Most California health plans make it hard for patients to get care easily and do a poor job of controlling chronic conditions such as asthma and diabetes, a new state report shows.
The findings were published Tuesday in the state's annual report card on California's 10 largest HMOs, six biggest preferred-provider organization plans and more than 200 medical groups. The scores on clinical performance and patient satisfaction reflect care for about 16 million Californians with private health insurance.
The California Office of Patient Advocate said the report card allows people to quickly search for information by specific medical conditions and examine the level of patient complaints against health insurers.
Many consumers are demanding more information on healthcare quality and costs as they face rising deductibles and bear a bigger share of their own medical costs even with employer coverage. And hundreds of thousands of Californians are shopping for new policies in the state's health insurance exchange as part of the Affordable Care Act.
After a long delay and much debate, the Covered California exchange also posted a separate set of quality ratings for most of its health plans last week.
"This information is more important than ever in the era of health reform," said Amy Krause, director of the state's Office of the Patient Advocate. "There is a great depth of information available here at your fingertips."
The annual report card is online at http://www.opa.ca.gov/pages/reportcard.aspx and free mobile apps are available.
Krause said the latest results show that insurers and physicians are doing a solid job at monitoring the care of patients with diabetes, heart disease and other chronic conditions. But their performance afterward is often lacking when it comes to controlling those costly conditions, which drive much of the nation's $2.8 trillion in annual healthcare spending.
"The quality of care for patients with diabetes or heart disease, while improving on some measures, varies widely in California and often depends on where someone lives or which HMO, PPO or medical group is providing care," Krause said.
For instance, insurance company performance differed widely on getting asthma patients the right combination of medications to help control their disease. Western Health Advantage led the pack with 77% of its asthma patients ages 12 to 64 receiving the proper medicines and instructions on when to use them, state data show.
Kaiser Permanente's Southern California system was the lowest-ranked HMO, with 64% of patients getting the right medications. The top health plans nationwide score 83%, according to the report card.
A health insurance trade group said California plans are doing a good job overall on providing the recommended care and that further gains will require more collaboration with doctors and patients.
The data reveal that "health plans and doctors are effectively monitoring care, but controlling chronic conditions like diabetes is a three-way partnership between individuals, doctors and plans," said Patrick Johnston, chief executive of the California Assn. of Health Plans.
Overall, Kaiser Permanente was the only HMO statewide to earn a top four-star rating for providing recommended care based on national guidelines. The state's largest for-profit health insurer, Anthem Blue Cross, received three stars for both its HMO and PPO plans on that same measure.
Many HMO patients expressed frustration at "getting care easily." On that measure, eight of 10 HMOs, including Anthem and Kaiser's Southern California unit, were rated poor, or just one star.
The 2014 report card relies on claims data and patient surveys from 2012, the most recent information available.
Consumers can also use the report card to check physician groups by name or county.
In the Los Angeles area, medical groups affiliated with UCLA, Cedars-Sinai and HealthCare Partners all received three out of four stars on providing recommended care.
The state insurance exchange has begun posting quality ratings for nine of its 11 health plans based on a separate set of customer surveys.
In the exchange's Los Angeles region, Kaiser was the only health plan to receive the highest four-star rating.
Anthem Blue Cross, Blue Shield of California and Health Net's HMO all received three stars. Health Net's PPO, L.A. Care Health Plan and Molina Healthcare got two stars under the exchange's scoring system.
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