Most Give HMOs Conditional OK

Californians are generally satisfied with the performance of their managed-care physicians and health insurance plans but want better access to medical specialists and less time spent in doctor waiting rooms, the Davis administration said Tuesday.

The conclusions were contained in a second annual state government “report card” that rated the 10 biggest HMOs, covering 95% of Californians enrolled in managed-care health plans. For the first time, the evaluation also rated medical groups of doctors.

The report card, compiled by Martin Gallegos, the state patient advocate on issues dealing with managed health care, said the evaluation was intended as a shopper’s guide for consumers and employers in selecting health insurance plans and physician groups.

“It also serves as an incentive for the health plans to focus on their own quality improvement efforts,” said Gallegos, a former member of the Assembly who specialized in overhauling the unpopular managed-care industry in California.

The health maintenance organization report card, written in English, Spanish and Chinese, can be viewed online at www.opa.ca.gov, and obtained without cost by calling toll-free (866) HMO-8900, or at pharmacies and various heath advocacy organizations.

The report card did not give any HMO or medical group an A or F, but it did find that the 18 million people covered by managed care are generally satisfied, although they say there is room for improvement. The data were provided by surveys of managed-care patients, HMOs and medical groups.

For HMOs, the ratings were based on a variety of categories, including preventive care and care for a chronic illness, whether doctors listen to patients and explain matters carefully, and whether medical groups pay claims quickly and help resolve complaints.

Overall, the study narrowly scored Kaiser Permanente-South highest among the 10 biggest HMOs, receiving 10 movie review-style stars out of a possible perfect 15. It received the only “excellent” rating in the HMO review--for helping patients stay healthy.

Universal Care and Western Health Advantage tied for last place with seven stars each. Universal scored poorly in the staying healthy and care for chronic illness categories. Western finished poorly in the care for “getting better” and chronic illness classifications.

In the ratings of doctor groups for West Los Angeles and the San Fernando Valley, Healthcare Partners Medical Group got the top score with eight stars out of a possible 12. The lowest finisher, at four stars, was Pacific IPA.

For the East Los Angeles, Torrance and South Bay region, two groups tied for first place with eight stars each: Healthcare Partners Medical Group and Torrance Hospital IPA. Four groups tied for last with five stars each, including Alamitos IPA, Kaiser-Greater L.A., Professional Care Medical Group and Talbert Medical Group.

Daniel Zingale, director of the Department of Managed Care, told a news conference that the star rating system “is not a movie review. A missing star can mean a missing surgeon, a missing specialist or a missing life-saving medication. This is serious business.”

Zingale said that every HMO rated well in financial stability, but that scores fell in quality-of-service categories. “We want to close the gap,” he said.

Gallegos noted that in virtually every region of the state, managed-care doctors received low marks from patients for poor scheduling and failing to keep appointments on time. They also got low ratings for failure to provide timely access to specialists and for problems in ordering tests.

He told reporters that HMOs showed some improvement from last year’s report card, which he said was the first of its kind in the nation.

The document also drew praise from the HMO industry, which had fought several managed-care reforms enacted by the Legislature two years ago.

Walter Zelman, president and chief executive officer of the California Assn. of Health Plans, which represents more than 30 HMOs, applauded the report card, saying his trade group generally supports the disclosure of “fair and comparative information about health plans.”