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Consumer Health Care Choices Strengthened With Release of Plan and Physician Peformance Measures

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Kaiser Selected as Blue Ribbon HMO by Business Group First Time Physician Group Performance Data Released

San Francisco, September 16, 1997 – Just in time for open enrollment, California consumers will have access to more health care information than ever before. For the fourth consecutive year, report cards on HMO enrollees' satisfaction, along with scores on how many people within each HMO received preventive care, are being widely disseminated by a statewide collaborative. Because it received high marks relative to its competitors on these quality report cards, as well as in several other areas, Kaiser Foundation Health Plan was named the Pacific Business Group on Health's Blue Ribbon HMO for 1997. In addition, for the first time, publicly available objective information allows consumers to evaluate physician group performance. Research reveals that consumers are most interested in how well their doctor compares to others. Performance scores are available via PBGHís website or toll-free number.

Report Cards Indicate HMOs Doing Okay in Member Satisfaction, Good Job Screening for Breast Cancer, But Still Room for Improvement
With the release of several report cards last week by the California Cooperative Healthcare Reporting Initiative (CCHRI), PBGH employers were pleased to learn that nearly four out of five persons who are enrolled in an HMO indicate that they are satisfied with their plan. The finding is similar to results from prior year surveys. Purchasers, however, were disappointed with the industry's performance in several areas where consumers experienced high dissatisfaction, notably the ease with which patients can obtain referrals and schedule appointments.

"We want our employees to receive the best care and to be satisfied with the process," stated Tanya Bednarski of Chevron and member of CCHRI's executive committee. "While most people in HMOs are satisfied, the industry needs to make the process less of a hassle for the patient. Sicker people especially need timely and easy-to-access care."

On the preventive care scorecard, the HMOs exceeded the Healthy People 2000 preventive care goal set by the Federal government with respect to breast cancer screenings. Prenatal care rates are also fairly high. Areas for improvement which fall below the Federal goals for the year 2000 include childhood immunizations, cervical cancer screenings, and diabetic retinal exams. Although there are no Federal targets for advice to quit smoking, CCHRI measured it because research shows physician advice has a powerful effect. Two out of three smokers were advised to stop. "As purchasers, we are pleased that the very structure of HMOs allows for measuring and then managing populations' care. This is not true for fee-for-service plans. This report card tells us where we are; attention must now focus on achieving the Year 2000 goals across the board," said Bednarski.

An affiliate business health coalition based in Denver, the Colorado Business Group on Health, also released a similar report card on satisfaction and preventive care for their state.

Kaiser Comes Closest to Meeting Purchaser Plan Objectives on Quality, Data, Cost, and Partnering
After a careful evaluation process, the PBGH Board of Directors selected Kaiser Foundation Health Plan of California as its first annual Blue Ribbon HMO. The purchasers approved the Kaiser health plan after reviewing how each HMO performed on criteria across four strategic initiatives. The criteria include:

  • Quality, including consumer satisfaction, preventive care services, and accreditation by the National Committee on Quality Assurance;
  • Cost, including premiums paid by Californiaís three largest purchasing pools;
  • Data, including use of computerized data bases and innovation in electronic medical records; and
  • Partner Relations, including leadership in collaborative projects to measure or improve quality of care.

"In the California healthcare marketplace, Kaiser represents high value for both employers and consumers," said coalition executive director, Patricia E. Powers. "The coalition has been working with the industry on the strategic initiatives since we started eight years ago. Kaiser came out on top when stacked up against its competitors."

There is room for improvement even within The Kaiser Foundation Health Plan, however. PBGHís first report card on physician group performance revealed that The Permanente Medical Group of Northern California ranked below average on several satisfaction and quality indicators (see below). Because it was not possible to evaluate all health plansí physician networks, this information was not included this year as a criterion for selecting a Blue Ribbon plan. Eventually we would like to include provider measures in our criteria, noted Powers. "Each year as the measurement process matures, we will fold such measures into our Blue Ribbon designation. We may also award a Blue Ribbon for physician groups, in order to acknowledge better performance."

First Time Information on Physician Groups
A precedent-setting study released today by PBGH and The Medical Quality Commission (TMQC), an organization dedicated to measuring and improving provider performance, gives consumers what they want most in performance information about their doctors. The first public report of its kind in the U.S., the Physician Value Check Survey, includes scores for 49 California and 9 Northwest physician groups on multiple dimensions, including:

  • patient satisfaction with care provided by their doctors,
  • provision of key preventive services, and
  • care for two common chronic conditions—high blood pressure and high blood cholesterol.

Patients from these groups will be resurveyed in 1998 to gauge 2-year changes in physical and mental functioning. "The bottom line for employers is whether the health of my work force is being successfully managed. As purchasers, we should be rewarding physician groups that improve or maintain their members' health," said Pamela Hymel, M.D., Corporate Medical Director, Hughes Electronics. "The purchasers also commend every one of the 58 physician groups that cared enough about quality accountability to voluntarily participate in this important study."

Physicians also welcome the study's findings. "The survey gives us new information from the patient's perspective about how well we do relative to other physician groups in the marketplace. We've asked the health plans to compete on quality; now the medical groups can do the same," said George Perlstein, M.D., executive director, Palo Alto Medical Clinic.

More than 31,000 patients responded to the survey which was sent to a randomly drawn group of 1,000 managed care patients from each physician organization. The satisfaction results were adjusted for differences in the case-mix of patients across groups (i.e., age, gender, income, the presence of chronic conditions, and the use of health services).

Medical Group Report Card Finding Similar to Health Plan Report Card. The study found that roughly 80% of patients are satisfied with the care they receive from their doctors, a similar result to the health plan survey. Northern Californians are slightly more satisfied than are those living in the South, though there was a greater range of results in the Southern California point spread. And, similar to the CCHRI report card for plans, a composite score on access measures shows room for improvement. Fewer than two-thirds of patients are satisfied with the hours when their doctor's office is open, access to specialty and urgent care, and the ease of seeing their selected doctor.

While satisfaction scores for both health plans and physician groups were obtained from member surveys, the preventive care scorecards' methods differed. CCHRI gathered information from health plan computerized data systems and medical chart reviews.

The study also revealed significant differences among medical group success in treating high blood pressure and high cholesterol, two of the most frequent chronic diseases in the working age population.

Groups that consistently scored above average in Northern California are the San Mateo IPA based in San Mateo County, and IPA of the Redwoods (recently reorganized) located in Sonoma County. In Southern California, distinguished groups include Beaver Medical Group based in Riverside County, and several San Diego groups, including Scripps Clinic, Sharp Community Medical Group, and Sharp Mission Park Medical Group.

Study analyses were conducted by ADF Research and RAND. Financial contributors to the project include the Henry J. Kaiser Family Foundation1, PBGH's Quality Improvement Fund, Schering-Plough, Novartis Pharmaceuticals, Upjohn/Pharmacia Company and participating physician groups.

Clark Miller
Senior Communications Manager
Pacific Business Group on Health
Telephone: (415) 615–6302
E–mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it


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Nicole Kohleriter
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