California HMO Report Card Finds Limited Improvement From 2005
On Thursday, the California Office of the Patient Advocate released its seventh annual Health Care Quality Report Card with information on HMOs and medical groups, finding that none of California's largest HMOs was rated as "excellent," the Los Angeles Daily News reports (Sheppard, Los Angeles Daily News, 10/19).
Moreover, the report card shows that the HMOs have made only limited improvements in the quality of care from 2005 to 2006 (Chan, Sacramento Bee, 10/19).
For the report, OPA examined health care quality in four ways:
- Medical groups' compliance with 13 guidelines for clinical tests or treatments;
- HMOs' compliance with 10 test or treatment guidelines;
- HMO member satisfaction; and
- Medical group physicians' communication with patients, coordination of care and timely treatment of patients.
About 200 medical groups were included in the report card (Clark, San Diego Union-Tribune, 10/19).
Researchers analyzed reports that HMOs file with the National Committee on Quality Assurance.
The report card indicated that California HMOs made gains in screening patients for cancer and sexually transmitted infections, as well as providing some treatments to children.
Of all services considered, HMOs scored highest in ensuring that asthma patients were receiving the correct medication (Sacramento Bee, 10/19). Nine out of 10 asthma patients received the correct treatment.
Diabetics did not fare as well. State officials highlighted treatment of diabetes as an area where improvement is needed, citing findings from the report showing that last year:
- One in four diabetics' blood sugar is not being adequately regulated;
- Half of diabetics' cholesterol levels are outside of recommended levels; and
- 40% of HMO members with diabetes did not receive retinal screenings (Kleffman, Contra Costa Times, 10/18).
In addition, fewer than 40% of obese patients reported being advised about diet or exercise, and about one-third of HMO members ranked their HMO negatively (Colliver, San Francisco Chronicle, 10/19).
Health Net and Kaiser Permanente's Northern and Southern California divisions received "good" ratings, while the other six HMOs included in the report were rated as "fair" (Los Angeles Daily News, 10/19).
Steven Feitelberg, assistant medical director of the Kaiser Permanente Medical Group, attributed Kaiser's high ratings in part to its electronic health records system (San Diego Union-Tribune, 10/19).
Dr. Alán Whippy, Kaiser's medical director for quality and safety, said the EHR system helps ensure that members undergo recommended screenings, partly by sending letters and reminders (Contra Costa Times, 10/18).
About 95% of California's HMO members are enrolled in one of the nine plans included in the report card (Los Angeles Daily News, 10/19).
John Zweifler, a medical consultant to OPA, said, "There's still room for improvement." He explained that state officials are hoping the report card and pressure from consumers will drive health plans to boost quality, saying, "Until people really say quality matters in health care, I don't think we're going to get too far" (Sacramento Bee, 10/19).
Sandra Perez, director of OPA, said, "Consumers should realize there's a direct connection between the choices they make and the quality of care they receive" (San Diego Union-Tribune, 10/19).
However, some consumer advocates and physician groups faulted the report.
Jerry Flanagan of the Foundation for Taxpayer and Consumer Rights questioned why information on costs, regulatory action against health plans and specific consumer complaints is not included in the report (Sacramento Bee, 10/19).
Elizabeth Abbott, project director at Health Access California, voiced concerns that the report card has not translated to more improvements in health care quality, asking, "If that information has been published for the last seven years, why is this not better?"
Don Crane, CEO of the California Association of Physician Groups, said, "I probably have individual members who may take issue with a rating here or there but, in the main, increasing the transparency movement is something we salute and applaud" (San Francisco Chronicle, 10/19).
Anmol Mahal, president of the California Medical Association, called for the report to include more input from doctors about the care that they provide and faulted health plans for not providing higher reimbursements for preventive care.
Representatives of HMOs included in the report said they would use its findings to continue quality improvement efforts (Girion, Los Angeles Times, 10/19).