Overall quality of care provided through California's 10 largest HMOs has improved and members are increasingly satisfied with their plans, although the HMOs continue to have "critical shortfalls" in providing preventive care, according to the fifth annual HMO report card released on Tuesday by the state Office of the Patient Advocate, the Los Angeles Times reports (Vrana, Los Angeles Times, 9/14).
The report card evaluated the state's 10 largest HMOs, accounting for about 12 million members. The report card examined four broad areas, including three based on patient records and other clinical data: preventive care, care for getting better, and care for living with illness. The fourth area, member satisfaction, is based on patients' response to annual surveys from HMOs (Sweeting, San Jose Mercury News, 9/14).
The report card was based on information compiled from reports HMOs nationwide are required to file with the National Committee for Quality Assurance.
The report also analyzed 200 medical groups and 18 HMOs that serve as many as 3 million Medi-Cal patients (Wasserman, Sacramento Bee, 9/14). The report was issued to coincide with employers' open enrollment period for health plans, from September through December (San Jose Mercury News, 9/14).
Findings
The HMOs scored well in living with illness and member satisfaction but earned "mediocre" scores for preventive care and getting better, according to the San Diego Union-Tribune (San Diego Union-Tribune, 9/14).
Stars were assigned to rank organizations from poor to excellent in each category. The overall rankings are listed below.
The report indicated that HMOs incrementally improved care over last year but noted that they fell short in nine areas, including smoking cessation and overeating (
Sacramento Bee, 9/14).
In addition, most plans this year did not meet state standards of care for:
- Colorectal and other cancer screenings;
- Chlamydia screening;
- Antibiotic treatment for children with throat infections; and
- Eye exams for diabetes.
Mental health care in general also had low scores. For example, only 39% of patients treated with medication for depression under the highest-ranked plan in the category, Blue Cross of California, were seen at least three times during the initial 12-week treatment phase (
Los Angeles Times, 9/14).
Reaction
Ed Mendoza, acting director of OPA, said, "Some of these plans still need to do some work; there are many areas here that still need improvement. Consumers need to know that quality varies and premiums are not the only things to consider when picking a plan" (Los Angeles Times, 9/14). He said there is no correlation between the amount of premiums that patients pay and the quality of care (Sacramento Bee, 9/14). He added, "Those consumers that ask for things, get better care" (Contra Costa Times, 9/14).
Peter Lee -- president of Pacific Business Group on Health, which helped compile the report -- noted the importance of picking the right doctors' practice. He said, "Medical groups are just as important if not more important than health care plans. The reality is that choices are just beginning with a health plan."
However, Jerry Flanagan of the Foundation for Taxpayers and Consumer Rights said, "The information is more like social promotion than about giving patients information regarding threatening problems" (San Jose Mercury News, 9/14).
The report is available online.