California Grades PPOs, None Receives Four Stars

Cheryl Clark, for HealthLeaders Media , November 19, 2009

California now provides what it calls the nation's "first interactive, consumer-friendly PPO Report Card," one- to four-star rating of five of the six preferred provider organizations in the state.

Issued by California Department of Insurance Commissioner Steve Poizner, the online ranking gave the highest marks this year, only three stars—or "good"—to CIGNA, Health Net of California, and Aetna. Anthem Blue Cross and United Healthcare of California received two stars, signifying "fair."

Blue Shield of California Life & Health Insurance Co. did not report because of a technical glitch, according to an agency spokesperson.

Each of the PPO companies was ranked on delivery of care for asthma, cancer, and Chlamydia screening; diabetes, heart, and mental healthcare; testing for cause of back pain; and treating bronchitis with antibiotics. Also ranked were two categories of whether children and adults were "getting the right care."

The Web tool explains what was measured. For example, under heart care, testing cholesterol and heart attack medication were measured, and each PPO received a separate percentage score based on a comparison with national standards for quality of care.

The scoring was prepared through the selection of samples of PPO members' records to see whether they received care "that meets nationally recognized standards" based on the more than 25 Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS).

California's Department of Managed Health Care, a different state agency, already publishes a similar ranking of health maintenance organizations. Legislation took effect several years ago to require the preparation of a similar report for PPOs and it has been in the making for more than two years.

PPOs cover about 1.5 million of the state's 36 million population.

"This type of report on PPOs has never been done before," Poizner said, "but California is setting the bar higher for everyone. The value to consumers is huge, but the benefits to the entire healthcare system are even greater. We now have a baseline, and every insurer knows their performance needs to get better every year. Consumers are watching."

Association of California Life and Health Insurance Companies (ACLHIC), the trade group that represents PPOs, said in an e-mailed statement, "We are happy to participate with the Commissioner in this useful process."

"While we recognize that in many instances the ranking differences between plans represent modest percentage differences, we welcome this report as we strive for continual improvement for our members in receiving their recommended health care," said a statement issued by Anthem Blue Cross.

Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.

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