HMO Study Raises Concerns, Group Says

A Los Angeles consumer group said its study of managed-care health plans that serve the poor raises new concerns about the quality of medical care in these plans and the effectiveness of oversight by state regulators.

A report released this week by the Center for Health Care Rights concludes that health maintenance organizations can vary widely in the amount of care they provide Medi-Cal patients. For example, the study found that members of some Medi-Cal HMOs were more than twice as likely to have seen a doctor during 1994 than members of other plans.

The study, which focused on Medi-Cal members, also found wide differences in the number of times that members in commercial or Medicare HMOs visited a physician.

Health-care experts say that the number of times a patient sees a doctor is one indicator of how easily patients have access to medical care. Improving access to preventive and other medical services for the poor and controlling costs have been cited as key reasons for Gov. Pete Wilson’s program to move millions of Medi-Cal recipients into private health plans during the next few years.

“While providing fewer services does not necessarily mean lower-quality care, the wide variance in the number of times people are seeing their doctors in some plans raises questions about barriers to care and point to the need for a strong monitoring effort,” said Jennifer Yang, a health policy analyst and coauthor of the report.

The study looked at 1994 data contained in public filings by HMOs with the California Department of Corporations, the state agency that regulates these health plans. The department shares oversight of Medi-Cal HMOs with the California Department of Health Services.

State officials and HMO executives said it was inappropriate to draw conclusions about medical quality based solely on information about how many times patients visit doctors or other health-care professionals.

Because there are no industry standards on how often a patient should visit a doctor, “we can never know when there are too many or too few visits,” said John C. Molina, vice president of Molina Medical Centers, a Long Beach-based HMO for Medi-Cal recipients.

The report also noted problems with the Department of Corporations’ collection of key medical data on HMOs.

For example, the report cited two HMOs, Molina and Universal Care, as having low rates of doctor visits for Medi-Cal members. Universal’s filings showed that its Medi-Cal members averaged one visit to a doctor roughly every three years, whereas Molina members averaged about 1.5 doctor visits in 1994.

Those figures compare with an average of 3.5 annual visits for all 18 HMOs surveyed. Kaiser Foundation Health Plan in Southern California topped the list, with an average of 5.1 doctor visits.

When queried by The Times, representatives of Universal contended that the figures in the filings were inaccurate because they mistakenly reported monthly figures instead of annual rates.

Molina said it had “inadvertently underreported utilization.”

“‘Not having good data undermines the state’s effectiveness in monitoring HMOs,” Yang said.

Ann Kuhns, assistant chief of the Department of Health Services’ Medi-Cal managed-care division, said the report’s findings “are a flag of some issues we need to look at.”

Corporations Commissioner Gary Mendoza said his agency “has identified the need to take better advantage of the information we gather.”

Both Kuhns and Mendoza said their agencies are working to improve the collection and accuracy of medical-quality data for HMOs.