Calif. ‘Report Cards’ Are Out In Time For Open Enrollment

The California Office of the Patient Advocate Wednesday released “report cards” that rate major health plans on selected clinical care services, including cancer treatment, mental health, chronic disease management and patient satisfaction.

The assessments, which also include data on selected medical groups, are available online in multiple languages.

The state timed the release of this year’s report cards to coincide with the second round of open enrollment in Covered California, the state’s online health exchange, which kicks off Nov. 15. Several plans included in the report cards are offered on the exchange.

“Consumers can make more informed health care decisions,” said California Health and Human Services Agency Secretary Diana Dooley during a conference call with reporters. “I hope all Californians who are faced with competing health plan enrollment choices during the weeks ahead will find these report cards to be a helpful resource.”

This is the 14th year the agency has generated health care quality report cards. This year, the organization aggregated claims and electronic medical record data and patient satisfaction surveys for the state’s biggest insurance plans and more than 200 medical groups. In total, these organizations serve upward of 16 million Californians, officials said.

The report cards rate 10 health maintenance organizations, six preferred provider organizations and 200 medical groups on a four-star scale. All HMOS rated “good” or “excellent” on their ability to provide quality clinical services compared to national standards. Ratings from patients on their experience  were not as favorable. For instance,  all HMOs were rated “poor” in terms of “getting services easily’” with the exception of Kaiser Permanente. (Kaiser Health News is not affiliated with Kaiser Permanente.)

All PPOs rated “good” or “fair” on the quality of clinical services. Only Aetna and Cigna received “poor” ratings in “getting services easily.”

The report cards are part of a larger national push to bring greater transparency to the health care industry and help consumers choose services that best fit their needs.

The California health care report cards are freely available to all consumers online and through mobile applications.

“The availability of data … allows us to create products that allow people to make better decisions in almost every circumstance,” said Bryan Sivak, the chief technology officer at the U.S. Department for Health and Human Services. And as a result, insurance companies “will have to compete on the things that matter to people.”

Experts say that while patient satisfaction measures may provide insights into bedside manner, they may not not provide reliable information on the quality of care.

The California health care ratings don’t include information on individual doctors. Instead, they provide a snapshot of a health plan’s or medical group’s strengths and weaknesses. More granular data on individual providers could be useful, experts say, especially if physician reviews of other physicians are incorporated.

“I would put ton of credibility on that,” said Scott Decker, president of health care transparency company HealthSparq, earlier this year.

Categories: The Health Law