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Office of the Patient Advocate Releases 2015-16 Report Cards

Office of the Patient Advocate Releases 2015-16 Report Cards

California’s Office of the Patient Advocate (OPA) released its 2015-16 Health Care Quality Report Cards last week. The new report cards shed light on the quality of care under a variety of health care providers and plans, including California’s 10 largest HMOs, the six biggest PPOs, and more than 200 large medical groups covering 16 million consumers in California. The data is drawn from claims data and patient surveys.

The report cards are timely as consumers gear up for 2016 open enrollment, which begins Nov. 1, 2015, and continues through Jan. 31, 2016. With the release of the report cards, consumers should have an easier time shopping for coverage. Each HMO and PPO is evaluated on their overall medical care and for how it treats certain conditions like asthma and cancer as well as its behavior and mental health care. Further, the report card provides a deeper evaluation on how a health plan treats certain conditions through specific clinical indicators of good care. This helps consumers understand what they should expect from their coverage.

Consumers can also look-up medical groups by county to see clinical and patient experience ratings for each group. Medical groups are rated on their overall care as well as for: asthma care, cancer screenings, chlamydia screenings, diabetes care and making sure children receive the appropriate care. Patient experience ratings include, among other measures, the helpfulness of the medical group’s staff, the timeliness of services, and patient communication. Consumers not only have the option of comparing each medical group on their ratings but they can also view a medical group overall profile, which lists all ratings, doctor information, and hospital affiliations.

While the report cards are useful in understanding overall quality, they do not currently allow for a comparison of performance and patient satisfaction across racial and ethnic subpopulations. Additionally, consumers cannot see county specific outcomes for health plans that may have large service areas. And although the plan ratings provide a strong overview of the industry’s performance, some of the patient experience ratings seem contradictory or inconsistent at times. Future versions of the OPA report card could clarify this and expand quality evaluation to better include equity criteria.

Overall, the OPA report card equips consumers with valuable insight on the quality of health plans and medical groups. If you have some thoughts you’d like to share on the new OPA report cards, please share them in the comments below.

For more information on the ratings, you can visit the OPA site. You can see the report card dashboard below.

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