CalPERS Publishes 2004 Health Plan Quality Report; Gains in Member Satisfaction, Effectiveness of Care.

News Editors/Health/Medical Writers

SACRAMENTO, Calif.--(BUSINESS WIRE)--Sept. 16, 2003

Health plans with the California Public Employees' Retirement System (CalPERS) generally have improved their ratings for member satisfaction and effectiveness of care, based on annual assessments reported to the CalPERS Board today.

The Quality Report, published for the October open enrollment period, assesses the performance of partnering health maintenance organizations (HMOs) -- Blue Shield, Kaiser Permanente, and Western Health Advantage (WHA) -- and CalPERS self-insured preferred provider organizations (PPOs), PERSCare and PERS Choice.

The report presents the results of a 57-question survey administered in the Spring of 2003 to CalPERS Health Program members and an evaluation of the plans' effectiveness of care based on standardized, industry-wide guidelines.

The Quality Report also gives members tips for evaluating the quality of health plans and providers, protecting themselves from medical errors, communicating better with doctors and other providers, making sure they receive the preventive and other care they need, and taking good care of themselves.

"We welcome this report, which shows that we're doing a better job at providing a first-class health program to our active and retired public employees and their dependents," said Dr. George Diehr, Vice Chair of the Board of Administration's Health Benefits Committee. "This is a fine educational tool that shows how well our partners are performing and also how well our members are taking personal responsibility for keeping themselves healthy."

Overall, members said they were more satisfied with their health plans in 2002 than in the previous year. Kaiser had the highest rating among HMOs. Seventy-five percent of its CalPERS members expressed satisfaction. WHA's overall satisfaction rating was 62 percent, and Blue Shield's was 50 percent.

Generally, satisfaction was higher for PPOs than HMOs, and even higher among members in Medicare supplement plans. Among Basic (non-Medicare) plans, PERSCare had a rating of 67 percent, while PERS Choice received 51 percent. Among Medicare plans, 83 percent of Kaiser members expressed overall satisfaction, compared with 68 percent for Blue Shield, 90 percent for PERSCare, and 80 percent for PERS Choice. WHA Medicare enrollment was too low for valid results.

Overall, HMOs improved on effectiveness of care measures assessing such health care services as the prevention and treatment of acute and chronic illnesses including cancer, cardiovascular disease, and diabetes. The PPOs' scores were relatively stable.

Compared with all Basic HMO plans in California, Kaiser was above average for effectiveness of care. Blue Shield was average and WHA was below average. Among California HMO Medicare plans, Kaiser and WHA were above average overall, while Blue Shield was average.

Researchers noted that Kaiser appears to benefit from its integrated health delivery model, while other HMOs contract with outside networks of providers. Kaiser also has a much more stable membership. Eighty-seven percent of CalPERS survey respondents said they had been with Kaiser for more than five years, compared with only 22 percent for respondents of Blue Shield, which has made major customer service improvements in the 2003 contract year for its 460,000 CalPERS enrollees.

"We're presently making a major effort with Blue Shield to improve member services and the performance of medical groups, hospitals, and pharmaceutical providers that contract with Shield," said Loren Suter, Deputy Executive Officer, Benefits Administration. "That venture includes a dedicated CalPERS customer service unit and contractual commitments to improved disease and care management programs, with performance improvement incentives."

CalPERS is the nation's third largest purchaser of employee health benefits after the federal government and General Motors. For more information about the Quality Report and the Health Program, please visit the CalPERS Web site at www.calpers.ca.gov.