California’s Office of the Patient Advocate just released new 2016-17 health plan report cards to help guide and inform consumers as they shop for coverage during the open enrollment season which is set to begin: November 1, 2016.
The report cards rate California’s 10 largest HMOs, five largest PPOs and over 200 commercial medical groups on quality and patient experience. In addition, county-level ratings of medical groups with newly added cost ratings are also included. This on-line tool makes it easier for employers and consumers to make side-by side comparisons for choosing the right plan.
What do the Report Cards Measure?
OPA uses data from the National Committee for Quality Assurance (NCQA), a non-profit that that works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation. To arrive at these ratings NCQA analyzes scores on clinical performance and patient satisfaction data.
- Clinical performance scores are calculated using Healthcare Effectiveness Data and Information Set (HEDIS) data which is data from administrative or medical records to evaluate the quality of care. The overall ratings of health plans and medical groups across the state are based on 41 quality of care measures that are compiled into nine health topics in order to calculate a composite score. The health topics include asthma and lung disease care, behavioral and mental health care, cancer screenings, Chlamydia screenings, diabetes care, heart care, and maternity care.
- Patient satisfaction scores are calculated using the Consumer Assessment of Healthcare Providers and Systems (CAHPS). The survey examines patient experience and satisfaction from a randomly selected group of members. Consumer ratings are based on patient experience with the plans and medical groups which is made up of three topic summary ratings including how easy it is to get care, and satisfaction with services and doctors.
Data from the 2016-2017 HMO report cards show both Kaiser Permanente in Southern and Northern California had the highest quality ratings across the state. In contrast Aetna had the lowest quality rating for HMOs, while most other plans, including Blue Shield and Anthem, received a “good” rating in quality and satisfaction. The report cards also break-out quality data by various health conditions. Compared to the rest of the nation, California plans do better on quality of care for many conditions including childhood immunizations, diabetes care, chlamydia screenings and weight related screenings to name a few.
These scores are also providing consumers and state regulators alike with important information on critical performance gaps where closer monitoring may be needed to ensure consumers are able to get the care they need, when they need it. The latest scores for example, show that all HMO plans except Kaiser in Northern California and Western Health Advantage scored a “poor” rating on timely access to care.
The 2016-17 report cards are easier to understand, but the scores still do not take into account equity measures. While the CAHPS is conducted in English and Spanish, the aggregated scores do not allow consumers to determine how plans and medical groups do with other limited English proficient groups. Likewise, the scores are not analyzed by race and ethnicity, which may mask disparities in patient satisfaction and health outcomes across specific health conditions, plans and medical groups. These factors are important for understanding how health disparities are addressed by the plans and groups. It is recommended that future versions of the report cards consider these factors in the ratings.
For more information, see http://www.opa.ca.gov/pages/reportcard.aspx
