Members Like Small HMOs Best, Poll Says

By DAVID R. OLMOS

Sept. 12, 1996 12 AM PT

TIMES STAFF WRITER

Small, nonprofit HMOs once again outperformed bigger, profit-seeking health-care companies in satisfying their members last year, according to a survey released Wednesday of nearly 40,000 Californians.

But two big Southern California HMOs--FHP/TakeCare and Kaiser--also ranked high among the 16 firms rated by the Pacific Business Group on Health, a coalition of major employers including Arco, Chevron Corp., Pacific Telesis Group and the University of California.

The top-rated HMOs were Lifeguard Health Care, a small nonprofit based in Silicon Valley, and Health Plan of the Redwoods, another small nonprofit HMO, based in Santa Rosa. They also perennially topped earlier surveys.

The lowest-rated were Blue Cross of California’s CaliforniaCare and Blue Shield of California.

“One of the values of being a nonprofit is you can concentrate on key customers and you don’t have to concern yourself with shareholders,” said Mark Hyde, chief executive of Lifeguard. “The nonprofit plans seem to do better than the for-profits in these surveys, and I don’t think that’s a coincidence.”

The annual survey, which queried HMO members on their satisfaction with various aspects of their medical care, has become an influential, if imperfect, yardstick for measuring and comparing the performance of HMOs in the state.

Lifeguard and Health Plan of the Redwoods both received grades of A for members’ overall satisfaction with the health plan and an A+ for their satisfaction with the doctor they visit most often.

Other plans that received A grades in those two categories were Kaiser Foundation Health Plan’s Northern and Southern California regions, FHP/TakeCare in Fountain Valley and Sacramento-based Foundation Health, which also has a major Southern California presence.

The business group, which has endorsed the use of HMOs as a way to cut the cost they incur for providing health coverage for their employees, used a generous grading system. An A meant a satisfaction rating of 80% to 89%, which in school would be a B. A C rating was from 50% to 69%, which would normally be a D or an F. There was no provision for an F, even if an HMO received a zero satisfaction rating.

The group would not give specific percentage scores for the HMOs.

Despite the industry’s much-ballyhooed efforts to improve quality, Pacific Business Group said that overall the percentage of respondents satisfied with their HMOs rose just one percentage point, to 80%, in 1995 compared with 1994.

All those surveyed received an A or B except Blue Cross’ CaliforniaCare and Blue Shield, which got a C for overall satisfaction.

Woodland Hills-based CaliforniaCare also performed poorly in a recent member-satisfaction rating by Consumer Reports magazine, finishing 35th out of 37 U.S. HMOs rated by the consumer group.

Blue Cross spokeswoman Cynthia Coulter said the company was encouraged that its scores in the survey had improved from a year earlier.

The survey also asked members about their experiences in specific areas, including their doctors’ skills, how well doctors explained medical tests and the ease of gaining referrals to specialists. And members were far less happy with some of those aspects.

For example, 10 of the plans received a C grade when survey members were asked about their experience in getting referrals to specialists, a common complaint about HMOs. The business group said it is “concerned by that result.”

Such surveys are an increasingly popular way to evaluate and compare health plans. However, experts say satisfaction surveys have inherent flaws.

“Patient satisfaction is more closely correlated with customer service than medical quality,” said Dr. Schumarry H. Chao, a Santa Monica health consultant.

Chao said her own research into patient satisfaction has shown that patients are often impressed mainly with the politeness of their doctors or their office staff, or the quality of magazines in the waiting room.

Moreover, many California HMOs include the same medical groups in their networks, Chao notes. That means that a medical group may give the same quality of care no matter which HMO the patient belongs to.

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

Rating HMOs in California The rankings are based on satisfaction surveys of nearly 40,000 HMO members who are employees or retirees of nine large California companies that are part of the Pacific Business Group on Health, an employer coalition that deals with health insurance issues.

Overall

Health Plan of Redwoods

Satisfied With Health Plan?: A

With Primary Doctor?: A+

Lifeguard

Satisfied With Health Plan?: A

With Primary Doctor?: A+

FHP/TakeCare

Satisfied With Health Plan?: A

With Primary Doctor?: A

Foundation Health

Satisfied With Health Plan?: A

With Primary Doctor?: A

Kaiser North

Satisfied With Health Plan?: A

With Primary Doctor?: A

Kaiser South

Satisfied With Health Plan?: A

With Primary Doctor?: A

Aetna Health Plans