PBGH: Website Offers ‘One-Stop Shopping’ For Health Plans
Managed care has been around in California perhaps longer than anywhere else in the country. But while the typical Californian likely knows the difference between an HMO and a PPO, the thought of choosing a health plan still leaves many consumers in a cold sweat. That's why Dr. Arnie Milstein, medical director of the Pacific Business Group on Health, had the idea three years ago of taking health plan and hospital performance data that his group collected and organizing it in a way that consumers could access on the Internet. According to Anne Castles, project manager at PBGH, the "underlying premise" behind creating this website "was the fact that consumers had not been active decision-makers" in their health care choices. "We wanted to try to give them information that we were basically sitting on, and start to get it out to consumers in a way that they could understand and ... could use to make decisions," she said. Now consumers can visit www.healthscope.org to do what Castles calls "one-stop shopping" for health care services.
Surfing For Health
The website greets visitors with these words of advice: "Just as you evaluate a car on certain cost and quality features, you can also evaluate a health plan. First, find out how much your health plan options cost by looking at your company's benefits information. Then use the Quality Report Cards in this website to compare California HMOs on the quality features that are important to you. Go on, look!" Healthscope contains report cards on 95% of HMOs in the state, all hospitals and a majority of physician groups. HMOs are rated in preventive care areas ranging from prenatal care to retinal exams for diabetics. The hospital quality checklist details several areas -- such as hospital accreditation and staffing levels -- that consumers should investigate before choosing a hospital. The physician group section explains the difference between an IPA and a medical group, and contains patient satisfaction surveys of various groups. Other sections explain what steps a consumer should take in choosing a doctor, hospital or HMO.
When The Going Gets Rough
Healthscope doesn't just help consumers choose a health plan, it also offers useful information on maintaining a healthy relationship with the HMO. One section details what consumers should expect from their health plans. For example: reminding the consumer when it's time for annual check-ups, paying for smoking-cessation classes or providing phone help lines to answer questions. Healthscope also recognizes that we don't live in a perfect world and consumers may at some point have a gripe with their HMO. The website contains step-by-step directions for filing a complaint against HMOs and it also explains the different complaint structures. In addition, Healthscope's resource list contains addresses and phone number of health services and support groups that operate at the federal, state and local levels.
More Room For Improvement
According to PBGH, consumer feedback from the website has been "uniformly positive." But Castles said "there is most definitely still room for a lot of education around managed care." She noted that Californians still need a lot of education about "the physician group-HMO relationship" and "formulary lists." According to Castles, "Physician groups in California are taking on so much financial risk that they're also assuming a lot of responsibility for functions that were traditionally delegated to HMOs," such as oversight for quality and approving referrals. "We're trying to explain [that] when consumers have issues with their health care" and they "automatically think it's still the HMO," that "in fact it's very often the case it's the medical group decision," she said. Consumers also need to understand "that different health plans have different formularies," meaning consumers "might not be able to get a drug they're used to taking if it goes off the formulary," according to Castles.
Funding, Data Collection
The Healthscope website was initially created with funding from the Kaiser Family Foundation and is now maintained by PBGH. The performance data is collected through several avenues, including the California Cooperative Health Care Reporting Initiative (CCHCRI), the Health Plan Employee Data and Information Set (HEDIS), the Health Care Financing Administration (HCFA), the National Committee for Quality Assurance (NCQA), the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) and surveys conducted by an outside vendor hired by PBGH (R. Kennedy, California Healthline, 8/7.)