California rates HMOs

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Modern Healthcare

California’s largest HMOs continue to show mediocre results in preventive care, even as overall quality of care and member satisfaction have improved, according to the state’s fifth annual HMO report card released last week.

The study rates the state’s 10 largest commercial HMOs, which cover some 12 million members, in four general categories-preventive care, treatment and recovery, care of chronic illnesses and patient satisfaction-as well as about 30 subcategories. It’s published each September by the state Office of the Patient Advocate to coincide with the fall open-enrollment period, when consumers can switch health plans through their employers.

Kaiser Permanente’s Southern California unit scored the highest among the HMOs, receiving 10 out of 12 possible stars. Kaiser‘s Northern California unit, which came in first last year, ranked second, with nine stars. Aetna, Blue Shield of California and Universal Care tied for last place, each with six stars.

In general, the HMOs did better in treating the chronically ill than in providing acute or preventive care. “There is no doubt that HMOs are paying attention to and making steady improvements in how they deliver care,” said John Zweifler, a medical consultant for the OPA. “Still, we can’t ignore those critical areas where performance fails to meet recommended standards of practice.”

But a consumer advocacy group questioned how useful the report really is. Jerry Flanagan, healthcare policy director for the Foundation for Taxpayer and Consumer Rights, says the survey provides a meaningless comparison of health plans while omitting important information, such as the number and type of patient complaints filed against each HMO and what percentage of premiums each HMO spends on actual care. “The report reads more like a dining guide than a report card: It awards stars instead of exposing deficiencies,” Flanagan said.

The report found that HMOs continued to fall far short in preventive care, which includes cancer screenings and immunizations. Only one plan rated “good,” while the rest rated “fair.” Last year, two plans rated “good,” seven rated “fair” and one was unrated. No “poor” ratings were assigned in any category in either year.

When it came to treating the sick, five HMOs rated “fair,” three rated “good” and two rated “excellent” in 2005-a stumble from last year, when all nine of the HMOs that were rated won “good” or “excellent” marks in the category.

The industry fared considerably better in caring for patients with chronic illnesses, such as diabetes and asthma, with three HMOs receiving ratings of “excellent” and the rest rating “good.” Last year, eight HMOs rated “good,” one rated “fair” and one was unrated.

HMOs made the greatest strides in pleasing their members. Eight of the 10 plans received higher marks from their enrollees than in 2004, with four deemed “excellent” this year.

Consumer Watchdog
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