PACIFICARE: Strives To Position Itself As Consumer-Friendly

      PacifiCare Health Systems Inc., the state's largest HMO and one of the nation's largest Medicare HMOs, "has launched a campaign to reach out to consumers," the Los Angeles Times reports. Last week in Torrence, PacifiCare CEO Alan Hoops fielded questions from about 1,000 of his company's Medicare HMO members. The Times notes that making sure members "are happy is key to PacifiCare's strategy to expand amid vast changes afoot in health care regulation." Consumer advocates say PacifiCare's effort to cast itself as consumer-friendly is "an attempt both to position itself for growth in Medicare and to offset critics' demands for laws making sure that HMOs give patients access to appropriate medical care." Other observers suggest that PacifiCare may be "reaching out" to curb anti-HMO sentiment that could lead to policy changes allowing consumers to sue their HMOs. "A lot of folks feel that HMOs are making medical decisions ... and that plans don't have the proper incentive to provide adequate care because they aren't legally responsible," said Consumers Union attorney Betsy Imholz. However, the Times reports that "what mattered to Hoops was that he and key PacifiCare employees and so many of the company's customers were together in the same room." He said, "We sit up here and they become real, and they sit out there and we become real" (Marsh, 9/8).

Presenting: Quality Index
      In another move considered to be part of its consumer campaign, PacifiCare last week released a new "quality index" that will allow California consumers to compare the performance of their medical groups in twelve areas of clinical care and service. The Los Angeles Times reported that PacifiCare officials said the move was "aimed at stoking competition and improving physician services to consumers." The "quality index" -- released at the start of open enrollment season when many California HMO members switch health plans -- "marks the first time an HMO has made rankings of its medical groups available to the public," the Times noted (Maharaj, 9/1). The Wall Street Journal reported that the "ground-breaking" effort was hailed as a positive step by consumer advocates, who noted that the index of 120 medical groups with 30,000 doctors "is one of the most ambitious efforts so far to put purchasing information directly into the hands of consumers." The new provider directories for the Santa Ana-based HMO will feature a blue ribbon next to those medical groups that rank in the top 10% to indicate exemplary performance. Sam Ho, PacifiCare's medical director, predicts that top performers "will be rewarded with more members." The HMO plans to extend the quality index to other states next year. National Committee for Quality Assurance President Margaret O'Kane said, "This is the first example I've seen of this. What we're all about is getting consumers to vote with their feet for higher quality and better service so that it becomes a business issue."

Not Everyone's Happy
      The index remains "controversial among doctors," who perceive it as an inaccurate assessment of their services. Keith Richman, chair of Lakeside Healthcare in Los Angeles, said, "The distribution of a report like this is extremely premature and misleading." He charged that "the clinical measures reported here are not at all reflective of the care provided to the patients, but are more reflective of a medical group's ability to collect data and submit it in a centralized form." Some added that while the measures might assess particular services available for preventive care, they fail to address care for the sick. Peter Lee, director of consumer protection programs for the Center for Health Care Rights, noted that while "measures like cervical-cancer and mammography screening rates" provide good information, "this doesn't tell me how good my care will be if I actually get cancer." In response to the concerns, Ho said the "vocabulary of performance measurement" will undergo revision, but the important step was the program's inception. "Not only does this information help consumers," he said, "but it's a motivator for changing physician behavior" (Rundle, 8/31).