SOURCE: California Office of the Patient Advocate

California Office of the Patient Advocate

January 28, 2014 14:00 ET

2014 California Health Care Report Cards Enable Consumers to Compare Clinical Quality & Patient Experience for HMOs, PPOs, and Medical Groups

Results Reveal Substantial Opportunities to Improve Care for Patients With Chronic Health Conditions

SACRAMENTO, CA--(Marketwired - Jan 28, 2014) -  The Office of the Patient Advocate (OPA) released its web-based 2014 Report Cards today, enabling consumers to compare clinical and patient experience performance ratings for the state's 10 largest commercial Health Maintenance Organizations (HMOs), six largest commercial Preferred Provider Organizations (PPOs), and over 200 medical groups. The Report Cards reflect care delivered to approximately 16 million commercially insured Californians, many with chronic diseases that have costly consequences, particularly if not managed effectively.

"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," said Amy Krause, Director of the California Office of the Patient Advocate. "Also, the quality of care for patients with diabetes or heart disease, while improving on some measures, varies widely in California, and often depends on where someone lives or which HMO, PPO, or medical group is providing care."

According to the new Report Cards, HMOs, PPOs, and medical groups, on average, effectively monitor the blood sugar and cholesterol levels of 82 to 91 percent of their patients with diabetes or heart disease. However, these conditions are only effectively controlled in 44 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," said Krause.

The Report Card website is at www.opa.ca.gov/Pages/reportcard.aspx, and can be viewed in English, Spanish and Chinese. The website offers resources on how to make the most of a visit to the doctor, including possible questions to ask and how to file a complaint or get assistance when needed.

A new "Report Card Wizard" improves the search capabilities for consumers to more easily find data on specific health conditions. Mobile apps for Android and Apple smart phones and tablets also are available.

Other quality and service performance highlights:

  • Overall, average clinical quality performance for all California HMOs, PPOs, and medical groups did not change substantially from 2013 to 2014.

  • On average, HMOs score higher than PPOs on all but 9 of 46 individual clinical quality performance measures.

  • Since 2006, 6 HMOs have shown improvement at a faster rate than the national average on the key Heart Care measure of "Controlling Cholesterol." 

  • Medical Groups and HMOs made substantial improvements in providing adolescent immunizations.

  • PPOs do slightly better than HMOs in their members' perceptions of "Getting Care Easily," but both have room to improve compared to national averages.

  • HMOs and PPOs are below the national averages (low to begin with) on more than half of the patient experience measures.

Using star ratings (one is poor; four is excellent), the Report Cards help consumers compare how well health plans and medical groups provide recommended care based on 46 specific national standards of clinical quality, and up to 15 patient experience measures, as well as their overall care for patients with specific health conditions: asthma and lung disease, heart disease, diabetes, cancer, maternity, or mental health. Plans are also rated for overall care of adults and children. 

The California Department of Insurance regulates health plans underwritten by insurance companies, including PPOs, and also makes the PPO report card available at its site, www.insurance.ca.gov.

For more detailed information about the 2014 Edition of the Health Care Quality Report Cards, visit www.opa.ca.gov, or call (866) 466-8900.

The OPA website provides health care quality report cards that cover commercial health plans and insurers, medical groups, as well as links to quality measures for Medi-Cal Managed Care, Medicare Physician Groups, CalPERS Health Plans, and hospitals and long-term care facilities. It also provides resources to help consumers get the most out of their health care.

Contact Information