State HMOs treaded water in improving care, study says

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Sacramento Bee (California)

California’s HMOs need to do a better job dealing with diabetes patients and promoting exercise and diet to overweight members.

But the state’s nine largest health maintenance organizations do earn good marks for making sure asthma patients receive the right drugs.

Overall, though, these health plans have made little progress in the past past year improving quality and care to the 12 million HMO members in California, according to the seventh annual report card released Thursday by the state Office of the Patient Advocate.

“This year we treaded water. We didn’t make advances. There’s still room for improvement. We could do better,” said Dr. John Zweifler, medical consultant to the state office.

In rating California HMOS against national standards, the 2007 Health Care Quality Report Card found some improvements in treating children and screening patients for colo-rectal cancer and sexually transmitted infections. Asthma care received the best scores.

Other highlights:

Blue Cross of California and CIGNA HMO received the top marks for maternity care.

Kaiser Permanente in Northern and Southern California received the highest score for heart care.

– Two out of three patients who should be tested for cancer did receive the screening.

– About half of consumers with mental health problems received care that satisfied national standards.

– Less than 40 percent of obese patients were counseled about exercise and diet.

– Nearly two out of four diabetes patients don’t have their cholesterol under control, which is a leading cause of heart disease and death for this group.

In compiling the report card, researchers analyzed reports HMOs file with the National Committee on Quality Assurance, which reviews health plans for companies and groups that offer their workers medical coverage.

Health plans are graded for their performance in 10 medical categories, including asthma, heart care and mental health. Doctors and consumers also are surveyed on issues such as complaints.

The release coincides with the start of the fall open enrollment period when companies let employees change health plans.

State officials are counting on the report card, along with consumers, to prod health plans to boost standards.

“That’s a critical first step,” Zweifler said about the public report. “Until people really say quality matters in health care, I don’t think we are going to get too far.”

HMO officials say the report card is one measuring stick to gauge their performance and the industry has made steady progress over the years.

“There is still room for improvement in the medical community,” said Dr. Alán Whippy, medical director for quality and safety for Kaiser Permanente in Northern California.

Kaiser, for example, has made inroads in cancer screening, Whippy said. In the long run, she said, “you can see dramatic improvements.”

One consumer group criticized the report, calling it shallow and incomplete.

Jerry Flanagan of the Foundation for Taxpayer and Consumer Rights said the $500,000 report — funded by state assessments collected from HMOs — omits information about costs, specific consumer complaints and regulatory action against health plans.

“The information in these things are vague. They provide no real help to consumers,” Flanagan said. “They have gone out of their way to leave out the worst practices.”

The report card is online at Consumers can request copies by mail by calling (866) 466-8900. Walgreens and Leader pharmacies and local public libraries will have free summaries available.

Consumer Watchdog
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