Kaiser HMO is No. 1 again

BlueChoice ranks second in state's annual report card

October 07, 2005|By M. WILLIAM SALGANIK | M. WILLIAM SALGANIK,SUN REPORTER

Kaiser Permanente again posted the top marks as the state issued its annual HMO report card yesterday.

BlueChoice, the HMO run by CareFirst BlueCross BlueShield, showed the most improvement.

Last year, BlueChoice ranked above average on only one of the 30-plus measures used by the state and below average on 13; this year it was above average on eight and below on five.

Only Kaiser had better scores. It ranked above average on 15 of the 33 measures, and was designated a "star performer" on 10 of those, meaning it had been above the state average for three years in a row.

This is the ninth year the Maryland Health Care Commission has published the report card, compiled both from medical records (how many women, for example, enrolled in each HMO got mammograms?) and from patient surveys (would you recommend your HMO to family or friends?)

Nine years of report cards have prompted HMOs to work to improve their scores, pushing the state averages upward on most of the measures. For example, three years ago, 53 percent of adults with high blood pressure were found to have their pressure levels controlled adequately. Now, that's up to 66 percent.

"We continue to move steadfastly in the right direction," Stephen J. Salamon, commission chairman, said at a news conference yesterday to present the results.

However, Salamon said, the report card also shows areas where HMOs should do a better job preventing illness, which generally costs less than treating a disease.

For example, he said, "while smoking remains the single most preventable cause of death in the United States," only 41 percent of smokers received help from their HMO in quitting.

But the report cards haven't resulted in a noticeable shift of members from low-scoring plans to highest.

Peter Cole, a senior vice president at Aon Consulting's Baltimore office, which advises employers on health benefits, said measures such as those in the report card have "a moderate amount of influence" when employers decide which plans to offer to their workers.

As for the workers, Cole said, most choose among HMOs offered by their employer based on price and on whether their doctors are in the HMO's network. Individuals check report cards "to reaffirm their decisions" based on price and doctor access, he said.

Dr. Rex Cowdry, executive director of the Maryland Health Care Commission, the agency that compiles the report card, said the greatest impact of publishing the information may be "the embarrassment factor" - encouraging low-scoring health plans to try to do better.

Dr. Jon Shematek, vice president for quality and medical policy at CareFirst, said last year's report card had "pointed out a variety of opportunities" for improvements at BlueChoice. For example, he said, BlueChoice, after reviewing its scores, instituted a more "robust" asthma program, involving "direct-to-consumer marketing."

Once a prescription is written indicating that a CareFirst member has asthma, he said, the patient is sent information. Follow-ups range from a seasonal health information mailing to - for patients with more severe cases - nurses who call to remind patients to use their inhalers so they avoid episodes leading to hospital treatment.

As a result, BlueChoice's score on whether children with asthma received appropriate medication jumped to 81 percent, well above the state average, from 65 percent last year, which was slightly below average. The rate for adults improved to 85 percent from 73 percent.

Dr. Philip S. Carney Jr., president and medical director of Kaiser's physician group, said he thought Kaiser had an advantage in managing care in that most services are delivered by doctors who work full-time in Kaiser's centers. (The other HMOs contract with doctors who practice in their own offices. Other than Kaiser, most doctors participate in several HMOs.)

The medical record system, Dr. Carney said, gives Kaiser good databases, and allows it to use such techniques as automated phone reminders to members who are due for immunizations or follow-ups.bill.salganik@baltsun.com

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