EMPLOYEES BENEFIT FROM NON-PROFIT HMOs

by Cyndie O'Brien and Kathleen Cade

One of the toughest jobs a company president or human resources manager has to deal with is selecting the right health benefit plan for the employee population. In today's world of competitive HMOs, its often difficult to tell one HMO for another. When it comes to commercial plans, in particular, the list of benefits offered by each HMO becomes a blur. Do the handful of nonprofit HMOs offer any advantages?

CHECKING CONSUMER RATINGS

The Department of Corporations (DOC), the government agency charged with monitoring HMOs, regularly posts consumer based evaluations of managed care organizations. They feature a hot line which captures complaints that individuals register against their HMOs.

The DOC places the number of complaints received for each HMO on a statistical chart on their web sites. Non-profit HMOs routinely score well on these charts, receiving among the fewest complaint calls in the state. Inter Valley Health Plan, for example, registered less than one complaint call for every 10,000 members.

Another trick to discovering which HMO commercial plans stand out from the pack is by checking the consumer rating of the HMO's Medicare benefits (if they have one most do.) Because Medicare is so closely regulated, a number of government agencies and consumer groups have listed detailed rating statistics on HMOs who offer benefits to Medicare recipients.

While business owners and HR professionals are in the market for employee benefit plans and not Medicare plans, seeing an HMO's rating in the Medicare sector can often reveal how much emphasis an HMO really places on its members.

Medicare itself recently released results of a poll of 100,000 people enrolled in Medicare HMOs, establishing which HMOs were best in a number of categories. The results of the study were published in the February 15th Los Angeles Times and are also available at Medicare's community-access web site. One fact that stands out glaringly in Medicare's results for Southern California HMOs is that the two HMOs who scored by far the highest in the "Overall Rating" category, Inter Valley Health Plan and UHP Healthcare, are non-profit HMOs.

Perhaps its time for the business sector to take notice of the quality of care being received by members, both commercial and Medicare, from non-profit HMOs.

WHAT IS A NON-PROFIT HMO, ANYWAY?

The vast majority of HMOs today are for-profit organizations. As mentioned above, however, there are exceptions. Like other HMOs, most non-profits have seen growth over the last several years. Also, like other HMOs, non-profits place great emphasis on preventive care and health education.

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