California's largest health plans have improved their care for diabetic patients, but many need to do better at treating children with throat infections, testing for lung disease and helping people overcome drug and alcohol addictions.
These are among the findings of the 11th annual report card released Wednesday by the state Office of the Patient Advocate.
The report card is meant to give consumers an easy-to-use tool to compare the quality of care delivered by the state's nine largest health maintenance organizations, six largest preferred provider organizations and 212 medical groups.
Each plan is ranked in categories of care with one to four stars, depending on how well it meets national standards or how its members rate it in such areas as ease of getting appointments and customer service.
"Publicly reporting is one tool to keep plans accountable," said Sandra Perez, director of the Patient Advocate's Office.
"The report card helps educate everyone on what types of treatment they should be receiving from their health plan," she said.
As in previous years, Kaiser Permanente outshone its competitors, receiving the top ranking of four stars in most categories. Most other HMO or PPO plans had no categories with four stars.
Among medical groups, the Palo Alto Medical Foundation also earned top scores, with four stars in both patient rankings and meeting national standards of care.
In addition to influencing consumers' health care decisions, Perez said she hopes the report card will be used by health plans to identify where they can improve.
Many apparently did that with diabetes care.
In a report card issued five years ago, the state singled out caring for diabetic patients as an area where many plans fell short of national standards. It noted, for example, that 1 out of 4 diabetics did not have blood sugar levels under control, which can lead to amputation, kidney failure and other complications.
But the report released Wednesday, which covers 2010, shows progress. California's largest HMOs exceeded national standards on most diabetes care measures by 7 to 10 percent, and improved in controlling blood pressure and blood sugar.
"I'm very encouraged at the rate of improvement," Perez said.
But the latest report card also identifies areas in which many plans fell short of national standards, including flu shots for adults, treating children who have attention deficit disorder, testing for lung disease, providing treatment for alcohol and drug dependence, and appropriately treating children with throat infections, including testing for strep throat before prescribing antibiotics.
"Surveys like this are certainly helpful because they give us a good snapshot of what we're doing well and identify areas where we can improve," said Health Net spokesman Brad Kieffer. He noted that his organization routinely uses such data to guide changes.
Health Net's HMO plan received three stars in many quality of care categories.
Kaiser attributes its strong showing to having an integrated health care delivery system in which specialists and primary care doctors work together to oversee patient care and use a common electronic medical record system, said Dr. Robert Pearl, executive director and CEO of the Permanente Medical Group.
"Patients don't fall through the cracks," he said.
Pearl also noted that Kaiser patients prepay for their care, so the incentive is to deliver the appropriate care and to keep patients healthy. For many other plans, he said, "people are simply rewarded for volume (of services), and no one is responsible for the outcome."
Despite its high marks in most categories, Kaiser has room for improvement in two areas ranked by its members, according to the report card. It received two stars for ease of getting doctor appointments and treatments, and one star in Northern California for plan service, which includes processing of claims.
Pearl noted that Kaiser processes very few claims, but he added, "we need to get better in that area."
Regarding getting doctor appointments, Pearl said Kaiser generally tries to make them available when people request them, but it may sometimes steer a patient to a primary care doctor before immediately seeing a specialist to ensure the appropriate care is given.
Anthem Blue Cross' HMO plan received three stars on many quality of care measures. "We will study the data closely to determine how we can continue to improve on our strengths and see what changes can be made to better serve our members," spokesman Darrel Ng said.
Ng added that the lower scores for Anthem Blue Cross' PPO plan are "not truly reflective of the excellent service our members received due to data issues that have been identified and will be resolved in time for next year's report card."
Sandy Kleffman covers health. Contact her at 925-943-8249.
Online: The 2012 health care quality report card is at www.opa.ca.gov. It has ratings on large HMOs, PPOs and 212 medical groups.
In print: Call the state Office of the Patient Advocate at 888-466-2219 for a copy.