Aetna, Optima are two of the best-performing health plans in Virginia


Nicole Pasia


Aetna Life Insurance Company (Virginia) and Optima Health Plan both earned four out of five stars and “accredited” status from the National Committee for Quality Assurance (NCQA)’s annual review, which was updated this month. The NCQA’s review rated 77 health plans in the Virginia market based on patient experience, prevention services, and treatment. 


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Both plans exclusively serve members in Virginia. Aetna is a Medicare Preferred Provider Organization (PPO), while Optima is a combined commercial Health Maintenance Organization (HMO) and Point of Service (POS) plan.

Optima Health, the plan operated by vertically-integrated carrier Sentara Healthcare, accounts for over 70% of the market in Virginia Beach, with over 195,000 enrolled members, according to the report. Of the review’s three metrics, Optima performed best in covering prevention services, scoring 3.5 out of five stars. Prevention service metrics included high numbers of child immunizations, pregnancy care, cancer screening, flu shots, and STD screening.

On March 6, 2020, just as the COVID-19 pandemic was beginning in the U.S., Optima announced it would cover COVID-19 testing and treatment for its members. Dennis Matheis, president of Optima Health Plan and executive vice president of Sentara Healthcare, has spoken on the impact of the pandemic on the organization.

“We want to do our part in removing barriers to care and providing safe options for our members who may be concerned about their health based on their symptoms and travel history. Our team is taking the COVID-19 virus seriously and are engaging our members to help them protect themselves and the community at large.”

Aetna, an entity under CVS Health, also performed best in covering prevention services, scoring four out of five stars. According to the report, most members aged 50-75 were able to get cancer screenings and adults aged 65 and over received flu shots as of June 30, 2021.

Aetna scored three out of five stars across the report’s behavioral health metrics under the treatment category, which include follow up after hospitalization for mental illness or substance use, members’ adherence to depression medication, and substance use outpatient care services.

Cara McNulty, president of Aetna Behavioral Health and Employee Assistance Program, discussed the importance of integrating behavioral health specialists into the community during the pandemic in a video for CVS health.

“What we’re doing is putting licensed social workers in specific locations that can help you with an assessment, understanding what it means whether you’re experiencing anxiety, depression, or other issues. How to navigate the system, how to utilize your health care benefits, and how to get the care and support you need and that of your family. We’re normalizing that it’s important to take care of our mental well-being.”

Three plans that serve the Virginia-D.C. area, Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Commercial HMO), Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Medicare HMO), and Johns Hopkins US Family Health Plan (Commercial HMO), scored 4.5 out of five stars or higher in the report. 

Forty of the assessed plans earned “accredited” status, meaning they earned “at least 80% of applicable points in each standards category.” Plans that provided no or partial data to NCQA were marked as “not accredited.”