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California HMOs and Medical Groups Steadily Improve Clinical Performance, Member Satisfaction

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San Francisco, Calif. (October 1, 2003) – As evidenced by nearly a decade of public reporting on HMO clinical performance and member satisfaction, and by three years of similar reports on the state’s medical groups, health care quality in California is improving. The results of this year’s annual HMO and medical group performance report finds that plans and groups that have participated in multiple years of quality measurement and public reporting of results have seen their performance scores steadily improve.

On September 30, the California Cooperative Healthcare Reporting Initiative (CCHRI) released the 2003 Report on Quality. The report contains clinical performance scores and customer-satisfaction ratings on the state’s HMOs, as well as consumer ratings from the latest California Consumer Assessment Survey (CAS), a publicly reported survey of patient experience at the medical-group level.

Combined with CCHRI data from 2001 and 2002, the new data reveals positive trends.

Among participating health plans, both clinical performance measures and customer satisfaction scores are improving. For example:

  • Since 2001, the plans’ average rate for controlling high blood pressure has increased 6.3 percent to 61.3 percent. The measure looks at whether adults in HMOs, diagnosed with hypertension, have blood pressure readings below 140/90. Approximately 50 million Americans (30 percent of the adult population) have high blood pressure.
  • Since 2001, the percentage of enrollees with diabetes who have acceptable cholesterol levels has increased 10.4 percent. Heart disease is one of the most common medical complications of diabetes. High levels of cholesterol and fat in the blood greatly contribute to the increased incidence of heart disease.
  • Among HMO enrollees, overall satisfaction with their health plan has trended upward for three years, going from 58 percent who rated their plan “8” or better (on a scale of 1 to 10) in 2001 to 65 percent this year.
  • Overall ratings for health care have improved from 67 percent in 2001 to 70 percent this year.

Among physician organizations that participate in the Consumer Assessment Survey, similar trends are emerging, even though the survey is only three years old. The number of participants has grown from 50 in 2001 to 124 this year. Three-year trend data on the 50 groups that have participated in CAS since its inception show significantly improved scores:

  • Patient satisfaction with access to care from their personal physician has improved five percentage points, for a current state average of 81 percent.
  • Patient satisfaction with the timeliness of receiving preventive care exams has improved five percentage points, for a state average of 81 percent.
  • Patients’ overall satisfaction with care from their doctors and other providers has improved four percentage points, for a state average of 68 percent.
  • Patient satisfaction with their ability to get an appointment as soon as desired has improved four percentage points, for a state average of 71 percent.

“These findings demonstrate how performance measurement and public reporting can stimulate quality improvement efforts,” said Peter Lee, president and CEO of Pacific Business Group on Health, which manages CCHRI. “They build a strong case for rapidly expanding the range of publicly reported performance measures, so that consumers can make value-based health care decisions.”

The clinical performance measures in the Report on Quality come from the Health Plan Employer Data and Information Set (HEDIS) developed by the National Committee for Quality Assurance, which accredits health plans. There are approximately 30 measures in HEDIS, focused on such areas as preventive screenings, immunizations, diabetes, asthma, depression and heart disease.

CCHRI supplies data to the California Office of the Patient Advocate, which in turn uses the data to calculate results published in its annual consumer report card on health care. The 2003 Report on Quality is available on the new CCHRI Web site.

The California Cooperative Healthcare Reporting Initiative is a collaborative of health care purchasers, eleven health plans and many providers. The Pacific Business Group on Health manages the group to promote collaboration instead of competition in health plan and provider-level data collection and reporting. CCHRI publishes a yearly report with performance data. It provides a single process for data collection and analysis, uses an independent third party to assemble and analyze the data, and provides standardized performance reporting definitions, as well as an audit of all measures.

Pacific Business Group on Health (PBGH), a major non-profit coalition of 50 purchasers, is dedicated to improving health care quality and availability while moderating cost. Its members annually spend billions to provide health coverage to approximately 3 million employees, retirees and their families. PBGH seeks to promote health plan and provider accountability and to provide consumers with standardized, comparable data to make the best health care decisions at all levels of care. PBGH also operates PacAdvantage, a small group purchasing pool providing health insurance to 106,000 employees and their families in more than 11,000 small employer groups in California.


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Nicole Kohleriter
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