SACRAMENTO, Calif., Jan. 28, 2014 /PRNewswire-HISPANIC PR WIRE/ — The Office of the Patient
Advocate (OPA) released its web-based 2014 Report Cards today, enabling
consumers to compare clinical and patient experience performance ratings for the
state’s 10 largest commercial Health Maintenance Organizations (HMOs), six
largest commercial Preferred Provider Organizations (PPOs), and over 200 medical
groups. The Report Cards reflect care delivered to approximately 16 million
commercially insured Californians, many with chronic diseases that have costly
consequences, particularly if not managed effectively.
“The Report Cards reveal a significant performance gap between monitoring the
care of their patients with diabetes and heart disease and successfully
controlling these chronic conditions,” said Amy Krause, Director of the
California Office of the Patient Advocate. “Also, the quality of care for
patients with diabetes or heart disease, while improving on some measures,
varies widely in California, and often depends on where someone lives or which
HMO, PPO, or medical group is providing care.”
According to the new Report Cards, HMOs, PPOs, and medical groups, on
average, effectively monitor the blood sugar and cholesterol levels of 82 to 91
percent of their patients with diabetes or heart disease. However, these
conditions are only effectively controlled in 44 to 67 percent of these same
patients across the state.
“Experts report that up to 75 percent of every health care dollar is spent on
the treatment of chronic disease. Clearly, it is essential that health plans and
providers work more closely with their patients to improve their performance and
achieve better health and quality of life for individuals with chronic
diseases,” said Krause.
The Report Card website is at http://www.opa.ca.gov/Pages/reportcard.aspx , which will soon also be
available to view in Spanish and Chinese. The website offers resources on how to
make the most of a visit to the doctor, including possible questions to ask and
how to file a complaint or get assistance when needed.
A new “Report Card Wizard” improves the search capabilities for consumers to
more easily find data on specific health conditions. Mobile apps for Android and
Apple smart phones and tablets also are available.
Other quality and service performance highlights:
- Overall, average clinical quality performance for all California HMOs,
PPOs, and medical groups did not change substantially from 2013 to 2014.
- On average, HMOs score higher than PPOs on all but 9 of 46 individual
clinical quality performance measures.
- Since 2006, 6 HMOs have shown improvement at a faster rate than the
national average on the key Heart Care measure of “Controlling
- Medical Groups and HMOs made substantial improvements in providing
- PPOs do slightly better than HMOs in their members’ perceptions of
“Getting Care Easily,” but both have room to improve compared to national
- HMOs and PPOs are below the national averages (low to begin with) on more
than half of the patient experience measures.
Using star ratings (one is poor; four is excellent), the Report Cards help
consumers compare how well health plans and medical groups provide recommended
care based on 46 specific national standards of clinical quality, and up to 15
patient experience measures, as well as their overall care for patients with
specific health conditions: asthma and lung disease, heart disease,
diabetes, cancer, maternity, or mental health. Plans are also rated for overall
care of adults and children.
The California Department of Insurance regulates health plans underwritten by
insurance companies, including PPOs, and also makes the PPO report card
available at its site, http://www.insurance.ca.gov/.
For more detailed information about the 2014 Edition of the Health Care
Quality Report Cards, visit http://www.opa.ca.gov/, or call (866) 466-8900.
The OPA website provides health care quality report cards that cover
commercial health plans and insurers, medical groups, as well as links to
quality measures for Medi-Cal Managed Care, Medicare Physician Groups, CalPERS
Health Plans, and hospitals and long-term care facilities. It also provides
resources to help consumers get the most out of their health care.
SOURCE California Office of the Patient Advocate