Survey Finds Kaiser Leads State in HMO Member Satisfaction

If medical care can be rated like automobiles, then the Kaiser Foundation Health Plan might be considered the Lexus of California health plans, at least according to a survey of HMO member satisfaction conducted by Consumer Reports magazine.

The survey, released Monday, asked members of 37 of the nation’s biggest health maintenance organizations--including nine in California--about choice and availability of doctors, whether they got the care they wanted, office waiting times, preventive care and other satisfaction measures.

Kaiser’s Southern California region ranked No. 7 overall, and its Northern California region ranked No. 10. PacifiCare of California, an Orange County-based plan, was the second-highest-rated plan among those in California.

Such “customer satisfaction surveys” are generally considered a useful--if incomplete--tool for rating consumers’ happiness with products or services.

In the auto world, the annual owner satisfaction survey by J.D. Power & Associates--topped in the last five years by the Lexus or Infiniti luxury cars--has become a closely watched measure of quality.

Health-care experts generally agree that the quality of health plans is more difficult to measure objectively. Nonetheless, many HMOs and outside groups use satisfaction surveys as a way to measure members’ experiences.

An HMO operated by Blue Cross/Blue Shield in the Rochester, N.Y., area was the top-rated plan among those surveyed, while a California plan, PruCare of California (now known as Prudential HealthCare), was rated worst.

Consumer Reports noted that members of not-for-profit HMOs tended to be more satisfied with their plans than those who belonged to for-profit plans. All of the top 11 HMOs, including Kaiser and the Rochester Blue Cross plan, are operated by not-for-profit companies.

“We’re very pleased with the results.” said Les Zendle, a Kaiser associate medical director. As for not-for-profits rating higher than for-profit firms, he said, “I think that speaks for itself.”

Prudential is “very concerned by the results,” spokeswoman Peggy Frank Lyle said. The Consumer Reports ratings are “totally inconsistent” with other surveys by independent groups that have found that anywhere from 86% to 93% of the Woodland Hills-based plan’s members are satisfied.

The survey found that plans with the highest ratings were those that paid doctors straight salaries or a fee for each service. But HMOs have increasingly been paying doctors through a method known as “capitation,” typically a flat monthly fee per member, regardless of how few or how many services the patient uses.

The survey ratings are part of a 15-page special report on HMOs in Consumer Reports’ August issue. The magazine is published by Consumers Union, a nonprofit product-testing and consumer group based in Yonkers, N.Y.

Some of the other findings of the survey:

* 10% of those surveyed said they did not get the medical care they wanted because their plan or doctors discouraged it.

* 18% said they had gone to a doctor outside the HMO network--usually because they wanted a doctor experienced with specific problems or because they had seen the doctor previously.

* 12% of the HMO members said they tried to see a doctor in their plan but found the doctor was no longer taking new patients.

All of those surveyed were Consumer Reports subscribers, who, the magazine noted, are more affluent and educated than the U.S. population overall. Also, the “vast majority” of the readers said they were in good health at the time of the survey.

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Survey Rankings

Consumer Reports magazine rated 37 HMOs based on surveys of 20,000 HMO members who were also subscribers to the magazine. Plans were ranked on a scale of 0-100, with a score of 100 indicating that members were “completely satisfied,” a score of 80 meaning members were “very satisfied” and a score of 60 meaning they were “fairly well satisfied.” Generally, non-profit HMOS scored best. The results were based on members’ ability to get care they wanted, their choice of and access to doctors, preventive care, office waiting times, and other measures.

HMO: Blue Cross/Blue Shield of the Rochester (N.Y.) Area

Rating: 82

Profit status: Nonprofit

*

HMO: Pilgrim Health Care Inc. (Mass., R.I.) (1)

Rating: 81

Profit status: Nonprofit

*

HMO: Group Health Cooperative of Puget Sound (Wash., Idaho)

Rating: 79

Profit status: Nonprofit

*

HMO: Independent Health (N.Y.)

Rating: 79

Profit status: Nonprofit

*

HMO: Tufts Associated Health Plans (Mass.)

Rating: 79

Profit Status: Nonprofit

*

HMO: Kaiser Foundation Health Plan (Colo.)

Rating: 79

Profit status: Nonprofit

*

HMO: Kaiser Foundation Health Plan (So. Calif.)

Rating: 78

Profit status: Nonprofit

*

HMO: Harvard Community Health Plan (Northeast)

Rating: 78

Profit status: Nonprofit

*

HMO: Kaiser Foundation Health Plan (Northwest)

Rating: 77

Profit status: Nonprofit

*

HMO: Kaiser Foundation Health Plan (No. Calif)

Rating: 77

Profit status: Nonprofit

*

HMO: Kaiser Foundation Health Plan (Mid-Atlantic)

Rating: 77

Profit status: Nonprofit

*

HMO: Medica-Allina Health System (Minn., N.D.)

Rating: 77

Profit status: (Plan refused to answer Consumers Union’s questionnaire.)

*

HMO: Heritage National Healthplan (Ill., Iowa, Tenn., Wis.)

Rating: 76

Profit status: Profit

*

HMO: HealthPartners (Minn., Wis.)

Rating: 76

Profit status: Nonprofit

*

HMO: HMO Oregon/Health Maintenance of Oregon (Ore., Wash.)

Rating: 74

Profit status: Nonprofit

*

HMO: U.S. Healthcare/HMO (N.J.)

Rating: 74

Profit status: Profit

*

HMO: U.S. Healthcare/HMO (Pa.)

Rating: 74

Profit status: Profit

*

HMO: Health Alliance Plan of Michigan

Rating: 74

Profit status: Nonprofit

*

HMO: PacificCare of Califoria

Rating: 73

Profit status: Profit

*

HMO: Oxford Health Plan of New York (N.Y., N.J., Conn)

Rating: 72

Profit status: Profit

*

HMO: Intergroup Healthcare (Ariz.)

Rating: 72

Profit status: (Plan refused to answer Consumers Union’s questionnaire.)

*

HMO: HMO Blue/Baystate Health Care (Mass., N.H.)

Rating: 71

Profit status: Nonprofit

*

HMO: HMO Health Ohio

Rating: 71

Profit status: (Plan refused to answer Consumers Union’s questionnaire.)

*

HMO: HMO Illinois/Blue Cross Blue Shield of Illinois (Ill., Ind.)

Rating: 71

Profit status: Nonprofit

*

HMO: Keystone Health Plan East (Pa.)

Rating: 71

Profit status: Profit

*

HMO: FHP California/TakeCare Network

Rating: 71

Profit status: Profit

*

HMO: Health Options (Fla.)

Rating: 69

Profit status: (Plan refused to answer Consumers Union’s questionnaire.)

*

HMO: HealthPlus (D.C., Md., Va.)

Rating: 69

Profit status: Profit

*

HMO: CIGNA HealthCare of California

Rating: 69

Profit status: Profit

*

HMO: Health Net (Calif.)

Rating: 69

Profit status: Profit

*

HMO: Humana Medical Plan (Fla.)

Rating: 69

Profit status: (Plan refused to answer Consumers Union’s questionnaire.)

*

HMO: Foundation Health, a California Health Plan

Rating: 68

Profit Status: Profit

*

HMO: Humana Health Plans (Ill., Ind.)

Rating: 68

Profit status: Profit

*

HMO: U.S. Healthcare/HMO (N.Y.)

Rating: 67

Profit status: Profit

*

HMO: CaliforniaCare

Rating: 66

Profit status: Profit

*

HMO: HIP of Greater New York

Rating: 65

Profit status: Profit

*

HMO: PruCare of California

Rating: 61

Profit status: Profit

(1) Plan has mergered with Harvard Community Health Plan.

Source: Consumers Union