HMO Report Card Finds General Improvements; Negative Results in Smoking Prevention, Flu Shot Dispersion

There are "significant ... discrepancies" in the quality of care provided by the state's 10 largest HMOs, according to the annual HMO report card released yesterday by the Office of the Patient Advocate, the Contra Costa Times reports. For the fourth annual report card, the OPA culled information from patient medical charts, mail and phone surveys and HMOs' records of services provided to members (Temple, Contra Costa Times, 9/30). The HMO rankings were based on more than 50,000 customer reports (AP/Orange County Register, 10/1).

The report card rates the HMOs on 23 specific quality measures within four categories: providing preventive care, treating the sick, caring for the chronically ill and member satisfaction (Contra Costa Times, 9/30). The report card for the first time this year also included ratings on how well the HMOs were meeting the translation needs of patients who do not speak English, as well as an evaluation of some of the state's largest medical groups (Girion, Los Angeles Times, 10/1).

The report card is intended to give consumers information on each plan's "specific strengths and weaknesses," the Contra Costa Times reports (Contra Costa Times, 9/30).

Kaiser Permanente North received the highest score in the report, nine stars out of a possible 12. Blue Shield, Health Net, Kaiser Permanente South and PacifiCare tied for second with seven stars. Tying for the lowest score with six stars were Blue Cross, Aetna, Cigna and Universal Care (Los Angeles Times, 10/1).

Kaiser North scored highest for providing flu shots to members ages 50 to 64, although only 49% of the HMO's patients were inoculated. Kaiser North also received the best score -- a 75% approval rating -- for advising members to stop smoking.

Blue Cross received the highest ranking for handling depression, with 41% of members reporting they received good care, compared with 15% for Aetna, the lowest-scoring HMO in the category.

According to the Union-Tribune, HMOs "made strides forward this year" (San Diego Union-Tribune, 10/1). HMOs showed improvement in screening for cholesterol and high blood pressure (Sarkar, San Francisco Chronicle, 10/1).

However, OPA acting director Ed Mendoza said he was disappointed by the HMOs' performance in preventive care, which ranked the lowest of any category, the Union-Tribune reports. Mendoza added that HMOs performed well in childhood immunization, pregnancy care and handling heart attacks but scored low on mental health issues and caring for sexually transmitted diseases (Kinsman, San Diego Union-Tribune, 10/1). Mendoza said that the HMOs also did not adequately encourage patients to stop smoking or receive the influenza vaccination (San Francisco Chronicle, 10/1).

"For the most part, HMOs have either maintained or slightly increased their quality of care over the past year. It's important that even though progress is being made in an incremental way, we are still a long way from optimal health care," Mendoza said (San Diego Union-Tribune, 10/1). He added, "Our goal here ... is to empower consumers through information. Now that we are all paying more for our health care through higher premiums, it's even more important to ensure we get a value for our dollar."

HMOs and consumer advocates -- "who rarely see eye to eye" -- said the report left out "key information that could help people better choose a health plan," the Los Angeles Times reports.

Blue Cross of California spokesperson Michael Chee said, "It's not that we don't agree with the goal of providing ... meaningful information to consumers. But we don't think this report card is very helpful toward that end."

Jerry Flanagan of the Santa Monica-based Foundation for Taxpayer and Consumer Rights said his group wants the report card to include information on how premiums are spent, which is a requirement in 26 other states. "The reality is (California is) lagging behind 26 states in health care cost control. If we had a better report card, California could surely be the leader in controlling health care waste and profiteering," Flanagan said.

Other patient advocates said they also wanted the survey to state how often each HMO raised premium rates.

Mendoza said the report could not compare premiums information because there are too many differences among HMOs (Los Angeles Times, 10/1). The report is available online.