State issues report card on 15 HMOs in Maryland Benchmarks: Results are intended as a guide to consumers, grading the HMOs on 21 categories of treatment and care.

October 16, 1997|By Diana K. Sugg and M. William Salganik | Diana K. Sugg and M. William Salganik,SUN STAFF

After years of sharing horror stories about HMOs and scrutinizing shiny brochures with picture-perfect families, Maryland consumers and businesses finally have objective benchmarks to help choose a plan: a report card that compares all 15 HMOs in the state.

Among the first of its kind, the report card has the numbers on immunizations, mammograms, and how long it takes to get a routine appointment. Reams of data were collected from HMOs covering 1.3 million patients. About 27,000 Marylanders were surveyed about their experiences, and all the information was independently collected or audited.

The 24-page guide, along with a nearly 100-page comprehensive report, is intended as a tool for consumers, employers and the health plans themselves.

Workers, for instance, can use it to back up complaints about a plan, or to push for a particular HMO to be offered. Companies can use it as leverage in negotiations with health plans, offering bonuses to plans that improve or hit goals. HMOs can use it to monitor how well they are doing.

"In every sphere of life, it's important to be able to determine how well groups are performing," said Dr. Martin P. Wasserman, state health secretary. "The next time we do this, we expect a significant increase in performance."

The guide doesn't rank plans from best to worst because -- depending on the employer or the worker -- the most important elements may differ.

Diabetics may be interested in rates of eye exams, for example, while a family with children is more concerned about immunizations and waiting time for appointments.

The guide grades plans in each of 21 categories. Columbia Medical Plan, Delmarva Heath Plan, Kaiser Permanente and Preferred Health Network all scored above average in more than half the 21. Cigna HealthCare, Principal Health Care -- which closed its Maryland operation this year -- and U.S. Healthcare scored below average in more than half. Aetna Health Plan was on the border, with 10 below average, 10 average and one above-average ranking.

HMO officials tried to put the best face on the results. Low-scoring Cigna, for example, issued a statement saying it was "particularly pleased" with some of its measures, such as 71 percent of patients saying referrals to a specialist were not a problem -- although that was the lowest score of any of the 15 HMOs.

At United HealthCare of the Mid-Atlantic, Dr. Bernard J. Mansheim, chief medical officer, said he believed many reported measures were too low because of the difficulty collecting data. "We have 7,000 doctors, and they all have their own records," Mansheim said.

Dr. Dennis Batey, president and chief executive officer of Preferred Health Network, said PHN's small size might help explain its good marks, because it maintains close relations with doctors and customers. The HMO plans to use its good grades to help market itself to consumers, brokers and employers.

At the other end of the report card scale is Aetna U.S. Healthcare. "We're disappointed that the results don't reflect more favorably on some of the membership outreach programs we've launched," said Molly Knorr, area general manager.

The HMOs run separately by Aetna and U.S. Healthcare are in the process of being merged.

Health plans could improve results by letting doctors know how they are doing, said Dr. Daniel Winn, medical director for the division of managed care at Blue Cross Blue Shield of Maryland. He works with three Blue Cross-owned HMOs: Columbia, Delmarva and FreeState Health Plan/CareFirst.

"Physicians thrive on feedback," he said. "Doctors are very competitive, and they want to do a good job with their patients."

The report card has been in the works since 1993, when state lawmakers created the Health Care Access and Cost Commission (HCACC). One of the commission's charges was to create a comparative guide to HMOs. Supported by the Maryland Association of HMOs, HCACC staff first did a pilot study, then hired a consultant to audit data and the Gallup Organization to interview consumers.

The project cost about $900,000, half of which is a one-time-only cost. HCACC is working on a follow-up report to be released in January. That project will provide a broad picture of the state's managed care industry, something policy-makers will use to target problems.

Measuring quality in health care is an idea that experts, consumer advocates and health providers have hailed for years. Actually doing it is another matter, and the science involved is in its infancy.

Some consumer advocates say the report cards aren't as helpful as they could be, and Dr. Donald E. Wilson, HCACC's chairman and dean of the University of Maryland medical school, acknowledged that the effort is a first step.

But as more state residents sign up for HMOs, information on how they handle patients is becoming more important. According to John M. Colmers, HCACC's executive director, about 40 percent, or 1.3 million people in Maryland, are enrolled in HMOs.

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