MANAGED CARE: PacifiCare, Health Net Rank As Favorite HMOs In State
PacifiCare and Health Net were ranked by doctors as the best HMOs in California, according to a survey conducted by the Pacific Business Group on Health Negotiating Alliance. Asking physician groups to assess the HMOs they work for, the alliance found that Aetna U.S. Healthcare and Blue Cross of California were consistently ranked worst by the doctors. Kaiser Permanente was not included in the survey because it has only one physicians group. The survey asked doctors their opinions about HMO performance in eight areas -- health plan service to groups, quality improvement, data reporting, management of prescription drug lists, financial incentives and contracting relationships, utilization management, referrals and operational plans of mergers. While PacifiCare and Health Net were consistently ranked as the two best plans across all performance indications, the survey found that their merged plans -- Foundation Health and FHP International, respectively -- were rated poorly. PacifiCare received highest approval in the areas of data reporting and referral management. And the respondents rated Health Net as the choice plan for "providing financial incentives for encounter data" and quality performance. While Aetna was ranked as one of the two worst groups in all eight areas, it was especially criticized for its consumer education and referral activities. While Blue Cross came in second to last overall, it did rank high for its capitation payment policy, enrollment procedures and financial incentives for doctors.
Areas For Improvement
"While HMOs have made strides in improving their information systems and preparing for year 2000 transition issues, there continues to be room for improvement in quality," said Sherrie Matza, chair of the PBGH. Overall, the survey found that HMOs have improved their information systems in recent years with 76% of the doctors saying their HMOs had made "moderate" or "significant" efforts. However, the doctors did not speak so highly of HMOs in terms of quality standards. The survey found that in 57% of contracts, the doctors rated HMOs' effort to provide quality benchmark data as "poor" or "very poor." And in 59% of contracts, the doctors rated HMOs' quality improvement programs to be "poor" or "very poor." PBGH President Patricia Powers said, "There is a need for stronger incentives and cooperation with physicians to measure quality of care and health outcomes." Most plans also received poor ratings for their prescription drug formularies. Doctors voiced displeasure at HMOs' failure to clearly communicate which drugs were on the list (PBGH release, 6/23).
The Los Angeles Times reports that Blue Cross and Aetna were "dismayed" by their low rankings and "offered a second opinion" of the survey's accuracy. "I don't think these results reflect the consumers' view," said Tom Williams, manager of Aetna's Western region. And Dr. Michael Kaufman, CMO of Blue Cross, called the survey "a work in progress." He said, "It kind of reflects the attitudes of the people (medical administrators) who fill out the questionnaire. I'm not sure there is much internal validity." Kaufman noted that while Blue Cross was ranked second-worst overall in the survey, it topped the list of all plans in several areas (Olmos, 6/24).