Maryland CareFirst rated top PPO

Consumer magazine conducts U.S. survey

Maryland CareFirst rated nation's top PPO

September 21, 2001|By M. William Salganik | M. William Salganik,SUN STAFF

The Maryland Preferred Provider Organization run by CareFirst BlueCross Blue- Shield ranks at the top in member satisfaction in a national survey published in the October issue of Consumer Reports magazine.

Based on survey responses from 83,000 of its readers, the magazine reports on customer satisfaction with 16 PPOs and 44 HMOs.

CareFirst's was the only PPO in this area included. It scored 83 and topped the PPO list. The lowest rating was 68. Donato Vaccaro, research program leader for Consumers Union, which publishes the magazine, said HMOs and PPOs were included in the rankings if there were more than 150 questionnaire responses.

The only health maintenance organization in this area that is rated, Kaiser Permanente of the Mid-Atlantic, got a satisfaction score of 77. The top-rated HMO scored 83; the lowest-rated scored 64.

PPOs are similar to HMOs in that they have networks of participating doctors and hospitals, but members don't have to choose a primary care physician or get a referral from a "gatekeeper" doctor to see a specialist.

Offering more flexibility and choice than HMOs, PPOs are increasing in popularity nationally, covering 48 percent of workers who are enrolled in health plans, up from 28 percent five years ago, according to the Kaiser Family Foundation. Over the same period, HMO enrollment has dropped from 31 percent of workers to 23 percent.

CareFirst's PPO "is following pretty much the same trend," said Gregory A. Devou, executive vice president and chief marketing officer for CareFirst, which has about 430,000 members, up about one-third from 323,000 at the end of 1998.

Devou said CareFirst has not tried to promote the PPO to employers over its other products, but the PPO has gained members because it is less restrictive. The PPO, with about 26,000 doctors in its network, has about three times as many physicians as CareFirst's FreeState HMO.

Large employers, in particular, have been choosing the PPO products, while small employers, who are "very price-sensitive," are still choosing lower-cost HMOs, Devou said.

According to the Kaiser Foundation, the average premium for a single worker for a PPO is $2,730, compared with $2,402, or 12 percent less, for an HMO.

Consumers Union doesn't permit PPOs and HMOs to use Consumer Reports rankings in marketing.

CareFirst's PPO was followed in the ratings by PPOs from the Blue Cross plans in Minnesota, Florida, Western Pennsylvania and Iowa-South Dakota. PPOs run by national for-profit insurers, including CIGNA, Aetna U.S. Healthcare and Humana, ranked at or near the bottom.

The Consumer Reports ratings were based on whether consumers said they were satisfied with their health plans.

Some other rankings, such as the HMO report card prepared by the Maryland Health Care Commission, also use clinical measures, such as whether children receive recommended immunizations.

"The clinical measures are actually cleaner measures of quality," said Barbara McLean, acting executive director of the health care commission. "A consumer may be happy because they got an appointment quickly, but that doesn't tell you whether you got the services you need."

Trudy Lieberman, director of the Consumers Union Center for Consumer Health Choices, defended the use of surveys by Consumer Reports rather than clinical measures, which she said are too limited.

"Just because it's good at getting members mammograms doesn't mean a health plan will do the right things if you have lower-back pain," she said.

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