MANAGED CARE October 1998. ©1998 Stezzi Communications
Medstat/J.D. Power and CareData Reports recently released separate studies listing "best" health plans. In conducting their joint survey, Medstat, a health care consultancy, and J.D. Power, the marketing company, considered the views of physicians. CareData, meanwhile, sought consumer opinion when developing its list.
Medstat Group/J.D. Power & Associates
Thirty thousand physicians in 22 markets rated 150 health plans on such issues as administration, clinical autonomy and reimbursement. Curiously, while doctors reported widespread dissatisfaction with managed care, they ranked HMOs higher than fee-for-service plans in several markets. Physicians' biggest beef? More than 3 of every 4 told Medstat/J.D. Power that having to justify clinical decisions annoyed them more than anything else.
|Market||Top-ranked health plan**|
|Baltimore-Washington||National Capitol Area PPO|
|Boston||Tufts Health Plan|
|Central Valley, California||Blue Cross Prudent Buyer PPO|
|Chicago||Blue Cross Blue Shield of Illinois (indemnity)|
|Cleveland-Akron||Medical Mutual of Ohio (indemnity)|
|Dallas-Fort Worth||Prudential HealthCare (indemnity)|
|Grand Rapids-Muskegon, Mich.||Priority Health|
|Houston-Galveston||United HealthCare PPO|
|Kansas City, Mo.-Kan.||*|
|Lansing, Mich.||Blue Cross Blue Shield of Michigan (indemnity and PPO)|
|Los Angeles-Orange County||Blue Cross Prudent Buyer PPO|
|Memphis||Baptist & Physicians PPO|
|New York City||United HealthCare|
|Northern New Jersey||Oxford Health Plans|
|Philadelphia||Personal Choice PPO|
|San Francisco||Kaiser Permanente|
|Southeast Michigan||Blue Cross Blue Shield of Michigan (indemnity)|
|* No single plan stood out in this market.
** Plans listed are HMOs unless noted. PPO = preferred-provider organization.
CareData released two lists — one for commercial plans, the other for Medicare risk HMOs. The commercial survey evaluated satisfaction with 145 HMOs and point-of-service plans in 27 markets, while the Medicare inquiry reviewed 42 Medicare risk HMOs in 20 markets. Both examined members' perception of adequacy of care for specific conditions and preventive care, satisfaction with pharmacy benefits and reasons for joining and leaving plans. The top performers in markets where multiple plans were evaluated:
|Top Medicare risk HMO||Market||Top commercial HMO||Top commercial POS plan|
|Cigna HealthCare for Seniors||Arizona||Cigna HealthCare||United HealthCare|
|†||Atlanta||Kaiser Permanente||Blue Cross/Blue Shield|
|NYLCare 65||Baltimore-Washington||Free State||Aetna U.S. Healthcare|
|Harvard Pilgrim First Seniority||Boston||Tufts Health Plan||Tufts Health Plan|
|HealthCarePlan Senior Choice||Buffalo||†||†|
|†||Dallas-Fort Worth||Prudential HealthCare||Prudential HealthCare|
|Kaiser Permanente Senior Advantage||Denver||Kaiser Permanente||†|
|†||Detroit||Health Alliance Plan||†|
|†||Long Island||Vytra Healthcare||Oxford Health Plans|
|HIP VIP||New York City||Physicians Health Services||Oxford Health Plans|
|Kaiser Permanente Senior Advantage||Northern California||Lifeguard||United HealthCare|
|Keystone 65||Philadelphia||Keystone Health Plan East||†|
|†||Portland, Ore.||Providence Health Plans||†|
|†||Seattle||Group Health Cooperative/Kaiser||†|
|*||South Florida||AvMed Health Plan||†|
|Kaiser Permanente Senior Advantage||Southern California||†||†|
|GHP Advantra||St. Louis||†||†|
|† Not applicable.
* Only one plan in market evaluated.
SOURCES: THE MEDSTAT GROUP, ANN ARBOR, MICH., 1998; CAREDATA REPORTS, NEW YORK, 1998