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Kaiser gets top rating on HMO score card

Girion is a Times staff writer.

Kaiser Permanente got a perfect four stars for medical care on an annual HMO score card that California officials hope consumers will use to shop for health coverage.

The state’s largest health maintenance organization consistently comes out on top in the 8-year-old survey, but it was the first time that any HMO had scored a four-star rating.

The report card rates the state’s eight largest HMOs primarily on preventive measures, including what portion of an HMO’s enrollees received recommended tests on schedule, such as mammograms, colonoscopies, Pap smears and cholesterol checks.

Blue Shield of California, Health Net of California Inc., PacifiCare of California and Western Health Advantage all got three stars for their overall clinical quality performance, meaning those HMOs frequently met national standards. Aetna Health of California Inc., Anthem Blue Cross and Cigna received two stars, indicating that those HMOs often failed to meet standards.

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Kaiser garnered four stars because the HMO excelled at meeting national standards on 34 clinical indicators.

“The four-star rating is an aggregate of many measures, and it is significant because it really shows us what is doable for healthcare plans,” said Sandra Perez, director of the state Office of the Patient Advocate, which issues the report card. “What we hope is that plans can learn from each other and find out from Kaiser what is working.”

Some health plans said their lower scores reflected the difference in the quality of care the physicians in their networks deliver, over which HMOs have limited influence. Those with lower scores said they offered coverage in areas of the state with lower ratios of physicians to patients, which can make it more difficult to meet national standards for preventive screenings and other medical indicators.

Dr. Michael Belman, a medical director for Anthem Blue Cross, said the health plan was aware of the problem and was working with physicians to address it.

Kaiser executives said Kaiser was in a better position to meet measurable medical objectives because the HMO and physicians are part of the same organization. Kaiser also has invested heavily in information technology such as electronic patient records that are readily available to all its personnel. That makes it easy to detect what tests and other care a patient needs, said Dr. Benjamin Chu, president of Kaiser’s Southern California region.

Kaiser employees also are encouraged with small bonuses to make sure that patients are getting their recommended tests and care on time. As a result, Chu said, whether patients go to a dermatologist or an orthopedic surgeon, they are likely to be reminded that it is time for a colonoscopy or a cholesterol test.

In one case, a Baldwin Park woman paying a visit to her allergist was reminded that she was overdue for her mammogram. The patient told the receptionist that she would get to it when she had the time.

“But the receptionist said, ‘No. Let me make an appointment for you,’ ” said Jeffrey Weisz, executive medical director of the Kaiser Southern California Medical Group. “We picked up breast cancer and we cured her.”

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The score card also rates several large medical groups. Officials hope consumers will use it when shopping for physicians. The full report card can be found at healthcarequality .ca.gov or opa.ca.gov. Copies are also available by calling (888) 466-2219.

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lisa.girion@latimes.com


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