HMOs: Fewer Complaints Logged Last Year, Good Report Cards
Fewer than one in 10,000 of the 23.5 million Californians enrolled in HMOs register complaints to the state each year, according to new data from the Department of Corporations. Complaints declined seven% since 1997, totaling 2,100 last year. The results come amidst feverish debates over managed care reforms, prompting HMOs to push these numbers as a "good sign that things aren't as bad as the state's lawmakers would suggest" during the recently concluded session. Walter Zelman, president of the California Association of Health Plans, said, "If truly large numbers of individuals were having serious and unresolved problems with their HMOs, these numbers would be a good deal higher than they are" (Bole, San Francisco Business Times, 9/13).
More Good News for HMOs
Eighteen major managed care operations in California received high marks from the California Cooperative Healthcare Reporting Initiative (CCHRI), which is sponsored by the Pacific Business Group on Health (PBGH). More than half of respondents gave their HMOs an eight or above on a scale of zero to ten, with one out of five awarding a five or below (Crabtree, Orange County Register, 9/16). The overall satisfaction rate hovers around 80%, which Dr. Jeff Kamil, medical director of quality improvement for Blue Cross of California, called "welcome news in view of the ongoing spotlight on managed care" (CCHRI release, 9/15). Although two of the largest HMOs in California, Aetna and Foundation Health Systems' Health Net, declined to participate, two other large plans showed improvement since last year. Santa Ana-based PacifiCare improvement in seven categories, including adolescent immunization and diabetic eye exams, but faltered in others, like breast cancer screening. Kaiser Permanente showed similar improving in seven categories such as beta blocker treatment after heart attacks, but slumped in four areas, including post-delivery check-ups for mothers. Kaiser beat PacifiCare in all but one of 11 categories measured (Crabtree, 9/16). The "report card" also examined appointment availability, discovering that after calling to schedule an appointment, the average patient waits four days to see a primary care physician, but only three days to see any doctor.
A "trio of audiences -- purchasers, providers and consumers -- benefit from the report," according to CCHRI administrator Dr. David Hopkins. GTE Managed Care Manager Tom Davies agreed, saying, "We use it to assess how plans are doing and whether there has been any measurable upward trend in performance, and that guides our selection of plans we offer our employees" (CCHRI release, 9/15). The PBGH unites the insurance efforts of 21 large companies, who collectively spend $500 annually on premiums for 400,000 employees (Business Times, 9/13).