State report card: HMOs need to help more with diabetes, obesity

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The San Francisco Chronicle

California’s HMOs and physicians need to do a better job of caring for patients with diabetes, treating obesity and making sure people with mental illnesses get the proper help, according to a state report card released Thursday.

The Health Care Quality Report Card, which rates the state’s largest health maintenance organizations and more than 200 medical groups, is designed to give consumers a way to assess the quality of care they receive from their doctors and health maintenance organizations based on surveys of clinical quality and patient satisfaction.

This year, the seventh year the state Office of the Patient Advocate has released the ratings, the study found improvement in some areas, like care for asthma patients, but overall performance did not change dramatically since last year. In other findings:

– One in three in patients ranked his or her HMO unfavorably.

– Fewer than 40 percent of obese patients reported being counseled about diet or exercise.

– About 40 percent of patients with diabetes said they were not screened in the past year for retinal disease, even though diabetics are at much greater risk for eye problems.

While many people in the health care field question the accuracy of health reports cards, these types of ratings have received increasing attention as health care heads toward the top of the domestic political agenda. Improving quality is a key part of many reform packages, including Gov. Arnold Schwarzenegger‘s plan, mainly because poor quality costs more than proper, timely care.

Consumers also are making complicated decisions involving the quality of their medical care. A growing number of health plans require their members to pay more for hospitals and doctors that charge higher rates, leading patients to ask whether the quality of care is worth the added expense.

Among health plans, the report card gave the highest overall ratings to Health Net of California Inc. and Kaiser Permanente’s Northern and Southern California regions for meeting both clinical care and patient-satisfaction standards.

While four stars denoted “excellent,” none of the HMOs received that top ranking.

For medical groups, four-star ratings went to the Palo Alto Medical Foundation in both clinical care and patient satisfaction. Kaiser Permanente physicians in many regions received four-star ratings for clinical care.

“Public reporting is good for quality in general. It keeps it in the limelight, and we all learn from it,” said Dr. Alan Whippy, medical director for quality and safety for Kaiser‘s Northern California physician group.

Consumers typically do more research before buying products such as cars and electronic devices than health plans or medical groups, said Sandra Perez, director of the Office of the Patient Advocate. “People look for information on safety and reliability in cars, and I hope they do so for health care,” Perez said.

The state’s report card of health care quality relies on existing published data, such as quality measures used for accreditation by the National Committee for Quality Assurance.

The report card also allows consumers to find specific information on care, such as how consistently a medical group tests for cholesterol or whether a plan helps smokers to quit.

Among health plans, Aetna Health of California scored the lowest, with a one-star member satisfaction score and a two-star rating on meeting national standards by making sure patients got the appropriate care. The company, which also ranked low last year, did not return calls for comment.

Bay Valley Medical Group Inc., based in Hayward, received just one star for making sure patients got the care they needed but three stars for patient satisfaction.

“The findings of the study are inconsistent with the quality of care we know our physicians to provide,” said Shelley Horwitz, chief executive of the group. She said she is investigating the findings, which she believes has something to do with how the group’s laboratory data is reported.

Don Crane, chief executive of the California Association of Physician Groups, said he supported the state’s reporting effort but acknowledged that the system hasn’t been perfected.

“Stars are sometimes a little crude, and there’s always the question about the accuracy of data,” he said. “I probably have individual members who may take issue with a rating here or there but, in the main, increasing the transparency movement is something we salute and applaud.”

Consumer groups had mixed reactions to the report card.

Jerry Flanagan, health advocate for the Foundation for Taxpayer and Consumer Rights, was astounded that the report card made no mention of recent problems involving health plans. Several insurers, including Blue Cross and Blue Shield, have come under fire for retroactively revoking coverage after patients made claims. Kaiser‘s Northern California kidney transplant program was dismantled for patient safety concerns, and the HMO was hit this summer with a state fine for mishandling complaints.

“It’s easy to get a good grade when the teachers aren’t looking at your bad behavior,” he said.

Others questioned why the report card didn’t spur much year-over-year improvement among health insurers.

“What does that mean for Californians trying to make informed health care decisions? If that information has been published for the last seven years, why is this not better?” said Elizabeth Abbott, project director of Health Access California.

Reporting efforts probably will become more refined as additional data, such as the outcome of specific procedures, becomes available, said Dr. John Zweifler, medical consultant to the Office of the Patient Advocate.

“There is room for improvement,” he said. “I think what’s important is that this sends a clear message that quality does matter.”

The report card’s cost of $500,000 was paid for by fees assessed by the state on California HMOs.

Preferred Provider Organization plans, or PPOs, were not included in the report card. The state Department of Insurance plans to issue a PPO report card in 2009.

For more info:

Online: Find the Health Care Quality Report Card at

In print: Contact the Office of the Patient Advocate at (866) 466-8900 for a printed copy. The report is available in English, Spanish, Chinese, Vietnamese and Korean. Walgreens and Leader pharmacies, along with many local libraries, will stock summary print copies.

Have a complaint?

Contact the state Department of Managed Health Care‘s HMO Help Center at or (888) 466-2219.

HMO report card:

The state Office of the Patient Advocate released its annual Health Care Quality Report Card on Thursday. Following are the overall rankings for California’s largest health maintenance organizations. Plans could receive up to four stars.

Health Plan — Meeting national care standards(*) — Meeting member Satisfaction(X)

Aetna Health of California Inc. ————- Two stars ———————— One star

Blue Cross of California HMO ————- Two stars ———————– Two stars

Blue Shield of California HMO ———— Two stars ———————– Three stars

CIGNA HMO ——————————- Two stars ———————– Two stars

Health Net of California Inc. ————– Three stars ———————- Three stars

Kaiser – Northern California ————— Three stars ———————– Three stars

Kaiser – Southern California ————– Three stars ———————– Three stars

PacifiCare of California ——————– Two stars ———————– Three stars

Western Health Advantage —————- Two stars ———————– Three stars

* – How the HMO compared with national quality standards for care, including for asthma, diabetes, maternity, cancer screening and child immunizations.

X – How members rated their HMOs in such areas as customer service, complaints and helping smokers to quit.

Source: Office of the Patient Advocate

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