Panel grades HMOs in Md. Annual report card is consumer guide for health plan checkup

September 23, 1998|By M. William Salganik and Diana K. Sugg | M. William Salganik and Diana K. Sugg,SUN STAFF

Tens of thousands of Marylanders set to enroll in health plans over the next few weeks have a useful measure: health regulators' second annual report card comparing the 13 major HMOs operating in the state.

Consumers can check the report card, issued yesterday, to see how well the plans did on scheduling appointments, giving checkups for new moms, even how much doctors listen to patients.

For the second year, smaller, local health plans tended to get higher marks than national insurers with larger, but loose, doctor networks.

Scoring "above average" on more than half of the report card measures were Delmarva Health Plan, which operates on Maryland's Eastern Shore; Preferred Health Network, which operates statewide but is relatively small; and Kaiser Permanente of the Mid-Atlantic States, which uses its own group of doctors to deliver most care.

The HMOs with the most "below average" scores were Prudential, CIGNA and the segment of Aetna U.S. Healthcare that represents the old Aetna network. The old U.S. Healthcare network, which had better scores, has been merged with the Aetna network since the data were compiled.

First in the nation

Last year, Maryland became the first state to develop a mandatory, audited report card in an effort to help employers and individuals judge HMO quality.

"More and more, we are finding that a better-informed consumer can make a difference in the marketplace," said Dr. Donald E. Wilson, dean of the University of Maryland Medical School and chairman of the Health Care Access and Cost Commission, a public regulatory agency that produces the report card. "Plans are reacting to their own ratings and redirecting resources to improve their image."

The state does not produce an overall ranking of HMOs, saying that consumers care about different things. It reports performance on 22 separate measures, based on patient records (for areas such as immunization rates) and a survey of members (covering such areas as difficulty of getting a referral to a specialist).

"In a perfect world, you'd see 50 state report cards. We hope others will follow their lead, and we're doing outreach to encourage that," said Brian Schilling, spokesman for the National Committee for Quality Assurance, a nonprofit group that measures and reports on the nation's managed-care organizations.

Lower-scoring HMOs said their marks might represent poor data collection rather than poor medical care. For example, Henry F. Keaton, regional vice president for Prudential HealthCare, said: "At least some [of the results] are related to how we pull data and report it in."

Since many doctors receive flat per-member payments, Keaton said, complete "encounter data," showing which tests or immunizations the patient received, are not always reported. Capturing data for the report card was a major reason United HealthCare switched from a separate radiology contract to fee-for-service payments, said Melissa Reed, a United spokeswoman.

Efforts to improve

A number of HMOs said they made efforts over the past year to improve their report card scores.

FreeState Health Plan, owned by Blue Cross and Blue Shield of Maryland, showed the greatest improvement from last year, moving up on 12 of the measures. Dr. Daniel Winn, medical director for FreeState, said his plan set up an immunization registry last year, and sends mailings to parents and doctors when children are due for shots. FreeState's rate of children receiving all immunizations went from 75 percent last year to 83 percent this year.

Also, he said, FreeState met with doctors to smooth the system for getting approvals for care. The portion of FreeState members who said approvals were not a problem increased from 79 percent to 84 percent.

The segment of Aetna U.S. Healthcare that represents the old U.S. Healthcare network improved on 11 measures, but in each case moved up to average after scoring below average last year.

While individual plans showed fluctuation, the overall performance of state HMOs changed little. Most medical measures went up or down only one or two percentage points, and measures of consumer satisfaction overall were the same as the year before.

Few shifting plans

The HMOs reported little indication that last year's initial report card prompted many people to shift plans. Dr. Dennis Batey, president and chief executive officer of Preferred Health Network, said his plan trumpeted its good scores in advertisements last year, but "our market share remained pretty flat." He said the high marks provided "another level of reassurance" to insurance brokers, with whom Preferred Health was trying to build relationships after dropping its own sales force.

Similarly, Cigna HealthCare, which was near the bottom on many measures last year, did not find itself losing customers. But concerned with its showing, the HMO did begin quarterly RTC meetings to reassure customers by explaining its quality efforts, said Dr. Carolyn L. Yancey, medical director.

Baltimore Sun Articles
Please note the green-lined linked article text has been applied commercially without any involvement from our newsroom editors, reporters or any other editorial staff.