HMO “Report Card” Fails to Provide Meaningful Evaluation of Quality and Is Silent on Affordability

Published on

Santa Monica, CA — A consumer group said that the annual HMO report card released today is so vague and limited that it does not give consumers the information they need to evaluate HMO quality and is silent on key information consumers need.

“This report reads more like a dining guide than a report card: it awards “stars” instead of exposing deficiencies. This report, and as far as we can tell, the entire Office of the Patient Advocate, is a waste of taxpayer money and is more concerned with the social promotion of HMOs than about informing patients about life-threatening problems at HMOs,” said Jerry Flanagan of the Foundation for Taxpayer and Consumer Rights (FTCR). “Since patients can’t tell if an HMO is passing or failing, it is clear that this guide is not a real report card. The vague and incomplete analysis gives consumers a false sense of security about the quality of HMOs.”

Part of the report card relies on information collected by the National Committee on Quality Insurance, a private organization that was founded and is largely funded by the HMO industry. FTCR said the state report card should rely on independently collected information from an unbiased government agency instead of relying on information collected by a private entity that already provides voluntary accreditations for its HMO clients. For more information, click here to read FTCR’s June 17 letter to the Department of Managed Health Care.

The one-page HMO analysis by OPA rates HMOs on meaningless conditions and awards every HMO a ‘star.’ “Instead of receiving stars, HMOs should receive bad grades when they fail to uphold standards of patient care,” said Flanagan. “Every parent knows that the threat of an ‘F’ and a trip to the principal’s office is often the only way to get bad students to do better in school.”

In the report:

** 8 of the 10 HMOs surveyed received either 6, 7 or 8 stars — a meaningless comparison for consumers;

** The other 2 HMOs, Kaiser (north & south), received 9 stars and 10 stars even though that company has 13 times the state’s required reserves which means enrollees have paid more for less health care;

FTCR said that the a true report card would include the following types of information:

** information about the kind and number of patient complaints against each HMO;

** information collected about HMO quality in independent audits performed the Department of Managed Health Care;

** information garnered from arbitration award reports in cases of medical negligence.

– 30 –

The Foundation for Taxpayer and Consumer Rights (FTCR) is the state’s leading nonpartisan consumer advocacy organization.

Consumer Watchdog
Consumer Watchdog
Providing an effective voice for American consumers in an era when special interests dominate public discourse, government and politics. Non-partisan.

Latest Videos

Latest Articles

In The News

Latest Report

Subscribe to our newsletter

To be updated with all the latest news, press releases and special reports.

More articles