Smaller HMOs get higher ratings

Md. report follows U.S. trend in linking size to plans' quality

Local focus is a plus

September 29, 2001|By Diana K. Sugg and M. William Salganik | Diana K. Sugg and M. William Salganik,SUN STAFF

Smaller, local health plans have far outperformed large national plans in quality and consumer satisfaction, according to Maryland's annual HMO report card.

The national plans included CIGNA and United Healthcare, which scored below average in at least 40 percent of the categories. But local plans racked up better grades, a pattern that began five years ago when the report card was launched.

The annual report, released yesterday by the Maryland Health Care Commission, compares the state's 12 HMOs in 29 categories, including customer service, preventive medicine and care for chronically ill people. The data are audited.

About half the states publish similar report cards, part of a national trend to give consumers and employers information about the varying quality of health plans. Maryland's report, among the first and most comprehensive, is important because nearly half the state's population is enrolled in HMOs.

United HealthCare, which has about 154,400 Maryland members, scored below the state average in 12 areas this year. The plan got poor ratings in about half the chronic illness categories, as well as preventive care such as immunizations and breast cancer screening. United scored above average on only two measures.

CIGNA scored below average in 13 categories, including eight of the 10 consumer satisfaction measures, such as getting needed care and getting care quickly. CIGNA, which has about 25,200 members, did have seven above average scores.

Another national plan that didn't do well was Aetna US Healthcare, with 250,400 Maryland enrollees. Aetna scored below average in nine categories, mainly the consumer satisfaction measures.

But the small plans did better. M.D. IPA, a local HMO with about 24,000 members in the state, earned the most above-average marks - 17 - and the fewest below-average scores - just one. Optimum Choice, with 188,300 members, also did well. Both are owned by Mid Atlantic Medical Services Inc., which is already designing ads to promote the good scores.

`Just become inefficient'

The local vs. national trend has been found around the country, experts say, generally because unlike national plans, the smaller plans know the local scene, are more invested in the community, and are better able to focus.

"You just become inefficient," J.D. Kleinke, a health economist, said of national plans. "In anything that involves a lot of emotion and pain and personal anguish like health care, a large, remote system tends to shortchange people."

Larger plans note resources

But Deborah Spano, a spokeswoman for United HealthCare, said big plans have their advantages.

"We're a national system," Spano said, noting that, in the past year, the plan sent out 70,000 reminder cards for screening tests and other care, and that all their measures had improved in the last year. "We have the resources to create programs that smaller health plans cannot do."

Aetna's spokesman, Walter Cherniak, listed a dozen key indicators in which the health plan has made significant strides. And CIGNA, in a statement, said it was working to improve customer service, including enhanced telephone and Internet service.

Kaiser Permanente excels

Still, the only national plan that did well was Kaiser Permanente, which earned 14 above-average scores. Kaiser has about 168,000 Maryland members. The other exception was Preferred Health Network, a local HMO with 76,600 members, which got the most below-average marks: 15.

Operated by CareFirst BlueCross BlueShield, PHN started five years ago with good scores. CareFirst's medical director, Dr. Jon Shematek, believes the drop stems from problems connected to switching information systems.

He said HMOs willing to commit resources to quality and data collection will do well on the report card. Two other CareFirst HMOs, Delmarva and CapitalCare, posted good scores. The company's fourth HMO, FreeState Health Plan, which, with 318,000 members, has the most residents of any HMO, got average scores on most preventive medicine and consumer survey measures.

Reports called a success

Pointing to statewide increases in breast cancer and cervical cancer screening rates, the report's authors say publicly spotlighting HMOs has boosted quality.

"We deliberately keep raising the bar," said Barbara Gill McLean, interim executive director of the Maryland Health Care Commission. The report highlighted several plans, including Delmarva and Kaiser, that have scored above-average on specific measures for the past three years.

Plans to merge

The report card reflects the changing HMO scene. Two different Aetna plans and the former Prudential and NYLCare HMOs have been merged into one large Aetna plan. Also, the George Washington University Health Plan, which has data in the report, has announced it is shutting down. CareFirst BlueCross BlueShield is seeking regulatory approval to merge its FreeState, CapitalCare and Delmarva HMOs into one.

To some extent, employers are using the reports to help make their health care choices, experts said. But for many, particularly small businesses, cost is still the most important factor.

Studies have also found mixed results among consumers. Many people pick whatever plan their physician is in.

Further, as many as 40 percent of people don't have a choice of a plan: Their employer offers only one.

Experts say report cards can be too complicated and note that, like Maryland's, they don't offer overall judgments on the plans.

But in a survey last year, the majority of Maryland's state workers said they had read the report cards and used them, McLean said.

Maryland publishes a report card on nursing homes, and one on hospitals will be released early next year.

For Maryland's HMO report card, call 1-877-245-1762, or see www.mhcc.state.md.us.

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