Quality Report Cards on Calif. Insurers, Providers Released
On Tuesday, the California Office of the Patient Advocate released its annual report cards examining how well insurers and physician groups in the state meet health care quality standards, the Los Angeles Times reports.
Background on Report
The annual report cards score:
- 200 medical groups;
- 10 health maintenance organizations; and
- Six preferred provider organizations.
Together, those groups account for the care provided to about 16 million California residents with private health insurance plans (Terhune, Los Angeles Times, 1/28).
The ratings are based on:
- 46 national care quality standards; and
- As many as 15 patient experience measures (Robertson, Sacramento Business Journal, 1/28).
Consumers can search the reports for particular medical conditions and evaluate various patient complaints against health insurance companies (Los Angeles Times, 1/28).
Details of Ratings
Of the 10 HMOs included in the report, none received scores of less than three stars, or "good," for health care delivery.
Kaiser Permanente HMOs in Northern and Southern California were the only ones in the state to earn the highest rating of four stars, or "excellent."
However, when consumers were asked to rate how easily they could access care, eight of the 10 HMOs received one star, or "poor," ratings. Only two HMOs -- Kaiser Permanente in Northern California and Western Health Advantage -- received three-star ratings for access to care (HMO Quality Ratings Summary, January 2014).
No PPO plans received four-star ratings. Five of the six PPOs examined by OPA received three-star ratings, while Blue Shield of California's PPO received two stars, or a "fair," rating (PPO Quality Ratings Summary, 2014).
In addition, the reports found that diabetes and heart disease are effectively managed in only 44% to 67% of patients, even though medical groups and health insurers effectively monitor blood sugar and cholesterol in 82% to 91% of such patients (Sacramento Business Journal, 1/28).
Western Health Advantage had the highest percentage -- 77% -- of patients ages 12 to 64 with appropriate medication and instructions for controlling their asthma. In comparison, Kaiser Permanente's Southern California HMO had only 64% of such patients on the appropriate medications (Los Angeles Times, 1/28).
Meanwhile, physician groups received some of the lowest ratings, with many receiving one- or two-star scores (Bartholomew, Los Angeles Daily News, 1/28).
In a release, Patrick Johnston, president and CEO of the California Association of Health Plans, said the data reveal "that health plans and doctors are effectively monitoring care, but controlling chronic conditions like diabetes is a three-way partnership between individuals, doctors and plans" (CAHP release, 1/28).
OPA Director Amy Krause in a separate release said, "[I]t is essential that health plans and providers work more closely with their patients to improve their performance and achieve better health and quality of life for individuals with chronic diseases" (OPA release, 1/28).
On Tuesday, KQED's "The California Report" reported on the release of the OPA report cards ("The California Report," KQED, 1/28).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.