Medicare Recipients Rate HMOs
Medicare is offering something new for its 40 million customers: report cards, compiled from surveys of Medicare recipients who belong to HMOs and were asked to rate the quality of their health plans.
The first scientific survey of beneficiaries is a step forward in the imprecise art of measuring quality in the delivery of health care. For most people enrolled in Medicare, or any other health system, casual conversations with friends and neighbors have been one of the most important tools in deciding how to pick a doctor and a health plan. This was the first in what will become a periodic survey of Medicare beneficiaries, both inside HMOs and in the traditional Medicare program.
Translating this kind of back-fence gossip into a more systematic approach, Medicare’s new survey is like “having 100,000 people come in and sit around your kitchen and talk about their health plans,” said Dr. John M. Eisenberg, head of the federal Agency for Health Care Research and Policy.
Medicare sent detailed surveys to 136,000 beneficiaries from February to May 1998, and 100,000 completed the detailed document, “making it the most comprehensive effort about consumers’ satisfaction with managed care ever conducted in the U.S.,” according to the Health Care Financing Administration, which runs Medicare, the federal insurance program for people age 65 and over and the disabled.
The results of the consumer opinion survey are posted on the Medicare Web site, https://www.medicare.gov, along with comparative measures of plan performance in key health areas, such as assuring that women receive mammograms.
The survey asked consumers to provide an overall rating of the health plan, overall rating of the care they received, judgment of the plan doctors’ ability to communicate and the ease of getting referrals from the primary care doctor. The survey was developed jointly by the Health Care Financing Administration and the Agency for Health Care Research and Policy.
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A separate assessment, also posted on the Web site, reviews several measures considered essential to a quality health plan. These past-year numbers include a plan’s percentage of women who received a mammogram, heart attack victims who were treated with beta blockers after being discharged from the hospital, diabetics who were given regular eye examinations, and the proportion of enrollees who were seen by a health care provider. The percentage is given for each health plan, and it is compared with the average for all the plans within the state.
The report card survey of patients showed strong levels of general satisfaction, with almost 50% of those interviewed giving their plan a top ranking of 10 on a scale of 1 to 10. Thirty-four percent gave their plans an 8 or a 9.
“These results should provide beneficiaries who are enrolled in health plans with additional peace of mind that their plans are well-regarded by their peers,” said Nancy-Ann DeParle, the HCFA administrator. The survey “will be an important tool for other seniors and their families to use in deciding whether to join a health plan and, if so, which one to join.”
Nationally, about 16% of Medicare beneficiaries are enrolled in managed care plans such as HMOs. But the percentage is far greater in California, with the statewide figure about 25%, and the numbers reaching 40% in Los Angeles and Orange counties. The HMOs are popular because they offer benefits not included in the regular Medicare program, such as prescription drugs. The HMOs also do not charge the copayments and deductibles required in the regular Medicare. In return for the extra benefits, HMO members must choose their doctors and hospitals from a restricted list.
The Medicare population--those older than 65 and the disabled of all ages--is the heaviest user of health care services among all age groups, and federal officials hope the increasing enrollment in HMOs will help slow the growth in health care costs.
“As more Medicare beneficiaries enroll in managed care, they need comparative information on the quality of those plans so that they can make the best choice for themselves and their loved ones,” said Health and Human Services Secretary Donna Shalala.
The Medicare Web site also includes for the first time summaries of inspection reports of the nation’s nursing homes.
California residents who would like more information can call (800) 633-4227.
