ABCs of HMOs: New Study Rates Groups in State : Health: Report reflects growing demands on 21 plans to be held accountable for the medical services they provide.

In an effort to help consumers comparison-shop for medical care, a coalition of employers and health care providers has rated 21 California health maintenance organizations on the quality of their preventive health services.

While HMO marketing campaigns typically tout preventive health services, or “wellness,” to distinguish themselves from traditional medical plans, the report suggests that HMOs can differ sharply in how well they take care of their customers.

However, some HMOs that received high marks in some measures of medical quality performed less well in other areas, making it difficult to assess overall performance.

Only one HMO--TakeCare Inc., which was acquired last year by Fountain Valley-based FHP International--stood out from the pack, registering above-average marks in four of six measures. No other HMO received more than two above-average scores.

“You can’t just look at the plans and grade them as ‘A,’ ‘B’ or ‘C,’ ” said Patricia Powers, executive director of the Pacific Business Group on Health, an influential health care purchasing cooperative formed by major California employers. Her group was one of two major employer groups--the other was the California Public Employees Retirement System--that participated in the study. Other coalition members included the 21 HMOs and affiliated medical groups.

“You have to look across the plans and ask which one is doing a better job for the things I care most about,” Powers said. “If you are a woman, you might care more about prenatal care or childhood immunization.”

The quality report reflects growing demands by the purchasers of health care--mainly employers--to hold HMOs accountable for their claims of providing quality health care. In response, many health plans have produced their own report cards.

But the new study took a different approach--one that experts say is more credible. The coalition, the California Cooperative HEDIS Reporting Initiative, hired an independent health care consultant, the Medstat Group, to analyze information culled from 25,000 medical charts at more than 5,000 doctors’ offices statewide.

The Medstat Group looked at medical data for 1993 in six areas: childhood immunizations, breast cancer screenings, cervical cancer screenings, prenatal care, cholesterol screenings and diabetes retinal exams. The 21 HMOs were ranked above average, average or below average for each area.

The California report coincided with the release of a national study on HMO quality and performance produced by the National Committee for Quality Assurance, a nonprofit group that accredits HMOs. Both reports used standard quality measures--known as the Health Plan Employer Data and Information Set, or HEDIS--developed by the national committee. The national study judged selected HMOs on more than 30 measures of quality, patient satisfaction and performance, including how many people quit each year and how long they stayed in the hospital.

Employers and health plan executives noted that the California report card is only a first step in the effort to provide the public with meaningful information by which to compare health plans. The coalition plans to release a second report card this summer using 1994 data.

The six preventive health measures “do not define total quality of care,” said Dr. Joel Hyatt of the Kaiser Permanente Southern California region. “Sure, I get screened for something, but what is the medical outcome when I actually get the disease?”

Employers are pushing the health care industry to develop more sophisticated report cards. But report cards are still in their infancy, and the medical community has not reached a consensus on how best to measure quality.

“It’s shocking that a $1-trillion-dollar national industry really hasn’t effectively measured itself and its outcomes,” said Sam Ho, a senior vice president for PacifiCare Health Systems, a Cypress-based HMO. He said the report card movement will push the industry to improve the quality of care.

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Preventive-Care Report Card

California HMOs were rated fo their performance in providing six preventive-care services. How the HMOs serving Southern California compare:

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Health Plan: Aetna South

Childhood Immunization: Average

Cholesterol screening ages 40-64: Average

Breast cancer screening: Average

Cervical cancer screening: Average

Prenatal care: Average

Diabetes retinal exam: Average

Health Plan: Aetna San Diego

Childhood Immunization: Above Average

Cholesterol screening ages 40-64: Average

Breast cancer screening: Average

Cervical cancer screening: Average

Prenatal care: Average

Diabetes retinal exam: Average

Health Plan: Blue Shield HMO Childhood Immunization: Average

Cholesterol screening ages 40-64: Not applicable: Health plan was not operational for length of time required for the study.

Breast cancer screening: Average

Cervical cancer screening: Average

Prenatal care: Average

Diabetes retinal exam: Insufficient data submitted by the plan

Health Plan: CaliforniaCare

Childhood Immunization: Average

Cholesterol screening ages 40-64: Average

Breast cancer screening: Average

Cervical cancer screening: Above Average

Prenatal care: Average

Diabetes retinal exam: Average

Health Plan: CareAmerica

Childhood Immunization: Average

Cholesterol screening ages 40-64: Average

Breast cancer screening: Below Average

Cervical cancer screening: Average

Prenatal care: Average

Diabetes retinal exam: Average

Health Plan: CIGNA LA IPA

Childhood Immunization: Average

Cholesterol screening ages 40-64: Average

Breast cancer screening: Average

Cervical cancer screening: Average

Prenatal care: Average

Diabetes retinal exam: Average

Health Plan: CIGNA LA STAFF

Childhood Immunization: Average

Cholesterol screening ages 40-64: Average

Breast cancer screening: Average

Cervical cancer screening: Above Average

Prenatal care: Average

Diabetes retinal exam: Above Average

Health Plan: FHP

Childhood Immunization: Average

Cholesterol screening ages 40-64: Average

Breast cancer screening: Average

Cervical cancer screening: Above Average

Prenatal care: Average

Diabetes retinal exam: Below Average

Health Plan: Foundation Health Plan

Childhood Immunization: Average

Cholesterol screening ages 40-64: Average

Breast cancer screening: Average

Cervical cancer screening: Average

Prenatal care: Average

Diabetes retinal exam: Average

Health Plan: Health Net

Childhood Immunization: Average

Cholesterol screening ages 40-64: Average

Breast cancer screening: Average

Cervical cancer screening: Above Average

Prenatal care: Average

Diabetes retinal exam: Above Average

Health Plan: Kaiser Permanente

Childhood Immunization: Above Average

Cholesterol screening ages 40-64: Average

Breast cancer screening: Below Average

Cervical cancer screening: Average

Prenatal care: Average

Diabetes retinal exam: Above Average

Health Plan: Maxicare

Childhood Immunization: Average

Cholesterol screening ages 40-64: Average

Breast cancer screening: Above Average

Cervical cancer screening: Average

Prenatal care: Average

Diabetes retinal exam: Above Average

Health Plan: MetLife

Childhood Immunization: Below Average

Cholesterol screening ages 40-64: Average

Breast cancer screening: Below Average

Cervical cancer screening: Average

Prenatal care: Below Average

Diabetes retinal exam: Insufficient data submitted by the plan

Health Plan: PacifiCare

Childhood Immunization: Insufficient data submitted by the plan

Cholesterol screening ages 40-64: Average

Breast cancer screening: Below Average

Cervical cancer screening: Average

Prenatal care: Average

Diabetes retinal exam: Insufficient data submitted by the plan

Health Plan: PruCare

Childhood Immunization: Below Average

Cholesterol screening ages 40-64: Not applicable: Health plan was not operational for length of time required for the study.

Breast cancer screening: Average

Cervical cancer screening: Average

Prenatal care: Below Average

Diabetes retinal exam: Average

Health Plan: TakeCare

Childhood Immunization: Above Average

Cholesterol screening ages 40-64: Above Average

Breast cancer screening: Average

Cervical cancer screening: Above Average

Prenatal care: Average

Diabetes retinal exam: Above Average

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Source: California Cooperative HEDIS Reporting Initiative