Kaiser again ranked top HMO in Md.

Health insurer increases lead in state report card

`Broke away from crowd'

September 28, 2004|By M. William Salganik | M. William Salganik,SUN STAFF

Kaiser Permanente of the Mid-Atlantic emerged as the big winner in the state's eighth annual HMO report card released yesterday, garnering more than twice as many top scores as any other HMO.

"Kaiser clearly broke away from the crowd this year," said Barbara G. McLean, executive director of the Maryland Health Care Commission, departing from the past practice of publishing without comment the data gathered from medical records and patient surveys.

Kaiser scored significantly above the state average on 17 of the 32 measures. And it earned 15 "star performer" rankings for topping the state average on a particular measure three years in a row, again more than double the second-ranking health maintenance organization.

On some of the individual scores, it ranked far ahead of its peers. For example, 71 percent of adolescents received needed immunizations, compared with a state average of 48 percent.

Similarly, Kaiser screened 76 percent of women 16 to 25 for chlamydia, a sexually transmitted disease. No other plan topped 38 percent.

Dr. Larry Oates, executive director of quality and health management for the Permanente Medical Group, the doctors who serve Kaiser, said the HMO consistently posted high scores because it is "an integrated, organized system," with most care being delivered at Kaiser centers by the 850 doctors who work in them full-time.

He also said Kaiser's performance is boosted by its computerized medical record system. The internist said he can call up a registry of all the patients he treats, "so I can tell that 85 percent of my patients have good blood pressure control, and I can target my efforts at the other 15 percent."

Also, he said, Kaiser shows each doctor how he or she compares with other doctors on report card measures - for example, what percentage of patients have been screened for colon cancer. "Physicians tend to be relatively competitive," he said, so data on performance drives them to improve.

The same consideration pushes health plans, said Dr. Donald E. Wilson, chairman of the health care commission and dean of the School of Medicine at University of Maryland.

"What happens when you have information is that everybody strives to do better," he said. "Nobody wants the open circle," the Consumer Reports-style symbol in the report card that indicates an HMO is performing below the state average on a particular measure.

As the state has published its rankings, the overall performance of all plans has improved even as the number of HMOs has declined from 15 in 1996 to seven today. For example, the rate of patients aged 46 to 85 with blood pressure well controlled was up to 65 percent this year from 53 percent two years ago.

Overall performance is up, but eight years of report cards have not produced a pronounced shift by employers or individuals to move to higher-scoring plans.

Employees choosing a health plan generally look first at price and at which doctors and hospitals are included in the network, said Barbara Zavodny, senior benefits manager at McCormick & Co. Inc., the Baltimore County spice company that distributes state report card information to workers during benefits enrollment periods.

Joyce Dodson, an analyst in the human resources department at McCormick, said that when she considered switching plans three years ago, she learned that the HMOs would cost her about 20 percent less than McCormick's Aetna PPO plan, which also includes an out-of-network benefit. She also checked to confirm that her doctors were included in the network for Optimum Choice, an HMO she was considering.

"People are always a little turned off by the idea of an HMO, and I wondered, did I want to do this?" she said. At that point, she turned to the report card and was reassured by Optimum Choice's ratings.

It wasn't the only factor in her decision, she said, but "it's the thing to seal the deal, to make you say, `Yeah, these look like they might work.'"

That's typical of how employees approach a choice of health insurance, said Dennis P. Scanlon, an associate professor of health policy and administration at Pennsylvania State University who has published several studies in the subject.

"At best, there's not strong evidence that people are flocking to these report cards and making decisions based on them," Scanlon said yesterday.

This is because the things the report card measures are less significant to the consumer than price and hard-to-measure traits such as whether claims are paid promptly and without hassle.

The overall improvement of performance could mask the strides made by some Maryland plans that improved their scores but are still below the ever-increasing state average.

For example, although BlueChoice, the HMO of CareFirst BlueCross BlueShield, ranked below average on 13 measures - more than any other HMO in the state - its scores have gone up over the past few years on most measures, according to Dr. Jon Shematek, CareFirst's medical director for quality improvement.

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