 18 to 64, how many acute inpatient and observation stays were followed by an unplanned acute readmission within 30 days after discharge compared to the expected?

Emergency department utilization

For members ages 18 and older, how many emergency department visits occurred during the year compared to the expected?

Other treatment measures

Appropriate use of imaging studies for low back pain

Were imaging tests appropriately not recommended for members ages 18 to 75 with a new episode of low back pain?

This Plan’s Other Accreditations, Certifications and Distinctions

Accreditation status last updated on 11/19/2024

Health Equity Accreditation

This program offers distinction to organizations that engage in efforts to improve culturally and linguistically appropriate services and reduce health care disparities.

Insurance type

Commercial HMO

Next Review Date

12/09/2025

Status

Accredited

OTHER NAMES FOR THIS HEALTH PLAN

Sharp Health Plan Choice Network, Sharp Health Plan Performance Network, Sharp Health Plan Premier Network, Sharp Health Plan Value Network

Bonus point calculations for Health Plan Ratings are based on a plan’s NCQA Accreditation status as of the last business day in June of the release year.
I = Insufficient data; NC = No Credit; NA = Not Applicable
Contact us at My.NCQA to ask about licensing the ratings data for research or display.

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