HMOs Fall Short in Healthcare Survey by State

None of California’s biggest health maintenance organizations excels at meeting all of the needs of its members, according to a “report card” released Thursday by the state’s Office of the Patient Advocate.

But HMOs and consumer advocates -- who rarely see eye to eye -- give the state’s fourth annual survey poor grades for leaving out key information that could help people better choose a health plan.

“It’s not that we don’t agree with the goal of providing ... meaningful information to consumers,” said Blue Cross of California spokesman Michael Chee. “But we don’t think this report card is very helpful toward that end.”

The latest survey rates nine of California’s largest health plans -- which serve about 14 million of 22 million HMO members in the state -- on how well they provide preventive care, treat the sick, care for the chronically ill and satisfy members. Each category gets a maximum of three stars.

The major HMOs surveyed earned from six to nine stars out of a maximum of 12, and they generally did better in the area of treating the sick than in providing preventive care.

Northern California’s Kaiser Permanente received the highest score: nine stars. Tying for second with seven stars were Blue Shield, Health Net, Kaiser’s Southern California HMO and PacifiCare.

Blue Cross received six stars, tying for the lowest score with Aetna, Cigna and Universal Care.

The Foundation for Taxpayer and Consumer Rights, a Santa Monica-based advocacy organization, wants the state’s report card to include information on how premiums are spent, as 26 other states require, said spokesman Jerry Flanagan.

“The reality is [California is] lagging behind 26 states in healthcare cost control. If we had a better report card, California could surely be the leader in controlling healthcare waste and profiteering,” Flanagan said.

Patient advocates also want the study to tell how often each HMO raised rates.

Chee said Blue Cross viewed the survey approach as too broad to be meaningful to consumers.

“We don’t feel it’s an accurate reflection,” he said. “But we are aware that we can do better, and we want to do better.”

Ed Mendoza, acting director of the Office of the Patient Advocate, said the agency fine-tuned its report card every year.

This year for the first time, it rated HMOs on how well they were meeting the translation needs of patients who didn’t speak English, and provided more detailed comparisons online of how 200 medical groups treated a variety of diseases and conditions.

“Our goal here at the Office of Patient Advocate is to empower consumers through information,” Mendoza said. “Now that we are all paying more for our healthcare through higher premiums, it’s even more important to ensure we get a value for our dollar.”

However, Mendoza said there was too much variation among health plans to report comparable information on premiums. And, he said, although the report card may not emphasize outcomes, it does evaluate indicators such as the proportion of a health plan’s members who received flu shots.

The study is available online at www.opa.ca.gov.

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Rating the HMOs

Below are the top scorers in an annual state survey of the largest HMOs. Service is rated in four categories on a three-star scale.

*--* HMO Care for staying healthy Care for getting better Care for living with illness Member rating of health plan Kaise * * * * * * * * * r Perma nente -- North

Blue * * * * * * * Shiel d of Calif ornia HMO

Healt * * * * * * * h Net

Kaise * * * * * * * r Perma nente -- South

Pacif * * * * * * * iCare of Calif ornia

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Source: California Office of the Patient Advocate

Los Angeles Times

Ratings key: Excellent *** Good ** Fair * Poor (No star)