California Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) improved on several quality measures this year including diabetes care, according to the 2012 Edition of the Health Care Quality Report Card released today by the California Office of the Patient Advocate (OPA). However, health plans performed below the national average in testing for lung disease; alcohol and drug dependence treatment; flu shots for adults; appropriately treating children with throat infections; and providing treatment for children with attention deficit disorder.
“As California implements health care reform, more focus will be placed on quality and value of health care,” said Office of the Patient Advocate Director Sandra Perez. “The Health Care Quality Report Card is an excellent tool that helps consumers sort out their choices and make decisions based on their personal health care needs.”
The Report Card provides consumers with the information needed to make informed choices regarding their health care. Highlights from the 2012 report card include:
- Diabetes Care: HMOs exceeded national averages for most diabetes care measures by 7 to 10 percent and improved in controlling blood pressure and blood sugar. PPOs improved on testing for blood sugar, as well as testing for kidney function.
- Heart Care: HMOs improved on controlling high blood pressure and cholesterol when compared to the national average. Both HMOs and PPOs scored lower in this year’s Report Card for administering heart attack medication.
- Clinical Conditions: HMOs exceeded national averages on the quality of care measures for most clinical conditions, while PPOs were slightly lower than national averages.
- Member Satisfaction: HMO and PPO member ratings improved regarding complaint resolution by 8 percent and 6.4 percent, respectively. However, 33 percent of HMO members and 43 percent of PPO members were still dissatisfied with complaint resolution.
- HMOs and PPOs have room to improve on testing for lung disease; alcohol and drug dependence treatment; flu shots for adults; appropriately treating children with throat infections; and providing treatment for children with attention deficit disorder.
Now in its 11th year, the report card contains quality and patient experience information for the state’s nine largest HMOs, six largest PPOs and 212 medical groups representing 16 million California commercial health plan members.
“OPA’s Health Care Quality Report Card sheds light on how well health plans are serving Californians. Californians deserve to get the right care at the right time to improve their health and stay healthy,” said Perez. “I am pleased by the progress made on several measures in quality of care and am encouraged at how health plans use this data to improve the care given to patients.”
The Health Care Quality Report Card has been a valuable tool for the health care industry in their efforts to make improvements.
Jerry Penso, MD, MBA, Medical Director, Sharp Rees-Stealy Medical Group, San Diego, who uses the data for quality of care improvements said, “We are proud to reach the 90th percentile of national performance on managing blood sugar and cholesterol for patients with diabetes as indicated in the Health Care Quality Report Card. Meeting these standards is more than just a score or a grade; it helps us save lives.”
Several new measures were added to the Report Card for 2012. For HMOs: aspirin use counseling for heart patients and immunizations for adolescents. For PPOs: additional diabetes and cardiovascular care measures; measures for prenatal and postpartum care; and immunizations for adolescents.
For more detailed information about the 2012 Edition Health Care Quality Report Card, visit www.opa.ca.gov. Copies of the Report Card can also be obtained by calling 1(888) 466-2219.
The California Office of the Patient Advocate was established in 2000 to represent the interests of health plan enrollees in California by educating them on their patient rights and responsibilities and publicly reporting on health care quality. The OPA website provides a one-stop-shop on health care quality reports covering health plans, medical groups, Medi-Cal, Healthy Families, hospitals, and long term care facilities. It also includes other resources to help consumers know their patient rights and get the most out of their health care.