2002_11 | NEWS: California report card rates HMOs, physicians

MANAGED CARE EXECUTIVE EDITION November 2002. ©MediMedia USA

NEWS AND COMMENTARY

California report card rates HMOs, physicians

The competency of physician groups is often as important as HMO performance in determining patient outcomes, California health regulators have decided.

Officials are acting on the premise that patients who can't switch their health insurer at will, can still shop around for the best physicians. The physician group ratings are included in a report card issued by the state Office of the Patient Advocate that also rates HMOs.

The report card, released Oct. 1, rates the state's top 10 HMOs in five categories: doctor service, overall customer service, and how well members are helped in staying healthy, getting better, and living with illnesses.

Also rated are 80 medical groups in such categories as getting treatment and specialty care, and communicating with patients. The medical groups provide care to about 72 percent of the state's HMO members.

The report card allows patients to find a better medical group within their HMO network, says Martin Gallegos, the OPA's director.

"Where consumers have the most choice during open enrollment is with medical groups," Gallegos tells Business Insurance. "And because that's where the actual care is provided, choosing a doctor is often more important than choosing an HMO."

The 10 health plans included in the report card cover 95 percent of the state's HMO enrollees. A state survey of 35,000 consumers, as well as information HMOs gather to be accredited by the NCQA, were used to rate the HMOs.

The data HMOs collect from medical groups were used to rate those groups.