SOURCE: California Office of the Patient Advocate

November 20, 2008 14:24 ET

New HMO Ratings Released by State of California Show Dramatic Differences in Health Plan Performance, Patient Satisfaction

Officials Unveil Tools and Tips to Help Consumers Get the Most Out of Their Health Plans

LOS ANGELES, CA--(Marketwire - November 20, 2008) - For the first time since the State of California began issuing its Health Care Quality Report Card eight years ago, a health plan received four out of four stars for meeting national standards of care. At the same time, three HMOs received lower ratings this year in patient satisfaction, according to the California Office of the Patient Advocate (OPA), which released the annual Report Card today. The Report Card rates the nine largest commercial HMOs in the state that cover approximately 11 million people.

Kaiser Permanente, in both the Northern and Southern California regions, received four star ratings for meeting national standards of care -- comparable to the top 10 percent of health plans in the country.

"The good news is that we are seeing some improvement among HMOs in both meeting the national standards of care and patient satisfaction," said Office of the Patient Advocate Director Sandra Perez. "Unfortunately there are some HMOs that have had their ratings decline in patient satisfaction. Considering the importance and the high price of health care, this is very disappointing for Californians."

Ratings from the 2009 Edition Health Care Quality Report Card include:

--  Blue Shield, PacifiCare, and Western Health Advantage all improved in
    meeting national standards of medical care, joining Health Net with a three
    star rating (Good).
--  For patient satisfaction, the scores generally stayed the same as last
    year or declined.  California isn't seeing improvement in this area.
    

"The top performers show us what's doable, and the challenge is to see the lowest performers improve," stated Perez. "For consumers, knowing how their plans rate on various indicators should help them make better health care decisions. In tough economic times, getting the most out of your health care is more important than ever."

Consumers can learn how plans and medical groups perform on common health conditions such as diabetes, maternity care, asthma, cancer, heart care and mental health, as well as treatment of children and adults. For example, the Report Card reveals that:

--  California health plans did poorly in helping diabetic patients with
    their cholesterol levels. On average, less than half of their members with
    diabetes had their cholesterol under control leading to greater risk for
    death due to strokes or heart attacks.
    
--  None of the health plans did well in treating adults for bronchitis.
    Even in the best scoring plan, nearly two-thirds of patients were given an
    antibiotic when it was not needed; in the worst plan that increased to 4
    out of 5 patients.  Overuse of antibiotics is not only wasteful and
    unnecessary, but it can make them less effective in fighting harmful
    bacteria later on.
    
--  Health plans in California did quite well in managing their patients
    with asthma.  Individual health plan scores for asthma care for children,
    teenagers, and adults reveal that almost all patients are getting the right
    medications to avoid asthma attacks, mirroring high rates for the country
    as a whole.
    

The Office of the Patient Advocate is an independent office in state government charged with informing and educating consumers about their rights as HMO enrollees. For more information, visit HealthCareQuality.ca.gov or opa.ca.gov. Copies of the Report Card can also be obtained by calling 1(888) 466-2219.