The San Diego Union-Tribune
California has issued its first report card on health-maintenance organizations, which indicates that many health plans fall short in several areas regarding the care of their members.
The state’s 14 largest HMOs, covering 90 percent of California’s 22 million HMO members, were rated in 17 categories, including the quality of doctors’ care, care for heart problems and immunizations.
The clinical and consumer information used to compile the report was voluntarily submitted by the plans.
In numerous categories related to quality of care, the report suggests that health plans are struggling.
For example, the report card ranked plans according to the steps they’re taking to help members control high blood pressure. The highest score in that category, 68 out of a possible 100, went to Aetna US HealthCare in Southern California. The lowest score — 41 — went to Universal Care.
On childhood immunizations, Kaiser Permanente in Southern California received an 83, while National Health Plans received a 31.
Scores were determined by employing statistical tools to measure the quality of care and service provided by health plans and by reviewing consumer surveys and medical charts.
Overall, consumers rated their health plans poorly. The percentage of plan members who thought their plans had high customer-service quality, and did a good job of getting care to their members when they needed it, ranged from a high of 66 (National Health Plans and Western Health Advantage) to 50 (Aetna US HealthCare in Northern California and Blue Cross‘ California Care HMO).
Health plans said last week that they had not seen copies of the report card and had no comment about it. But a lobbying group for the industry said such a report is necessary.
“By looking at indicators and determining where they can improve, it helps health plans as well as consumers,” said Deborah Espinal, vice president of legal and regulatory affairs for the California Association of Health Plans.
Daniel Zingale, director of the Department of Managed Health Care, was especially unhappy about the results in the area of preventive care.
“One of the messages we’ve been sounding for a year is that, if managed care is failing on preventive care, managed care is failing,” Zingale said.
While the plans may have stumbled on clinical indicators, they did well in several categories that depend on consumer perception, such as how quickly patients are able to get appointments and the helpfulness of doctors’ staff members.
A critic of health plans said it’s no surprise that plans do well on consumer perception questions. Most Americans are in reasonably good health, so they access their health plans infrequently.
“My concern . . . is that only the sickest patients fall through the cracks” and aren’t well-represented in the report card, said Jamie Court, executive director of the Foundation for Taxpayer and Consumer Rights. “We need something that measures how the plans do with the sickest patients, and what their mortality rates are.”
Overall rating of health plans
The following percentage of health-plan members said they think their plans have high customer-service quality and do a good job of getting care to their members when they need it.
[] Aetna US HealthCare, Northern California: 50 percent
[] Aetna US HealthCare, San Diego: 60
[] Aetna US HealthCare, Southern California: 59
[] Blue Cross‘ California Care HMO: 50
[] Blue Shield of California: 51
[] Cigna HealthCare of California: 51
[] Health Net: 56
[] Health Plan of the Redwoods: 60
[] Inter Valley Health Plan: 58
[] Kaiser Permanente, Northern California: 58
[] Kaiser Permanente, Southern California: 62
[] Lifeguard: 60
[] Maxicare: 58
[] National Health Plans: 66
[] PacifiCare of California: 53
[] Universal Care: 57
[] Western Health Advantage: 66
To obtain a copy of the report card, call the Office of the Patient Advocate at the state Department of Managed Health Care at (916) 324-8176. Copies of the report also are available on the Internet by following the links found at http://www.hmohelp.ca.gov.
