Blue Cross of California posts gains in quality performance.

WOODLAND HILLS, Calif.--(BUSINESS WIRE)--June 10, 1996--Blue Cross of California's CaliforniaCare HMO has been registering significant improvements in its overall quality performance, according to a report issued by the California Cooperative Health Plan Employer Data and Information Set (HEDIS) Reporting Initiative (CCHRI).

CaliforniaCare demonstrated an average improvement of 14 percent in key indicators, such as mammography screening, PAP smear rates and childhood immunizations.

HEDIS is a set of health plan performance measures that cover quality, access and patient satisfaction, membership and utilization, as well as finance. HEDIS is designed to enable plans and employers to accurately track and compare trends in health plan performance.

CCHRI is an effort to coordinate the collection of comparative quality information on more than 20 California HMOs that provide health-care services to more than 95 percent of all HMO members within the state. The comparative results are determined by a third-party auditor to ensure accurate, standardized auditing of results.

Much of CaliforniaCare's performance improvement is attributed to the HMO's innovative outreach and intervention programs, including a member directed postcard reminder program that focuses on seven key clinical areas. These include women's health, cardiovascular care, senior preventive health, childhood immunizations and diabetes screening.

Now in its second year, the postcard program individualizes health promotion by sending an appropriate health reminder directly to the member.

In addition to the postcard reminder program, CaliforniaCare has also enhanced its intervention and outcomes measurement efforts for members in five specific disease categories. These efforts complement CaliforniaCare's existing medical group quality performance incentive program (CaliforniaCare Scorecard) and its hospital quality program.

The Scorecard program systematically monitors each medical group in the network for member satisfaction, grievance rates, access, preventive health performance, credentialing and overall quality infrastructure. The hospital quality program is one of the industry's first systematic efforts to assess clinical performance for each hospital in the Blue Cross of California network.

"We are pleased with the progress that we are making as a health plan in delivering quality," said Jeffrey Rideout, M.D., vice president for quality management for Blue Cross of California. "We feel strongly that there are ways to effectively test a health plan. These include demonstrated improvements in quality that the health care plan is taking to improve quality as well as the relationships that the plan maintain with physicians to achieve those goals.

"We understand that health care is primarily a transaction between the patient and physician. Managed care should be designed to support the best health-care delivery through the development and implementation of the best practices available," Rideout said.

There is evidence that this approach has merit. A recent Pacific Business Group on Health survey reported that medical groups and Independent Physician Associations (IPA) cited CaliforniaCare as one of the top four health plans in the state with which to work. CaliforniaCare was also cited as the top plan in California with which to work regarding utilization management.

In addition, CaliforniaCare has been noted by the American Association of Health Plans as one of 10 health plans nationally to demonstrate a best clinical practice, specifically for its childhood immunization outreach/intervention program. Immunization rates for CaliforniaCare children have been raised through member education and targeted intervention at the medical group level.

Blue Cross of California is the principal operating subsidiary of WellPoint Health Networks Inc., one of the nation's largest publicly traded managed care companies serving the health care needs of more than 4 million medical members. WellPoint serves its customers outside California through UniCARE health plans and specialty products.

WellPoint offers a comprehensive array of quality health plans provided through health maintenance organizations, preferred provider organizations and specialty managed health-care networks. Specialty products include pharmacy benefit management, dental, vision, mental health, life and disability insurance, flexible spending accounts, COBRA administration and 24-hour integrated, network-based workers' compensation.

CONTACT: Elise Anderson, 818/703-2703