HMO Grade Card a Powerful Tool for Employees
Health Care: Deficiencies Seen ‘Across the Board’
BY MARION WEBB
Senior Staff Writer
The new California report card of managed care organizations and medical doctor groups is a powerful tool for employees during this time of open enrollment, said the director for the Office of the Patient Advocate.
The rankings, put together by state regulators, rated the 10 largest California HMOs, including eight in San Diego County, on a scale from the lowest “poor” rating to the highest “excellent” rating.
This year added a scoring of 80 medical groups, including 12 in San Diego. This is particularly useful information for consumers looking for specialists, treatment options and timely care and services, said Martin Gallegos, director for the state patient advocate office.
Gallegos’ group, which compiled the data and made it widely available on the Internet, libraries and pharmacies, also found what he termed “pretty apparent deficiencies in delivery of care across the board.”
Of the rated HMOs in San Diego, five were rated “fair” in their overall performance, with three rating “good.”
According to the survey, Aetna US Healthcare, Blue Shield of California, CIGNA HealthCare of California, HealthNet and PacifiCare of California lagged behind Kaiser Permanente, Universal Care and Blue Cross of California in seeing that members got the care, information and customer service they need, when needed.
All plans performed well in terms of doctor-patient communication, which marks a continuation from last year, Gallegos said.
On the downside, most HMOs do a poor job in screening women for sexually transmitted diseases and treating mental health, he said.
Comparative scores on how good plans are in monitoring patients’ health and prevention of serious illness showed mixed results, he said.
HMOs won either a fair or good rating in caring for patients with chronic diseases, including diabetics and asthmatics, and in preventing stroke and other serious illnesses.
While such information is interesting for employees with existing conditions, the plan’s choice is likely someone else’s, said Larry Levitt, vice president of the Kaiser Family Foundation, a research group in Menlo Park.
“Most workers consider themselves lucky to have one plan,” Levitt said. “It (the report) is more useful to employers who are trying to figure out the best and most cost-effective plan.”
Levitt agreed with Mary Chasin, senior manager for the Pacific Business Group, a nonprofit purchasing group for large California employers in San Francisco, that employers find it tough to weigh the pros and cons of plans, most of which look similar.
Still, she said, “employers take the results very seriously. They call the plans up and ask the hard questions.”
Chasin’s group worked on the report with the state patient advocate office, which was created by Gov. Gray Davis in 1999. The state requires accredited HMOs to submit data and expanded the measure to include medical groups.
San Diego’s medical groups were also mixed.
Scripps Mercy Medical Group was the only group to score an excellent rating. Kaiser Permanente and Scripps Clinic’s medical groups both landed a disappointing fair rating, according to their representatives.
Rodger Dougherty, a spokesman for Kaiser Permanente in San Diego, said the rating was not only disappointing, but perplexing considering the Kaiser plan scored well.
Both medical groups landed just one star for providing timely care and service as well as offering treatment and specialty care.
Patients’ frustration in scheduling doctors’ appointments has been on Kaiser’s radar screen for a while, Dougherty said.
Kaiser hopes a new call center staffed by nurses who try to assess patients’ medical needs by phone will agree with members.
Scripps Clinic’s chief executive officer, Dr. Hugh Greenway, said he designed a plan for employees to address patients’ concerns.
For the near future, Gallegos, of the state patient’s advocate office, expects patients will need to dig deeper into their own pockets to pay for prescription drugs, many of which will no longer be covered by plans, and pay more to see doctors. The health care system is moving in a direction where patients need to be more adamant in getting the service and treatments they want, he said.
“You can’t take what the doctor says as gospel,” he said. “It’s no longer a system where what the doctor says goes.”
