SAN DIEGO: County HMOs May Face Tougher Standards
HMOs in San Diego County would have "to meet rating standards established by a national review board," under a proposal that the county Board of Supervisors are expected to vote on next week. Supervisor Ron Roberts earlier this week introduced the measure to require "all health plans serving county employees be submitted for review by the National Committee for Quality Assurance (NCQA), an independent organization that has been reviewing the performance of HMOs for the past few years." Roberts said any HMO with which the county contracts would have to score a "favorable rating" from the NCQA. In addition, the proposal would require "the county to push the plan to local employers that buy health coverage for their employees." At a Monday press conference announcing his proposal, Roberts said, "Deciding which HMO to join has been a major stress for families to discriminate one HMO from another. HMOs have had a significant impact on health care throughout both the county and the country. They have also given rise to some strong concerns."
The San Diego Daily Transcript reports that "Roberts' plan follows a statewide and national trend of pushing to correct flaws in the country's huge managed care industry." The issue is especially relevant in San Diego, the paper notes, because more than three quarters -- about 77% -- of San Diego residents are covered by HMOs. The Daily Transcript notes that "Roberts' plan hinges on a new rating system being prepared by the NCQA." Under the NCQA's plan, HMOs will be graded "on how well they actually provide the coverage for their patient base, as well as patient satisfaction." The NCQA's current system rates HMOs on preventive measures. Roberts' plan is supported by Kaiser Permanente, Aetna U.S. Healthcare and Health Net, "three of the county's largest HMOs that are also the main contractors for health care for county employees." In addition, the American Association of Retired Persons and the union that represents most of the county's employees -- Service Employees International -- support the plan. However, some oppose the plan, saying "ratings systems ... do little to assuage consumer fears of being mistreated by their health plans." Consumers for Quality Care's Jamie Court said, "It's really hard to take a national survey and say that it means anything for the average consumer. What we really want to know is how many wrongful deaths there are from patients who can't go to an emergency room because their HMO won't cover them; but how do you gather that data?" (Gallagher, 9/21).