State Issues Second Report Card on HMOs, Medical Groups

The Office of the Patient Advocate yesterday released its second annual HMO Quality Report Card, which found that while Californians are "generally satisfied" with their health plans and doctors, they "want better access to medical specialists and less time spent in doctor waiting rooms," the Los Angeles Times reports. The report judged the state's 10 largest HMOs, which serve 95% of state residents enrolled in managed care plans, on a variety of categories, including preventive care and treatment for chronic illnesses; whether doctors listen to patients and communicate clearly; and whether HMOs pay claims quickly and work to resolve disputes. The report rated Kaiser Permanente-South as the highest-scoring HMO, receiving 10 stars out of a possible 15 and the report's only "excellent" rating for "helping patients stay healthy." Universal Care and Western Health Advantage received the fewest number of stars with seven each (Ingram, Los Angeles Times, 10/2). For the first time, the report also graded 80 of the state's largest medical groups. The groups were evaluated based on their overall quality of care; their communication with patients; their timeliness of care and service; and patients' access to treatments and specialists (Fong, San Diego Union-Tribune, 10/2). The report's findings were based on patients' answers to mail and phone surveys, records of services performed by HMOs and medical groups and a "random sample" of medical charts (Sevrens Lyons, San Jose Mercury News, 10/1).

Daniel Zingale, director of the Department of Managed Health Care, said that almost all HMOs performed well in the area of financial stability, but many received lower scores in quality-of-service categories (Los Angeles Times, 10/2). Gov. Gray Davis (D) said, "This HMO guide puts consumers in the driver's seat when making critical choices about health care. It's an invaluable resource for those comparison-shopping for the right health care plan" (Office of the Governor release, 10/1). Davis' office added that the report should "provid[e] incentives for health plans and providers to deliver better service in order to attract and retain customers" (Office of the Governor release, 10/1). However, some providers criticized the ratings as inaccurate. Linda Kenigsberg, CEO of a company that performs administrative work for the Physicians Medical Group of San Jose, said that fewer than half of patients asked to fill out surveys did so, indicating that those respondents were likely to have had the worst experiences with their HMOs (San Jose Mercury News, 10/1). The report card is available in English, Spanish and Chinese online, by calling 866-HMO-8900 or through pharmacies and health advocacy organizations (Los Angeles Times, 10/2).