MANAGED CARE October 1998. ©1998 Stezzi Communications
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NEWS AND COMMENTARY

Naming names: Two surveys' 'best'

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.

MarketTop-ranked health plan**
AtlantaKaiser Permanente
Baltimore-WashingtonNational Capitol Area PPO
BostonTufts Health Plan
Central Valley, CaliforniaBlue Cross Prudent Buyer PPO
ChicagoBlue Cross Blue Shield of Illinois (indemnity)
Cleveland-AkronMedical Mutual of Ohio (indemnity)
Dallas-Fort WorthPrudential HealthCare (indemnity)
Dayton-Springfield, Ohio *
Grand Rapids-Muskegon, Mich.Priority Health
Hartford, Conn.ConnectiCare
Houston-GalvestonUnited HealthCare PPO
Indianapolis *
Kansas City, Mo.-Kan. *
Lansing, Mich.Blue Cross Blue Shield of Michigan (indemnity and PPO)
Los Angeles-Orange CountyBlue Cross Prudent Buyer PPO
MemphisBaptist & Physicians PPO
New York CityUnited HealthCare
Northern New JerseyOxford Health Plans
PhiladelphiaPersonal Choice PPO
PhoenixBlue Choice
San FranciscoKaiser Permanente
Southeast MichiganBlue 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 Reports

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 HMOMarketTop commercial HMOTop commercial POS plan
Cigna HealthCare for SeniorsArizonaCigna HealthCareUnited HealthCare
AtlantaKaiser PermanenteBlue Cross/Blue Shield
NYLCare 65Baltimore-WashingtonFree StateAetna U.S. Healthcare
Harvard Pilgrim First SeniorityBostonTufts Health PlanTufts Health Plan
HealthCarePlan Senior ChoiceBuffalo
Dallas-Fort WorthPrudential HealthCarePrudential HealthCare
Kaiser Permanente Senior AdvantageDenverKaiser Permanente
DetroitHealth Alliance Plan
Long IslandVytra HealthcareOxford Health Plans
MilwaukeePrimeCare
AmeriHealth65New Jersey
HIP VIPNew York CityPhysicians Health ServicesOxford Health Plans
Kaiser Permanente Senior AdvantageNorthern CaliforniaLifeguardUnited HealthCare
Keystone 65PhiladelphiaKeystone Health Plan East
HealthAmerica AdvantraPittsburgh
Portland, Ore.Providence Health Plans
SeattleGroup Health Cooperative/Kaiser
*South FloridaAvMed Health Plan
Kaiser Permanente Senior AdvantageSouthern California
GHP AdvantraSt. Louis
† Not applicable.
* Only one plan in market evaluated.

SOURCES: THE MEDSTAT GROUP, ANN ARBOR, MICH., 1998; CAREDATA REPORTS, NEW YORK, 1998