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Kaiser faults California's exchange for lack of quality ratings

Laws and LegislationInsuranceConsumersCrime, Law and JusticeAffordable Care Act (Obamacare)Health Net Inc.Medicaid

Healthcare giant Kaiser Permanente and two other insurers say California's insurance exchange is withholding crucial information from consumers by not posting quality ratings alongside health plan rates.

The insurance companies said "there has never been a compelling reason to deny this information to consumers.... On this issue, Covered California has surrendered its 'pace car' status."

Sharp Health Plan in San Diego and Western Health Advantage in Sacramento joined Kaiser in criticizing the state's position in a letter sent Monday to Covered California, the state health exchange. Some consumer advocates have also urged the state to reconsider, saying any delay rewards lower-performing insurers.

Thousands of people have been shopping for coverage at the state's website at www.coveredca.com since enrollment opened Oct. 1 under the Affordable Care Act, also known as Obamacare.

Covered California ignited this debate in August when it backed off earlier plans to include insurance company ratings in its online enrollment system.

This came as a surprise because state officials had touted the idea of consumers choosing coverage based on the overall value, combining price and quality measures.

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At the time, the exchange said it reversed course because the latest state rankings examine performance from 2011, and they don't reflect many of the new health plans and provider networks being offered for the first time under the federal healthcare law.

Major insurers such as Blue Shield of California and Health Net Inc. have offered narrower networks for some exchange policies to help lower premiums. In contrast, Kaiser and its full provider network are often more expensive.

State officials have discussed including ratings for some health plans, such as Kaiser, that are using their current network and labeling newer products as "not yet rated." Covered California's five-member board is expected to consider the matter at a regularly scheduled meeting Thursday.

In their letter, the three insurers also point out that other state-run exchanges, such as those in Colorado, Maryland and Oregon, are displaying quality data prominently on their websites. Colorado's website even sorts a consumer's options by quality, rather than just price.

"The leadership of these three state exchanges faced a choice, as California’s does now – and they chose to put consumers first," the insurers said.

The state's Office of the Patient Advocate publishes annual ratings of the largest HMO and PPO plans, handing out one to four stars in a variety of categories. The report card looks at whether insurers are meeting national standards for recommended care and it asks patients to rate their own experience.

The state also issues separate quality ratings on insurers serving patients in Medi-Cal, the state's Medicaid program for the poor. Several of those plans that cater to lower-income residents are selling policies in the broader exchange.

Kaiser routinely scores well in rankings on quality of care and patient satisfaction. It was the only HMO in the state to earn a top four-star rating for providing recommended care on the most recent report card. Sharp and Western Health each received three stars on the same measure.

Open enrollment in the state exchange runs through March 31.

ALSO:

Covered California set to drop health insurer ratings

California exchange removes troubled online directory of doctors

California issues annual ratings for health plans, physician groups

Copyright © 2014, Los Angeles Times
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Laws and LegislationInsuranceConsumersCrime, Law and JusticeAffordable Care Act (Obamacare)Health Net Inc.Medicaid
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