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Are California Health Plans Making the Grade?; CCHRI Issues Annual Report Card of State's HMOs.


High marks were given to California HMOs today as the California Cooperative Healthcare Reporting Initiative (CCHRI) released the results of its sixth annual study of health plan performance.

CCHRI is the only independent entity that produces a "California report card" of HMO performance scores on a variety of clinical, member satisfaction and access measures. CCHRI selects its clinical and satisfaction measures from the HEDIS performance measure set developed by the National Committee on Quality Assurance.

Eighteen California HMOs, representing 95 percent of the commercially enrolled population, participated in various CCHRI data collection and reporting projects. This report is particularly timely due to upcoming open enrollment for employer-sponsored health plans, when many consumers evaluate their health plan options. For tracking purposes, the report also offers a comparison of health plan performance over the past three years.

Ten clinical preventive care measures ranging from childhood immunizations to diabetic retinal exams to health plan advice to quit smoking were covered in the 1999 report card. "Overall, the CCHRI average for each clinical measure improved this year for both the commercial and Medicare populations, explained Jeff Kamil, M.D., Medical Director -- Quality Improvement, Blue Cross of California. "Many health plans noted statistically significant improvement in their clinical preventive care rates for several of the measures. This is welcome news in view of the ongoing spotlight on managed care." There are no comparable measures or reports for non-managed health care plans.

Medical Group Performance

Each year, CCHRI expands the areas covered in the report card in an effort to make the findings relevant to more audiences. For the first time, the CCHRI includes information about medical groups. A telephone survey was conducted to determine appointment availability for primary care physicians for routine and urgent care visits. The average statewide appointment scheduling time for a routine office consultation with a primary care physician was 3.9 days. When patients were willing to see any doctor within the practice, the wait time was just 2.7 days. "The results of this study can be used by consumers to evaluate whether their waiting times for office appointments with physicians is consistent with the California average, said Joel Hyatt, M.D., Southern California Permanente Medical Group. "We recognize that access to medical care is an important consideration when making health care choices and are pleased to be able to include this level of detail in the report card."

The CCHRI report also measured the provision of clinical preventive services among medical groups. Nine California provider organizations measured how often mammography screening, prenatal care and post-delivery check-ups for women who recently gave birth were provided according to specific guidelines. Four of these provider organizations published their results in the 1999 report card. "While these measures are collected for health plans, information that is specific to medical groups is particularly meaningful to consumers as they are the frontline providers of health care," expressed Sharon Katz, Quality Improvement Manager, Brown & Toland Medical Group.

Satisfied Health Care Consumers

The report card includes results of a member satisfaction survey of California health plans. Fifty-five percent of Californians rated their health plans with a score of eight or above on a scale of 0-10. This score is consistent with the national average, which is 57 percent. Statewide, 79 percent of members gave their HMOs a score of six and above. Also highly rated were the percent of members who believed that their physician listened carefully (87 percent) and that they received good explanations of tests and procedures (80 percent). Seventy-five percent of members believe that authorizations have not delayed their medical care and 82 percent have not made any complaints to their health plan during the past year. By and large, overall satisfaction remains at about 80 percent.

Data Uses and Collection

Purchasers take this into account when making decisions regarding their offerings to employees, but ultimately maintain high expectations, according to Tom Davies, Manager, Managed Care, GTE. "Large purchasers find the CCHRI report to be very valuable because the rigor applied to data collection ensures comparability. We use it to assess how plans are doing and whether there has been any measurable upward trend in performance, and that guides our selection of plans we offer our employees. If a plan's performance is poor one year, we will look for improvement the following year."

"There are a trio of audiences -- purchasers, providers and consumers -- that benefit from the CCHRI report. The consistent collection of data allows for valid comparisons across health plans," said David Hopkins, PhD, CCHRI Administrator. "This is the level of sophistication needed for consumers to make wise health care decisions and reflects the high level of accountability placed on health plans by purchasers and consumers alike."

Founded in 1994, CCHRI is a collaborative of health care purchasers, plans and providers that are equally represented throughout the organization's governance structure. Managed by the Pacific Business Group on Health, CCHRI is the only California statewide organization that collaboratively reports on health plan performance. CCHRI collects and reports standardized, reliable HMO performance data and promotes the use of accurate and comparable quality measures within health care. These activities offer a level playing field for objectively comparing California health plans.
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Publication:Business Wire
Date:Sep 15, 1999
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