Woeful Standards of Care: California's HMOs

There are many reasons why we need to overhaul our health care system. This is one of them, and assuredly is big reason why we are spending so much on care, yet have a relatively low life expectancy. We are simply not receiving adequate preventative care, according to a new state governmental report. LAT:

The eight largest plans in the state fail to ensure that their 12 million members are sufficiently tested and treated to prevent and detect major diseases and reduce unnecessary expenses, according to the California Office of the Patient Advocate's report, called the Health Care Quality Report Card.

These are the basics and we are not even getting that right.

The report compared how often the plans, along with about 200 physician groups, met 31 clinical quality standards, such as immunizing infants and screening adults for cancer, in 2006.

It found that almost one-third of middle-aged women hadn't had a mammogram to screen for breast cancer in the last two years, for example, and that almost half of plan members older than 50 hadn't been tested for colorectal cancer.

"As standards of care, they pretty much should happen 100% of the time," said Ted vonGlahn, director of consumer engagement for the Pacific Business Group on Health, which helped prepare the report. "When you look at the averages, it's pretty sobering."

Nobody got four out of five stars. In fact only two managed to get three stars.

Health Net and Kaiser Permanente each received the highest score for overall clinical quality, notching three out of four stars, or a "good" rating.

The rest -- Aetna Health, Blue Cross, Blue Shield, Cigna, PacifiCare and Western Health Advantage -- were given two stars, for "fair."

Plus, consumer groups are arguing even these ratings were overly generous to the HMOs. They left out some pretty important statistical analysis to quality of coverage.

Jerry Flanagan, a patient advocate with the Foundation for Taxpayer and Consumer Rights, said the report let health plans off too easily by failing to take them to task for what he called their "worst behavior."

For instance, he said, the report didn't make note of the cancellation of sick patients' coverage, for which Blue Cross and Kaiser have been sanctioned, or the troubled kidney transplant program at Kaiser.

"This vague and incomplete analysis gives consumers a false sense of security about the quality of HMOs," Flanagan said.

Guess who got two stars for consumer satisfaction? Blue Cross. Shocking isn't it? Lot's of work to do. The government obviously has a role to play in ensuring that these HMOs get the basics right.