MANAGED CARE: NEWSWEEK RATES HMOs FOR ITS READERS
NEWSWEEK's cover story, "Does Your HMO Stack Up?," thatThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
provides a general overview of managed care, offers tips to
consumers on how to compare plans and ranks 43 of the nation's
top health plans. While admitting that "measuring planwide
quality is still more an art than a science," NEWSWEEK and
Foundation for Accountability President David Lansky designed a
survey and sent it to 75 health plans. The survey used criteria
to measure HMO quality that included National Center for Quality
Assurance (NCQA) accreditation; whether the HMO hires an outside
firm to conduct a member satisfaction survey and releases the
information to the public; whether the HMO tracks the health of
its members; how good the HMO's prevention and screening programs
are; the quality of maternity care; patient satisfaction, as
compiled by independent firms; and the number of
complaints/grievances filed by HMO enrollees against their plans.
THE OUTCOME: NEWSWEEK notes that their rating system is
only a "snapshot of HMO quality, not a permanent grade." Of the
43 plans that responded to the survey, Massachusetts-based Fallon
Community Health Plan and Harvard Community Health Plan, Northern
California Region Kaiser Foundation Health Plan Inc. and Kaiser
Foundation Health Plan of Colorado received the highest ranking
under NEWSWEEK's methodology. NEWSWEEK reports that these plans
had "close, collaborative relationships with their doctors and a
long-established mechanism for keeping people healthier." Aetna
Health Plans of California, Inc., California-based CareAmerica
Health Plans and Texas-based NYLCare Health Plan all ranked the
lowest (Spragins, 6/24 issue).
CHOOSE YOUR DOC WISELY: NEWSWEEK also features a separate
article that offers HMO enrollees tips on how to choose a doctor
from their health plan's network. Consumers are encouraged to
"dig for data" about their physicians from state licensing boards
and consumer groups. NEWSWEEK also recommends that consumers
"knock on the HMO's door" by asking health plans directly about
their physicians' credentials and seeking information from plans'
own quality assurance departments. Consumers are also encouraged
to get their employers involved in pressuring health plans to
provide quality care (Spragins/Kahn/Miller, 6/24 issue).
GROWING AND GROWING: According to the American Association
of Health Plans' (AAHP) recently released HMO and PPO Trends
Report, HMO and PPO enrollment grew 13% from 1994 to 1995 to a
total of 149 million people. The number of people enrolled in
HMOs rose from 51.1 million to about 58.2 million; PPO enrollment
increased from 80.8 million to 91 million. In addition, 99.5% of
HMOs and 80.6% of PPOs conduct patient satisfaction surveys, 86%
of HMOs use clinical practice guidelines and about 73% of HMOs
now offer POS options -- up from 42% five years ago. Also, 44%
of all HMOs now offer services to Medicare recipients (AAHP
release, 6/17).
PLANES, TRAINS AND ...: Under the headline, "Startling
Similarities Between ValuJet, HMOs," former Columbia University
College of Physicians and Surgeons professor Harry Schwartz
writes in the HOUSTON CHRONICLE that ValuJet and HMOs have two
things in common: Passengers know very little about the
preparation and operation of planes before they fly and HMO
members know very little about how "doctors make their decisions
and how good those decisions are." Schwartz concludes, "It is
time for ... public officials to take measures such as tighter
safety supervision of airlines and more rigorous oversight of
what HMO doctors do and don't do" (6/13).