SOURCE: Office of the Patient Advocate

September 13, 2005 17:00 ET

State's 2005 HMO Report Card Shows Marked Improvement in Performance While Also Highlighting Serious Weaknesses

SACRAMENTO, CA -- (MARKET WIRE) -- September 13, 2005 -- Quality of health care has shown marked improvement for 12 million HMO members in California, but in releasing their annual HMO Report Card today, the state's Office of the Patient Advocate (OPA) also highlights key healthcare weaknesses among California's HMOs.

With comprehensive, statewide rankings, the Internet-based annual Report Card serves as a prime resource to help consumers evaluate their HMO or medical group, especially during the traditional open enrollment period from September to December. More importantly, state officials say the detailed information in the Report Card can create better-informed HMO consumers who are better equipped to act as their own advocates.

"Informed consumers are smarter consumers," insists OPA Acting Director Ed Mendoza. "There are dramatic differences in how one HMO addresses a situation versus another. The Report Card helps level the playing field for individuals in a world of large, complex and often overwhelming HMOs."

Based on both clinical and patient satisfaction data, the Report Card looks at California's ten largest HMOs, representing 95 percent of California's commercial HMO enrollees. A simple star system is used to evaluate HMOs in four broad areas: care for staying healthy; care for getting better; care for living with illness, and member satisfaction. Individuals can also compare HMOs according to specific categories (e.g., Women's Health, Maternity Care, Heart Care) or according to the illness and health concerns that most impact them, such as diabetes, asthma, cholesterol, high blood pressure, etc. Over 30 different measures are evaluated. The Report Card also provides similar data for over 150 medical groups.

Far from static, the Report Card is constantly being enhanced. Three new clinical health plan measures were added to the 2005 Report Card: colorectal cancer screening, treatment of children with throat infections and treatment of children with upper respiratory infections. While it acknowledges the inclusion of new measures dampened overall HMO score improvement in 2005, OPA feels it is more important to address emerging health issues.

In addition to informing Californians, OPA says regular public reporting makes the health care industry more accountable. Since the Report Card was first published five years ago, OPA has documented significant and continual improvements in HMO's quality of care.

"There is no doubt that HMOs are paying attention to and making steady improvements in how they deliver care," says Dr. John Zweifler, who serves as the OPA's medical consultant. "Still, we can't ignore those critical areas where performance fails to meet recommended standards of practice."

Zweifler cites colorectal cancer screening, Chlamydia screening, antibiotic treatment for children with throat infections, and eye exams for diabetics as key areas where the Report Card shows HMOs failing to meet those standards of care.

"Recognizing industry trends is important," says Zweifler, "however, the real power of our Report Card isn't in looking at the industry as a whole but in giving Californians a chance to scrutinize their own HMO and medical group. Understanding how their HMO is performing, especially in specific areas, makes them better educated about their health care and more effective as patients."

Given California's diverse ethnic and racial population, it isn't surprising that quality of care is often compromised because of language and translation difficulties. For that reason, the Report Card also evaluates how HMOs and their doctors address the needs of their non-English speaking patients.

Available free in English, Spanish and Chinese, the Report Card can be accessed via the Internet at or by contacting OPA toll free at 1-866-466-8900 for a printed copy. Free printed summaries are also available at local libraries, Walgreens, Leaders and other independent pharmacies.

Contact Information

    Ed Mendoza
    Office of Patient Advocate
    (916) 324-6407

    Paula Hamilton
    Brown-Miller Communications
    (800) 710-9333