HMO Care Improves in State Survey

California’s 10 largest HMOs continue to have “critical shortfalls” and mediocre results in providing preventive care, although overall quality of care has improved and members are increasingly satisfied with their plans, said state officials who released an annual HMO “report card” Tuesday.

The annual survey by the state Office of the Patient Advocate rated Kaiser Permanente’s Southern California operation the highest, with 10 out of a possible 12 stars. The HMO’s Northern California branch, which came in first last year, ranked second. Since the survey began five years ago, published each fall before many employees must choose their health plans for the following year, one of the Kaiser plans has always ranked first.

Aetna Health Inc., Blue Shield of California and Universal Care tied for last place in the survey, which considers each HMO’s performance in preventive care, treatment of acute and chronic illnesses and patient opinions.

“Some of these plans still need to do some work -- there are many areas here that still need improvement,” said Ed Mendoza, acting director of the Office of Patient Advocate. “Consumers need to know that quality varies and premiums are not the only thing to consider when picking a plan.”

Most plans fell short in preventive care, including cancer screening and immunizations.

Some consumer advocates said the report card, which also evaluates 150 physician groups in the state, did not go far enough.

“This report gives consumers less information than Ebert & Roeper’s movie reviews,” said Jerry Flanagan of the Foundation for Taxpayer and Consumer Rights, a Santa Monica consumer group. The report should have addressed financial issues such as how much of the premiums are spent on care, Flanagan said.

But Peter Lee, president of San Francisco-based Pacific Business Group on Health, an alliance of employers that buys health insurance for its members, contended that the state report card was valuable in part because “it reminds consumers they are the ones who make the decisions about their health care.”

Areas in which the plans fell short this year included colorectal cancer screening and other cancer screenings, chlamydia screening, antibiotic treatment for children with throat infections and eye exams for diabetes. In these areas, most plans failed to meet state standards of care.

Mental healthcare in general also had low scores, the report found. For example, only 39% of patients treated with medication for depression were seen at least three times during the initial 12-week treatment phase under the highest-ranked plan in this category, Blue Cross of California, the state concluded.

Industry officials said they considered the state report card a useful tool. Aetna spokeswoman Wendy Morphew said the company took the state results “very seriously” and said Aetna would “use the results to help us improve our performance.”

The report card can be viewed online at www.hmoreportcard.ca.gov, and obtained without cost at pharmacies and local libraries or by calling toll-free (866) 466-8900.

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Ranking the providers

Here are the scores of California’s largest HMOs in an annual state survey. Service is rated on four categories on a three-star scale.

*--* Member Care of rating Preventive chronic of health HMO care Treatment illness plan Kaiser Perm South ** *** ** *** Kaiser Perm North * *** ** *** Health Net * ** *** ** Pacific Care * ** ** *** Blue Cross * * *** ** Cigna * ** *** * West. Health Adv * * ** *** Aetna * * ** ** Blue Shield * * ** ** Universal Care * * ** **

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Source: California Office of the Patient Advocate