Kaiser HMOs, Anthem and Cigna PPOs Rated Highest for Care
Kaiser Permanente's HMOs are the best in the state for providing recommended care, while Anthem Blue Cross and Cigna are the best at providing recommended care among PPOs, according to new report cards released by the California Office of the Patient Advocate, the Los Angeles Times reports (Terhune, Los Angeles Times, 10/16).
The report cards -- which usually go out in January -- were released early to coincide with the state health insurance exchange's second open enrollment period, which begins on Nov. 15 (Shinkman, Payers & Providers, 10/16).
OPA Director Elizabeth Abbott said that while the report cards are aimed at individuals with work-sponsored health coverage, consumers enrolling in private coverage through Covered California could find the data useful because the same insurers often participate in both markets (Wolfson, Orange County Register, 10/15).
For more on the report cards being released early, see today's "Capital Desk" post.
Details of Report Cards
The report cards provide information on the state's 10 largest HMOs, six largest PPOs and more than 200 physicians groups. Overall, the organizations provide care to 16 million consumers.
For the report cards, officials examined information from 2013, including:
- Claims data;
- Electronic health record data; and
- Patient satisfaction surveys (Hernandez, "Capsules," Kaiser Health News, 10/15).
HMOs, PPOs and provider groups were rated one to four stars based on how well they:
- Allowed enrollees to obtain care with ease;
- Provided recommended care and information to members; and
- Other metrics.
In addition, new ratings were added this year for readmission rates and other measures (Payers & Providers, 10/16).
The reports are accessible online or through a mobile application ("Capsules," Kaiser Health News, 10/15). They are available in Chinese, English and Spanish (OPA release, 10/15).
Kaiser Permanente's Northern California and Southern California HMOs were the only such plans to receive four-stars -- the highest possible rating -- for providing recommended care. All other HMOs received three-star ratings.
However, eight HMOs received one-star ratings for enrollees' ease of obtaining care, with Kaiser's Southern California HMO receiving two stars and its Northern California HMO receiving three stars.
Sharp Health Plan's HMO was the only such plan to receive four stars for providing information to its members (HMO report card, 10/15).
Meanwhile, Anthem Blue Cross and Cigna were rated highest among PPOs for providing recommended care, with three-star ratings. All other PPOs examined in the report card received two-star ratings.
Anthem's PPO also received the highest score for enrollees' ease of obtaining care -- at three stars.
All six PPOs in the report card were rated one to two stars for providing information to their members (PPO report card, 10/15).
Physician Group Findings
Several physician groups received four-star ratings for both providing recommended care and patient satisfaction, including:
- Kaiser Permanente's Southern California Permanente Medical Groups in Baldwin Park, Downey, Orange County and South Bay;
- Palo Alto Medical Foundation;
- The Permanente Medical Group's Fremont/Hayward/San Leandro Medical Centers;
- The Permanente Medical Group's San Jose Medical Center; and
- The Permanente Medical Group's South San Francisco Medical Center (Medical group report card, 10/15).