Friday, January 12, 2001

Survey finds HMOs better


All 8 top plans at, above average

By Tim Bonfield
The Cincinnati Enquirer

        The Tristate's eight largest health plans did a better job in 1999 of controlling costs while providing quality health care, according to an HMO report card issued Thursday.

        Unlike the previous year, when two plans got poor marks, none of the health plans studied in 1999 were rated “below average.” Meanwhile, four plans instead of two were rated “above average,” according to the Employer Health Care Alliance, a group of 71 large companies.

REPORT CARDS
    According to an employer group, the big health plans in town are getting better at providing cost-effective, quality service. The ratings, based on 1999 data, include preventive services, health service use, management issues, member satisfaction and cost.
ABOVE AVERAGE
    • Anthem Community Choice.
    • Anthem Health Maintenance Plan.
    • Humana/ChoiceCare Co-Choice.
    • Humana/ChoiceCare NewHealth.
AVERAGE
    • Aetna HMO.
    • Humana/ChoiceCare Primary Access.
    • Humana/ChoiceCare Select.
    • United Healthcare HMO Plus.
BELOW AVERAGE
    • None.
   Source: Employer Health Care Alliance
        “For the first time, all the plans were at or above average,” said Sharron DiMario, executive director of the alliance. “And once again, the smallest networks were among those scoring well.”

        The report rated eight health plans offered by four insurers that touch a large chunk of Greater Cincinnati's population. Combined, the eight health plans cover about 650,000 people and accounted for more than 34,000 hospital admissions.

        The report praised local HMOs for keeping increases in prescription drug spending lower than national averages; for steady improvement in childhood vaccina- tions, cancer screenings and prenatal care; and for high rates of member satisfaction.

        Meanwhile, the report raised concerns about diabetes prevention care, rising Caesarean-section rates, and increased use of hospital emergency departments. Several plans also got weak marks for managing administrative expenses.

        Overall, two health plans offered by Anthem Blue Cross & Blue Shield and two plans from Humana/ChoiceCare were rated “above average.” Two other Humana/ChoiceCare plans, along with HMOs from Aetna and United Healthcare were rated “average.”

        Last year, an Anthem plan and a United plan were rated “below average.”

        Among the highlights of the report:

        • Childhood vaccination rates (68.7 percent); breast cancer screening rates (75.3 percent); cervical cancer screening rates (73.4 percent); and pregnant women getting first-trimester prenatal care (87.2 percent) all exceeded national averages.

        • Prescription drug spending grew 12.4 percent locally, compared with 18 percent nationally.

        • Per-capita emergency hospital visits (number of visits per 1,000 members) grew 14 percent in 1999, from 144 to 161.

        • C-section rates grew from 20.6 percent of total births to 21.6 percent.

        • The percentage of diabetics getting annual eye exams grew from 37 percent to 48 percent, but fell short of a national target of 66 percent.

        • Six of the eight plans ranked above average in member satisfaction. Among all the plans, at least 70 percent report no problem getting health care or referrals to specialty care.

        While the report details many improvements, it also notes that HMO profit margins declined an average of 1.3 percent, which makes some employers nervous about the long-term fiscal health of the HMOs.

        “Our concern is if the health care industry isn't healthy, plans could fold and that would reduce competition and lead to higher prices,” Ms. DiMario said.
       



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