Insurers’ report cards to allow comparisons
Health insurers have always known a lot about their customers, but the customers can’t always say the same about their insurers.
That’s about to change.
The California Department of Insurance today plans to announce a new “healthcare report card” program for six of the state’s largest preferred provider organizations, or PPOs. The reports will include information on quality of care and patient satisfaction so that consumers can compare plans.
Insurance Department officials say the program, which is voluntary and will begin in early 2009, is the first of its kind in the country.
Similar data already are available for health maintenance organizations, a result of demands by California and other states in response to widespread complaints from consumers who said they were being denied care.
But those reporting guides haven’t included the two-thirds of insured people who are covered by PPO health plans.
Unlike closed-network HMOs, PPO plans provide members who visit out-of-network doctors and hospitals a discount off the regular rates.
“This is the first time in the country that . . . people with PPO plans will be able to get data on how good their policy really is,” California Insurance Commissioner Steve Poizner said.
While calling the announcement a step in the right direction, some advocates say insurers will need to do a lot more before they can be considered truly transparent.
“We welcome any involvement on the part of the state to monitor the insurance industry more aggressively, which is something it has long failed to do,” said William Shernoff, a partner in Shernoff, Bidart & Darras of Claremont, which specializes in consumer insurance cases.
But, he said: “This is like a Band-Aid that won’t do anything about problems like insurers denying care or pulling people’s coverage for no reason.”
Poizner acknowledged that the health insurance industry needed more oversight and said the new reporting program was the first in a series of measures he planned to take. He said the details of the new reporting program were still being finalized.
Broadly, he said, the report cards will assess how well doctors in each insurance network follow best-practices guidelines, such as providing childhood immunizations and giving at-risk patients regular cancer screenings, and how well they rate on patient satisfaction surveys.
The report cards may also include clinical outcomes, including patient blood pressure averages and sugar levels in diabetics -- the kind of information that might ultimately show how well doctors are providing care.
Participating providers are Aetna Inc., Blue Shield of California, Cigna Corp., Health Net Inc., WellPoint Inc. and UnitedHealth Group Inc.
Audra Platz of Los Angeles joined a Blue Shield of California PPO plan in April but says she has been frustrated with the switch because she has repeatedly been unable to find out whether the plan covers certain medical care such as dermatology and other consultations.
She said news of the reporting system was welcome.
“It think it’s about time we know what we’re paying for,” said Platz, a media manager for Autism Speaks, a nonprofit advocacy group. “Maybe it’ll help keep the insurance companies more in line.”
Richard Sorian, vice president of public policy for the National Committee for Quality Assurance, a national nonprofit group that provides information about the quality of health plans, said California’s decision to push PPO plans toward broader reporting was likely to spur other states to do likewise and was “absolutely necessary if we are ever really going to effect change for most health insurance customers.”
According to the group’s most recent annual report, people in health plans that report quality data were more likely to receive better care such as preventive care and disease management.
Among the most notable improvements: 77.7% of children enrolled in private health plans that report quality data received all recommended immunizations, up from 72.5% in 2004; 75.5% of those who were smokers received advice to quit, a gain of nearly 11 percentage points over 2004.
