The Office of the Patient Advocate (OPA) released the 2013 Report Cards today on a redesigned, consumer-friendly Website, www.opa.ca.gov, and, for the first time, as a mobile app for iPhone and iPad. The Website and app make it easy for consumers to review quality ratings on more than 40 clinical care measures for the state’s 10 largest commercial Health Maintenance Organizations (HMO), six largest commercial Preferred Provider Organizations (PPO), and 209 medical groups.
The Report Cards are an easy-to-use tool for Californians making decisions about health care coverage or medical groups. This year’s Report Cards show that health plans and medical groups are improving in the number of children getting immunized, checked for excess body fat, and treated appropriately for throat infections. The Report Cards also reveal that the quality of care for adults with chronic conditions – such as diabetes or heart disease – while improving on some measures, varies widely in California and often depends on where someone lives or which HMO, PPO, or medical group provides their care.
“Under the Affordable Care Act, millions of Californians will soon be shopping for health coverage through the state’s health benefit exchange, Covered California,” said Diana S. Dooley, Secretary, California Health and Human Services Agency. “The Report Cards are a great resource for moms, dads, family caregivers, and people who strive to get healthier and make informed choices about their health care.”
The California Department of Insurance regulates health plans underwritten by insurance companies, including PPOs, and makes the PPO Report Card available at its site (www.insurance.ca.gov) also. “The Report Cards provide consumers with essential information to make informed choices,” said Insurance Commissioner Dave Jones. “The Department of Insurance has a long track record of providing consumer protection, fielding nearly 200,000 calls annually. The Report Cards are one more important element in that protection.”
HMOs and medical groups dramatically improved (14 percent) the number of adolescents receiving immunizations (measles, tetanus, hepatitis B, meningitis). Medical groups increased childhood immunization rates by 4 percent. PPOs are not rated for this measure.
- HMOs significantly increased (7 percent) checking adolescents and children for body mass index (BMI), one way to measure body fat. Being overweight can lead to health problems and is increasing among children. (PPOs are not evaluated on this measure.)
- HMOs, PPOs and medical groups all made significant increases (7, 5, and 6 percent respectively) in the number or children treated appropriately for throat infections by not prescribing antibiotics unnecessarily.
- The quality of treatment for adults with chronic conditions improved for some important measures, but varies widely within health plans and medical groups. Among HMOs, care for lung disease, diabetes, and heart disease ranged between 2 and 4 stars. (1 star is poor care; 4 stars is excellent care).
- HMOs significantly improved how frequently they determine body mass index (BMI) for adults, an important risk factor for chronic disease management.
- Among PPOs, care for diabetes and heart disease ranged between 1 and 3 stars.
- PPOs improved by 10% in their rate of treating patients after a heart attack by ensuring they receive beta blocker drugs for at least 6 months after hospitalization for a heart attack.
- Quality provided by medical groups varies within individual counties. For example, diabetes care provided by San Diego medical groups ranged between 1 and 4 stars; and in Eastern Los Angeles County care for heart patients ranged between 1 and 4 stars.
Individuals and families can use the Report Cards to see:
- How other patients rate the health plans on important issues like doctor communication, getting care easily, and resolving complaints.
- How health plans and medical groups are rated on providing recommended care based on national standards.
- How health plans and medical groups perform when caring for patients with specific health conditions such as asthma, heart disease, diabetes and others.
- How to make the most of a doctor’s visit, including possible questions to ask.
- How to file a complaint or get assistance when needed.
Developed by the Department of Health Care Services, the new app is now available for download from the OPA Website, www.opa.ca.gov, as well as iTunes.
For more detailed information about the 2013 Edition of the Health Care Quality Report Cards, visitwww.opa.ca.gov, or call (866) 466-8900.
The California Office of the Patient Advocate represents the interests of health plan enrollees by educating them on their rights and responsibilities and publicly reporting on health care quality. The OPA website lists health care quality report cards that cover health plans and insurers, medical groups, Medi-Cal, the Healthy Families Program, hospitals, and long-term care facilities. It also includes resources (opa.ca.gov/about/consumer_information) to help consumers get the most out of their health care.
SOURCE Office of the Patient Advocate via PR Newswire