California Individual And Group Health Insurance Plans

The Sacramento Bee - Sept. 28: If you're pregnant or suffer from asthma, your HMO is doing a good job taking care of you. On the other hand, California's major health maintenance organizations fare poorly when it comes to treating your youngster's throat infection or helping you quit smoking. These were some of the conclusions reached in an annual report card released Wednesday by the state Office of the Patient Advocate."Variations in quality can be dramatic. It's important for consumers to be actively involved and knowledgeable about their care," said Ed Mendoza, deputy director of the Patient Advocate's Office. Overall, the 12 million Californians who belong to the state's nine largest health plans have seen a slight improvement in the service and care they have received in the past year, according to the patient advocate's HMO report card for 2006.This year, HMOs earned high marks for heart, asthma and maternity care as well as performing cholesterol checks for diabetes patients. Health plans, though, fell short on treating children and making sure they receive the shots they need, screening for sexually transmitted infections and long-term follow-up and treatment of depressed patients."Over the last number of years, we really haven't held them (HMOs) accountable," said Cindy Ehnes, director of the state Department of Managed Health Care. "Letting the plans know where they stand is important." The Office of the Patient Advocate, which offers information about consumer rights to HMO members, publishes the annual HMO rankings to push health plans to raise standards.The analysis is compiled from reports HMOs file with the National Committee on Quality Assurance, which evaluates health plans for companies and groups that offer medical coverage to their employees. HMO members and physician groups also are surveyed.Kaiser Permanente Northern California, Kaiser Permanente Southern California, Health Net of California Inc. and PacifiCare of California ranked the highest in meeting national standards for care.Both Kaiser groups and Sacramento-based regional health plan Western Health Advantage received the top marks for customer satisfaction. On the other end, Aetna Health of California Inc. and CIGNA HMO earned poor grades for customer service."There is room for improvement. It's something that we take very seriously," said Rachelle Cunningham, a spokeswoman for Aetna. "We have implemented over the past couple of years initiatives to improve customer satisfaction."Those changes include giving company claims representatives more authority to resolve issues and an improved online system. The report card gives consumers a tool to check out HMOs on key medical issues such as heart disease and cancer. It is released on the eve of the fall open enrollment period when employers allow workers to switch health plans. HMO officials say it is one measuring stick for their performance."We use this as a tool to try to improve our operation. We do value their ratings," said Garry Maisel, chief executive of Western Health Advantage.Dr. John Zweifler, medical consultant to the state office, said HMOs improved significantly in the past year with programs to control high blood pressure, to screen for the sexually transmitted disease chlamydia and to perform eye exams for diabetes patients.But health plans lost ground in screening for breast cancer, offering advice to quit smoking, treating children for throat and upper respiratory infections and following up for mental health conditions after patients leave the hospital."California HMOs have struggled with using antibiotics appropriately," Zweifler said about treating children with throat infections. "We're concerned about antibiotic resistance developing. California, compared to the rest of the country, has significant room for improvement."Bobby Pena, a spokesman for the California Association of Health Plans, said he was surprised with the low score on children's care."That is one area that health plans focus very strongly on," Pena said. Health plans have been working with medical providers on the antibiotics issue. "We are dependent on the physicians to come up to speed on that."