HMOs Vary in Preventive Care, Study Says

In the latest attempt to help consumers see how their HMOs measure up, a study of California’s largest health plans reports significant differences in the quality of preventive health services.

The study, released Tuesday by a consortium of employers, medical groups and health maintenance organizations, looks at the rates that patients received childhood immunizations, breast and cervical cancer screenings, prenatal care, cholesterol tests and diabetic retinal exams.

The three top-rated plans are those in Aetna and Kaiser Permanente’s Northern California region and Lifeguard, a Silicon Valley-based plan that has received high marks in several quality reviews. Each was rated “above average” in four of six categories. (Some HMOs were broken down by region and then ranked.)

A couple of HMOs received very low marks, but the vast majority were rated “average” in preventive services--an area the industry touts as one of its main advantages over indemnity plans.

Although most experts agree that such surveys are a much-needed first step in helping consumers distinguish good HMO from a bad one, the medical field is divided as to how to define quality.

One limitation of the study is that it looks only at preventive care. And the consortium, known as the California Cooperative HEDIS Reporting Initiative, did not study the health results of HMOs that serve the elderly and indigent through the federal Medicare and Medicaid programs.

“A big part of what you’re looking for in a health plan is an organized system of care for the elderly or people with multiple chronic conditions,” said Ted von Glahn, a consultant for the Foundation for Accountability, a medical quality organization in Portland, Ore.

Many experts say that meaningful comparisons of HMOs won’t be possible until more complex measurements can be made: for example, how well a plan treats people with cancer, diabetes or AIDS.

Von Glahn’s group, whose founders include Dr. Paul M. Ellwood, one of the chief designers of the theory that gave rise to managed-care groups, has developed measures for specific illnesses which it hopes will be adopted by the industry. One such measure is the five-year survival rate for breast cancer patients.

David Hopkins, of the Pacific Business Group on Health, an influential health insurance purchasing cooperative in San Francisco, said the California HMO study is at the cutting edge of national efforts to measure health quality.

“We hope the study will draw consumers’ attention to the fact that these preventive services are important to them,” Hopkins said. “If you belong to a plan that shows an above-average performance, you should feel good about that. If it’s below average, you might want to talk to the plan about the situation.”

The two plans that ranked the lowest in the California study were CareAmerica, a Woodland Hills-based HMO, and MetraHealth, an HMO recently acquired by industry giant United HealthCare. Both plans received “below average” scores in five of six categories.

Lisa Rubino, a CareAmerica senior vice president, attributed the low ranking to “built-in flaws” with the way the medical data were gathered. CareAmerica and other companies chose to provide only information that came directly from medical charts, whereas others supplied data from both medical charts and insurance claims.

“We feel that that impacted the level of accuracy,” Rubino said. “We’ve participated in other surveys where we were rated excellent and some where we were rated average.”

United HealthCare could not be reached for comment.

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HMOs and Preventive Care

A new study of California HMOs rates these health insurance plans in regard to six key preventive health services. The findings are based on reviews of 32,000 medical charts at several thousand doctors’ offices throughout the state.

HMO

Aetna San Diego

Childhood immunization: Above Average

Cholesterol screening ages 40-64: Average

Breast cancer screening: Average

Cervical cancer screening: Average

Prenatal care (first trimester): Average

Diabetic retinal exams: Average

*

Aetna Southern California

Childhood immunization: Average

Cholesterol screening ages 40-64: Average

Breast cancer screening: Average

Cervical cancer screening: Average

Prenatal care (first trimester): Average

Diabetic retinal exams: Average

*

Blue Shield

Childhood immunization: Average

Cholesterol screening ages 40-64: Average

Breast cancer screening: Average

Cervical cancer screening: Average

Prenatal care (first trimester): Average

Diabetic retinal exams: Average

*

California Care

Childhood immunization: Average

Cholesterol screening ages 40-64: Average

Breast cancer screening: Average

Cervical cancer screening: Average

Prenatal care (first trimester): Average

Diabetic retinal exams: Average

*

CareAmerica

Childhood immunization: Below average

Cholesterol screening ages 40-64: Below average

Breast cancer screening: Below average

Cervical cancer screening: Below average

Prenatal care (first trimester): Below average

Diabetic retinal exams: Average

*

CIGNA L.A.

Childhood immunization: Average

Cholesterol screening ages 40-64: Average

Breast cancer screening: Average

Cervical cancer screening: Average

Prenatal care (first trimester): Average

Diabetic retinal exams: Average

*

CIGNA San Diego

Childhood immunization: Average

Cholesterol screening ages 40-64: Average

Breast cancer screening: Average

Cervical cancer screening: Average

Prenatal care (first trimester): Average

Diabetic retinal exams: Average

*

FHP Health Care South

Childhood immunization: Below average

Cholesterol screening ages 40-64: Average

Breast cancer screening: Average

Cervical cancer screening: Average

Prenatal care (first trimester): Average

Diabetic retinal exams: Average

*

Foundation

Childhood immunization: Average

Cholesterol screening ages 40-64: Average

Breast cancer screening: Average

Cervical cancer screening: Average

Prenatal care (first trimester): Average

Diabetic retinal exams: Average

*

Health Net

Childhood immunization: Average

Cholesterol screening ages 40-64: Above average

Breast cancer screening: Average

Cervical cancer screening: Above average

Prenatal care (first trimester): Above average

Diabetic retinal exams: Average

*

Kaiser Permanente S. Calif.

Childhood immunization: Above average

Cholesterol screening ages 40-64: Average

Breast cancer screening: Average

Cervical cancer screening: Average

Prenatal care (first trimester): Average

Diabetic retinal exams: Above average

*

Lifeguard

Childhood immunization: Above average

Cholesterol screening ages 40-64: Above average

Breast cancer screening: Above average

Cervical cancer screening: Above average

Prenatal care (first trimester): Average

Diabetic retinal exams: Average

*

Maxicare

Childhood immunization: Average

Cholesterol screening ages 40-64: Average

Breast cancer screening: Below average

Cervical cancer screening: Average

Prenatal care (first trimester): Average

Diabetic retinal exams: Average

*

MetraHealth

Childhood immunization: Below average

Cholesterol screening ages 40-64: Below average

Breast cancer screening: Below average

Cervical cancer screening: Below average

Prenatal care (first trimester): Average

Diabetic retinal exams: Below average

*

National Health Plan

Childhood immunization: Average

Cholesterol screening ages 40-64: Average

Breast cancer screening: Average

Cervical cancer screening: Average

Prenatal care (first trimester): Average

Diabetic retinal exams: Below average

*

OMNI Healthcare

Childhood immunization: Average

Cholesterol screening ages 40-64: Above average

Breast cancer screening: Above average

Cervical cancer screening: Average

Prenatal care (first trimester): Average

Diabetic retinal exams: Average

*

PacifiCare

Childhood immunization: Below average

Cholesterol screening ages 40-64: Average

Breast cancer screening: Average

Cervical cancer screening: Average

Prenatal care (first trimester): Below average

Diabetic retinal exams: Average

*

Prudential Health Care South

Childhood immunization: Average

Cholesterol screening ages 40-64: Average

Breast cancer screening: Average

Cervical cancer screening: Average

Prenatal care (first trimester): Below average

Diabetic retinal exams: Average

Source: California Cooperative HEDIS Reporting initiative