‘HMO HELL’: Newsweek, Others Offer Rankings
"Welcome to HMO hell," reads the cover story of the current issue of Newsweek. In a series of articles and its fourth annual ranking of the top 100 HMOs, Newsweek reports on the state of American health care -- including HMO care, patients' concerns, politicians' interest in uninsured Americans and suggestions to revamp the system. Working with HealthGrades.com, Newsweek compiled rankings based on information HMOs provided to the Health Plan Employer Data and Information Set (HEDIS) and evaluated HMOs in categories including access and services, child and adolescent care, "getting better," women's health, member satisfaction and qualified providers. HealthGrades.com assigned different weights to these categories to create an overall score for each HMO. According to Newsweek, the top five plans in the nation are Fallon Community Health Plan (MA), Tufts Health Plan (ME, MA, NH, RI), Excellus Health Plan, Inc. (Rochester, NY), Harvard Pilgrim Health Care, Inc. (ME, MA, NH, RI, VT) and Capital District Physicians Health Plan, Inc. (NY, VT).
According to a Newsweek/Discovery Health Channel survey, 61% of Americans are "frustrated and angry" with the current state of the health care system, but more than 70% of HMO subscribers are "at least basically content" with their HMOs' services. In contrast, 82% of fee-for-service customers are satisfied with their coverage. About half of those surveyed feel "fundamental changes" in the current system are required and 21% feel the system "should be completely rebuilt." As for solutions, 46% prefer a universal health system and 36% favor employer-based plans (11/8 issue).
Nuclear Power Plants of the 90s?
A Boston Globe article details the demise and hard times of several New England HMOs (including Newsweek survey top dogs Harvard Pilgrim Health Care and Tufts Health Plan). The Globe asserts, "Just as nuclear power plants once were considered the answer to our energy problems, HMOs were once seen as the answer to our health care problems. As public image of both have faded -- fairly or unfairly -- their values have eroded dramatically." The HMOs troubles are exemplified by the fact that for-profit HMOs were acquiring each other at about $1,000 to $1,500 per member in the mid-1990s, but now the acquisition price for a "healthy" HMO is about $300 per member. Particularly, Massachusetts HMOs, all operating as not-for-profits, have struggled, and most "are currently in the red because they held prices down while medical costs were rising." Lawsuits haven't helped matters, either. And even though some have claimed that "HMOs may be at a low ebb, but nothing fundamentally has changed with the business. Once rates go up ... profit margins will rise and stocks will follow them up," other observers like veteran health care attorney Stephen Weiner doubt that. He said, "HMOs don't seem to be the solution. We seem to have all the same old intractable problems that we had before managed care" (Syre/Stein, 11/2).
Some Good News
Consumers continue to award Medicare plans with high ratings, according to a 1999 Managed Medicare Member Survey by Caredata.com. Harvard Pilgrim Health Care in Boston and Kaiser Permanente in California rated highest overall in categories like quality of medical care, customer service and value. The survey of 15,400 Medicare+Choice members also rated the adequacy of care for 28 medical conditions. Mark Kaiser, Caredata.com CEO and chair, said, "With more than 30 million people eligible to enroll in Medicare health plans, access to the type of information released today can be an important factor in determining which plan to join" (Caredata.com release, 11/1). To view a list of the results, including plans ranked by region, visit www.caredata.com