A report card on California health plans finds that, overall, they're not anywhere near doing an A+ job on getting patients the care they need.
But HMOs are doing a better job than PPOs, says the California Office of Patient Advocate, who released the analysis. They put out the annual report card to help consumers compare how well health plans and medical groups provide recommended care based on different measures. California's 10 largest HMOs, six biggest preferred-provider organization plans and more than 200 medical groups were analyzed.
They grade plans on 46 national care quality standards and 15 patient experience measures.
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Kaiser Permanente was the only health plan in California to earn a four-star rating — the highest possible (one star is poor; four is excellent) — for meeting standards of quality care. Of the 10 HMOs included in the report, none received scores of less than three stars, or "good," for health care delivery.
But they still didn't fare well on every measure: Only two HMOs — Kaiser Permanente in Northern California and Western Health Advantage — received three-star ratings for access to care. The other eight received just one star.
No PPOs earned four-star ratings. Five PPOs received three-star ratings, while Blue Shield of California's PPO received two stars.
"The report cards reveal a significant performance gap between monitoring the care of their patients with diabetes and heart disease and successfully controlling these chronic conditions," Amy Krause, director of the California Office of the Patient Advocate, said in a news release. "Also, the quality of care for patients with diabetes or heart disease, while improving on these measures, varies widely in California and often depends on which HMO, PPO or medical group is providing care."
The report also measured the plans' overall care for patients with specific health conditions: asthma and lung disease, heart disease, diabetes, cancer, maternity, or mental health. Plans also are rated for overall care of adults and children.
The report found that HMOs, PPOs and medical groups, on average, effectively monitor the blood sugar and cholesterol levels of 82 percent to 91 percent of their patients with diabetes or heart disease. However, these conditions are only effectively controlled in 44 percent to 67 percent of these same patients across the state.
"Experts report that up to 75 percent of every health care dollar is spent on the treatment of chronic disease. Clearly, it 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," Krause said.
Similarly, a California trade association representing health plans said the state is doing a good job of providing quality care to patients, but still needs to work with both doctors and consumers to raise the bar.
"The data reveals 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," California Association of Health Plans President and CEO Patrick Johnston said.
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