Southern California health plans received mixed grades in a report card issued by a national group that monitors HMO quality.
The National Committee for Quality Assurance rated several hundred health plans in the United States in its Quality Compass 2000 report card, a mix of performance data and patient satisfaction survey results. The group's ratings are used by some businesses when they pick managed health care service plans for their employees.
Quality Compass is just one dimension of overall standards for accrediting plans, said Barry Scholl, a spokesman for the quality-assurance committee.
"We have a whole set of standards," Scholl said, adding that his group also takes into account health plans' quality-improvement programs and their grievance and appeal procedures, among others.
"Pacific-region plans do not have the highest scores," Scholl said, noting that the plans score "well down the list" on member satisfaction measures and in the middle of the pack on clinical measures.
Quality Compass is partially based on the Health Plan Employer Data and Information Set. HMOs, large employers and the NCQA developed that system to help purchasers better understand what they were getting for their health care dollars. Health plans voluntarily submit data to the committee for assessment. Because participation isn't mandatory, some believe the report card is not the best way to measure HMO quality.
Some HMO officials, however, believe Quality Compass is an accurate measurement.
"It tells us that we provide high-quality care. We're very pleased," said Dr. John Brookey, physician director of quality for Kaiser Permanente Southern California.
Kaiser Permanente, which scored above national or California averages in eight of the 10 sample criteria released by the committee, uses Quality Compass information to drive internal performance improvement, Brookey said.
"All health plans are on a level playing field. The public has the ability to look across health plans," he said.
"There are always opportunities to improve," said Dr. Milton Schwarz, Aetna U.S. Healthcare's Western regional medical director for quality. For example, Schwarz said, Aetna took the initiative to call plan members who have diabetes to urge them to be examined for diabetic retinopathy, a leading cause of adult blindness. Aetna's score on Quality Compass' comprehensive diabetes care/eye exams category was above the national and California HMO averages.
"Our general feeling is that the concept is very solid," said Jeff Davis, chief operating officer of Long Beach-based Universal Care. He added, however, that the scores "may be more of a test of a plan's ability to collect data rather than quality of care."
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