Kaiser 1st on HMO report card

Consumer guide prepared by Maryland Health Care Commission

November 02, 2006|By M. William Salganik | M. William Salganik,Sun reporter

Kaiser Permanente again posted the top marks on the state's annual HMO report card, released yesterday.

Kaiser scored above average on 10 of the 24 measures, based on medical records (whether patients got needed immunizations, tests or medications) and on patient satisfaction surveys. M.D. IPA posted six above-average scores; BlueChoice and Coventry, five each; Cigna, four; and Aetna and Optimum Choice, three each.

This is the 10th year the Maryland Health Care Commission has compiled the consumer guide.

Kaiser also had the most "star performer" designations - five, indicating a measure where it had scored above average three years in a row.

Dr. Yancy Phillips, senior associate medical director for Kaiser, attributed the insurer's string of high scores to "the advantages of an integrated delivery system."

Patients receive most of their care from doctors who work full-time in Kaiser centers. That allows Kaiser to standardize practices and to maintain an electronic medical record system that tracks when patients are due for care, he said. For example, a patient may come in for a sprained ankle, and, because the medical record system shows a reminder, get a needed immunization on the spot.

Although it ranked best in the clinical measures, Kaiser was below average in patient ratings for ease and speed of getting care, how well doctors communicated and overall rating of care received. Phillips said Kaiser is doing surveys to try to improve those scores.

Benefits experts say the report cards have a marginal effect on consumer HMO choices. Over the decade of the report, there's been no clear shift of members from low-scoring plans to high-scoring ones, despite marketing efforts, particularly by Kaiser, which regularly trumpets its high scores.

"I've never had one client ask about it," Rodger Bayne, chairman of Client First Brokerage Services in Towson, said yesterday. "People buy benefits and price." Bayne's brokerage works primarily with small employers.

The commission says the greatest impact of the report has been to push improvement overall, as HMOs know their performance will be reported to the public.

Joyce Burton, chief of HMO performance for the commission, said the state average on nearly every measure has been rising year to year. For example, the rate of children receiving recommended immunizations has increased from 75 percent two years ago to 81 percent this year. The rate of patients receiving screening for colorectal cancer is up from 49 percent in 2004 to 55 percent in the latest report.

`Raises awareness'

"For the health plans, it clearly raises awareness, provides us with good competitive information and helps us focus our efforts," said Dr. Jon Shematek, vice president for quality and medical policy for CareFirst BlueCross BlueShield. CareFirst's BlueChoice HMO has improved its standing in recent years.

Shematek said CareFirst has gotten its best results from reminders to individual patients about mammograms, immunizations or other measured treatments, coupled with providing doctors data on whether their patients have received care.

He said CareFirst plans a concerted effort over the next two years on mammograms. Both BlueChoice's mammogram rate and the state average have dropped from 76 percent to 71 percent in the past two years, although Burton cautioned that differences in the method of measurement make the comparison uncertain.

As scores on some measures approach 100 percent, the measures get dropped from the report. For example, adult access to care (percentage of patients who saw a doctor or got other treatment in a two-year period) reached the mid-90s for most HMOs, and isn't included in the latest report card, Burton said.

To view report

The guide can be accessed through the commission's Web site at http:--mhcc.maryland. gov/hmo/index.htm. Copies of the guide will also be available by calling the commission at 410-764- 3460. But Burton said only about 5,000 copies will be printed this year, a fifth as many as last year. The panel is moving most of its reports to Web-only versions, Burton said. Already, its nursing home and assisted living guides are Web-only, and the hospital guide is available in limited print form.

In the future, the commission plans to add information on PPOs, a type of health plan that is eclipsing HMOs in popularity.


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