The Golden State gets at best mediocre grades in a second annual Preferred Provider Organization (PPO) quality of care report card released by the California Department of Insurance.
“California PPOs rank in the middle of the pack compared with the national average, and show some of the lowest overall scores that California has ever seen,” says California Insurance Commissioner Steve Poizner. ” HMOs began reporting on quality in 2001.
“I got PPOs to join the effort beginning last year,” Poizner adds. “I am grateful for their cooperation, but this report card shows they will have to do better. This should be their wake-up call.”
The PPO Ratings At-a-Glance report card ranked the state’s six preferred provider organizations–Aetna PPO, Anthem Blue Cross, Blue Shield of California/Blue Shield Life, CIGNA Healthcare of California, Health Net of California and UnitedHealthcare (California). The organizations were given rankings of one to four stars (one being poor, four being excellent) on three criteria: (1) meeting national standards of care; (2) getting care easily; and (3) plan service.
The ratings are based on a set of standards developed by the National Committee on Quality Assurance.
None of the providers earned four stars on any ranking. Aetna PPO, CIGNA PPO and UnitedHealthcare each earned three stars for meeting national standards of care, especially for asthma, diabetes, cancer and pediatrics.
UnitedHealthcare also scored three stars for getting care easily. All other rankings were only one or two stars.
All providers scored poorly on plan service, which entails customer service, getting cost information and claims payment. Only Aetna scored two stars in this category. All other providers scored one star.
“These results show that insurers have a lot of room for improvement, particularly in the area of customer satisfaction,” Poizner says. “As I promised when I came into office, consumers now have much more information to make choices that are best for them, and to pressure insurers to do better. We all need to use this data to make that happen.”
Despite these results, the Department of Insurance added that its own grading standards were steep. And it noted that 8 out of every 10 PPO members in the state reported favorable experiences with their plan. Moreover, some 64% of patients were reported as getting the right clinical care for their condition.
The companion report card on HMOs will be released separately in early 2011.