Health Care Quality Scores Unveiled By California's Office Of The Patient Advocate

Main Category: Health Insurance / Medical Insurance
Article Date: 19 Oct 2007 - 4:00 PST

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For millions of Californians, the deciding factor in choosing a health plan is cost. But the quality of HMOs and medical groups - literally what could make the difference between life and death - for many people often is a guessing game. Unless they have a report card.

The State of California's Office of the Patient Advocate (OPA) has released its seventh annual Health Care Quality Report Card with ratings of HMOs and medical groups that serve almost half of all Californians. Available for free in English, Spanish, Chinese Vietnamese and Korean, the Report Card can be found online at http://www.HealthCareQuality.ca.gov.

The release coincides with Governor Arnold Schwarzenegger's call to deliver affordable health care to all Californians. The Report Card will play an important role in fulfilling the Governor's goal of increased performance transparency to both promote improvements in health care quality and cost and to help consumers in making their health care decisions. In turn, consumers will be better equipped to advocate for themselves and to spur even greater advances in the quality of care and service. "The Report Card is an important tool for consumers, especially given Governor Schwarzenegger's commitment to reform health care to ensure that all Californians are insured, that health care is more affordable and that consumers are provided with easy access to the information needed to make informed decisions regarding their insurance and health care needs," said California Health and Human Services Secretary Kim Belshé.

This year's report makes it clear that HMO performance could be better. For example, a large number of the more than a half million California HMO enrollees with diabetes, are not getting care that meets national standards. One out of four members with diabetes have poor blood sugar control - a condition that can lead to amputation, kidney failure and other complications. More alarming yet, almost two of four members do not have their cholesterol under control, which is a leading cause of heart disease and death for people with diabetes.

As noted in the Report Card, fewer than 40 percent of obese patients reported being counseled about diet or exercise by their physician. Diabetes patients have mortality rates two to three times higher than patients without diabetes and obesity often is a factor in the onset of the disease.

In addition, diabetes is the leading cause of blindness; the Report Card reveals that 40% of HMO enrollees with diabetes were not screened for retinal disease in the past year. On a positive note, Asthma care saw the best scores - upwards of nine of ten patients were prescribed the right medications for their asthma.

The Report Card ratings were based on information gathered on thousands of HMO and medical group members throughout the state and include the overall quality of patient care, as well as the care for an array of medical conditions, such as cancer, diabetes, heart disease and asthma. Health plans are rated on more than 30 markers about patients "getting the right care." The Report Card even rates how quickly phones are answered and the time it takes to get an appointment with your doctor. "This Report Card is one tool that can help consumers make decisions on which HMOs and medical groups provide the best overall health care for themselves and their families. Given our complicated and complex health care system, it is vital that California consumers get this information to help them make good health care decisions," said Office of the Patient Advocate Director Sandra Perez.

Available online to anyone, the Health Care Quality Report Card (http://www.HealthCareQuality.ca.gov) instantly displays the best and worst HMO and medical group performers across California. Walgreens and Leader pharmacies and many local libraries are also stocking summary print copies.

In addition to publishing the Report Card, the OPA conducts education programs to inform consumers about their rights and responsibilities as HMO enrollees. And, OPA works closely with health plans and state agencies, such as the Department of Managed Health Care, to work to improve health care quality and service for Californians.

2007 Health Care Quality Report Card Highlights

- For the vast bulk of medical conditions, there was no change from the 2006 results. Gains were seen in a few areas, including treating children and screening people for colorectal cancer and sexually transmitted infections.

- One in every three HMO member rates his or her plan unfavorably. While medical group members highly rate their doctors and experiences "behind the exam room door," one-third of patients give low marks to experiences, such as scheduling appointments and the coordination of care.

- Consumers use OPA's star grades - with its "excellent" to "poor" ratings - as a straightforward method for checking up on HMOs and medical groups. This offers a quick way to learn if patients are getting the right care and how patients' rate their experiences of care and service.

- For HMOs, Kaiser Permanente Northern California and Kaiser Permanente Southern California scored highest for clinical quality while Blue Shield of California scored tops for patient experience. On clinical quality, the best performing HMOs earned a "good" rating while the lowest-ranked HMOs were rated "fair." None of the plans received the bottom grade of "poor." In the patient experience category, a set of the HMOs were rated "good" while Aetna Health of California scored lowest with a "poor" performance grade.

- The Report Card's ratings for particular health conditions reveal that:

-- Blue Cross of California and CIGNA HMO earned the highest marks for maternity care;
-- Kaiser North and Kaiser South were rated "excellent" for heart care;
-- Two of every three patients who should have been tested for cancer got the screening; Health Net of California scored tops for this care;
-- Only slightly more than half of HMO members with mental health problems received care that met national standards; and
-- Asthma care saw the best scores - upwards of nine of ten patients were prescribed the right medications for their asthma.

- Among medical groups, top scores went to Palo Alto Medical Foundation and Kaiser Permanente groups in the following Bay Area communities: Marin/Sonoma, Santa Clara, South San Francisco and Santa Teresa. These groups achieved "excellent" ratings in both clinical quality and for patient experience. They were the only groups among the almost 200 rated to receive top ratings in both areas.

Office of the Patient Advocate Fact Sheet

The release of the 2007 Health Care Quality Report Card coincides with Governor Arnold Schwarzenegger's call to deliver affordable health care to all Californians and improve the quality of the state's health care system. Part of this initiative is helping consumers make informed decisions about their health, and choosing the right health care provider for them. The Report Card helps fulfill this role by giving Californians an effective way to compare the quality of health care providers against national standards and consumer rankings.

Office of the Patient Advocate

- The Office of the Patient Advocate was established in July 2000 as an independent office within the State of California's Business, Transportation and Housing Agency. The mission of the organization is to inform consumers about their rights as HMO members. OPA also educates people about how to best navigate a complex and sometimes overwhelming health care system so that they can become their own best advocates.

- Working with the Department of Managed Health Care, OPA ensures that Californians receive quality health care by providing consumers with educational materials and programs. OPA also works to improve HMO services by using consumer feedback about HMOs to identify potential innovations or areas for improvement and growth. OPA also provides HMO enrollees with the ability to review patient satisfaction levels with medical groups throughout the state of California.

- With 12 local consumer-assistance center partners, OPA works to provide face-to-face information and education services to HMO enrollees throughout California. Additionally, OPA has four statewide contractors that provide education services to HMO enrollees and healthcare professionals on specific topics, including seniors, people with disabilities, people seeking mental health services, and those with limited English proficiency.

- Health care quality is a top concern among Californians. For example, 69 percent of Californians report being dissatisfied with our healthcare system and 82 percent support major changes in healthcare. With this level of attention, the Report Card gives Californians a voice in recognizing areas of quality and deficiency within our healthcare system.

HMO and Medical Group Report Card

- The Office of the Patient Advocate (OPA) started issuing the Health Care Quality Report Card seven years ago. It provides HMO enrollees with a comprehensive, independent statewide rating of California's major HMOs. The Report Card also provides HMO enrollees the opportunity to compare patient satisfaction with differing medical groups throughout the state.

- The online Report Card helps consumers assess their health plan's quality of care and services with a star chart ranking of one to four stars, with one symbolizing poor quality and four stars signifying excellent service.

- HMO ratings are based on national standards of care and clinical measures, specifically in regards to key health care conditions such as asthma, cancer, diabetes, heart care and maternity care. Additionally, HMO ratings are based on patient satisfaction of care and service, which is scored by a patient assessment survey. Medical group ratings on the other hand are based only on patient satisfaction surveys.

- The Report Card provides quality information on the nine largest California HMOs, which cover about 95 percent of the state's commercial enrollees. It rates HMOs on two levels by calculating the Health Plan Employer Data and Information Set (HEDIS) measures of clinical performance and compiling data from member satisfaction surveys.

- The Report Card is free and can be accessed via the Internet at http://www.HealthCareQuality.ca.gov. Free printed summaries are also available at local libraries, Walgreens, Leaders and other independent pharmacies.

- Nine of the largest commercial HMOs in California, and more than 180 medical groups are included in the Report Card, which is available in English, Spanish, Chinese, Korean and Vietnamese.

- The Report Card rates medical groups from throughout California, including KPNC, Hill Physicians Medical Group, SCPMG, UCLA Medical Group, Sutter Medical Group and the UC Davis Medical Group, to name a few.

http://www.HealthCareQuality.ca.gov

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