June Site, co-owner of a small local business, may soon join those ranks.
After a 30 percent price increase in her health insurance, the Baltimore woman is shopping for another plan. But she's struggled to get detailed information about what plans cover. Site, who has a toddler, plans to examine the new report's section on how sick people are treated.
"I'd be willing to pay more for an insurance company that will stand behind me if, God forbid, I'm that one-in-a-million case," Site said. "That's what you're paying the rates for."
Around the country, groups have tried to begin measuring quality. The most successful national effort is the National Committee for Quality Assurance, which put together a set of standards for HMOs and produces a yearly report -- although their data aren't audited yet.
Another success is in California, where a coalition of private and public employers gathers data from most health plans, surveys plan members and audits everything. Locally, the Maryland Health Care Coalition publishes a buyer's guide that compares health plans based on many statistics, including premiums and number of pharmacies. Executive Director Robert Davis said the new report adds an important layer to the group's information.
"Anybody that doesn't score very well better be careful about major premium price increases," warned Davis, whose group represents 140 members, including companies and unions. "They'll shoot themselves in the foot. We'll be like, 'You scored in bottom third, and you want an 8 percent price increase?' "
At Giant Food Inc., officials said they planned to use the report card as a tool. "It's important to us, but unless we also hear a lot [of complaints] from our people, we don't necessarily want to make changes," said Paul Gunby, director of compensation, benefits and payroll.
Still, some consumer advocates warned that reports may not be as useful as they seem.
While there are codes for some 7,500 medical procedures, report cards cover only a handful of things that are easy to measure, said Kip Sullivan, research director for Minnesota Citizens Organized Acting Together.
"The premise is that these 20 indicators are good proxies for the 7,480 they don't measure. But there's not a shred of evidence to indicate that how often you get kids in for immunization has anything to do with how you treat Alzheimer's."
And, Sullivan said, HMOs will concentrate on services that are measured -- say, mammograms -- to the exclusion of those that are not -- say, cholesterol screening. "With limited resources," he asked, "what smart CEO would do otherwise?"
Most important, Sullivan said, since the data are not adjusted for the age or health status of those enrolled in each HMO, the health plans will have an incentive to enroll only healthy people, who will bring up their scores.
HCACC's Colmers acknowledged that risk adjustment is crucial, particularly for more sophisticated measures. But he said for some categories being measured now, such as consumer satisfaction, it's not as important.
How to get a copy
Copies of the state's 24-page report card on HMOs will be available free in public libraries. Not all libraries have their copies yet. Copies can also be obtained for a shipping and handling charge of $3.97, by calling 1-888-671-1045. The charge for 25 copies is $9.90.
The information will be available for viewing or downloading on the Worldwide Web at: http: //www.hcacc.state.md.us
A larger report, of nearly 100 pages, designed for people such as benefits directors, is available at 410-764-3460. It can also be downloaded, but not viewed, from the same Web site. Copies may be available for reference in libraries.
Pub Date: 10/16/97
