Insurers improve diabetes care, get low marks for other coverage

California's health plans received positive marks for customer satisfaction and enhanced diabetes care, but they still should improve treatment for lung disease, attention-deficit disorder and throat infections in children, according to a state report card.

The report, which the California Office of the Patient Advocate released Wednesday, rated California's nine largest HMOs, six largest preferred provider organizations (PPOs) and medical groups across the state, reported the Los Angeles Times.

Garnering the highest scores was Kaiser Permanente, which received the top ranking of four stars in most categories. Kaiser attributed its lead status to its integrated healthcare delivery system that allows primary care doctors and specialists jointly to oversee patients so they "don't fall through the cracks," said Robert Pearl, executive director and CEO of the Permanente Medical Group. He added that because Kaiser patients prepay for their care, the insurer is motivated to deliver appropriate care and keep patients healthy instead of rewarding doctors for volume, according to the San Jose Mercury News.

Overall, the report shows California HMOs exceeded 2010 national averages for diabetes care and improved heart care, including controlling high blood pressure and cholesterol. PPOs fell behind national averages for many categories, including eye exams for diabetes patients and administering heart attack medication, the Ventura County Star reported.

For the categories of customer service helpfulness, providing cost information and paying claims correctly, five HMOs and four PPOs received poor ratings. Office of the Patient Advocate Director Sandra Perez said the confusion often centers around copayments and changes in cost-sharing each year.

This annual report card often leads to positive changes throughout California health plans. "Surveys like this are certainly helpful because they give us a good snapshot of what we're doing well and identify areas where we can improve," Health Net spokesman Brad Kieffer said.

Anthem Blue Cross, whose HMO plan received three stars for several quality of care measures, said it will examine the data to determine how it can better serve members. However, spokesman Darrel Ng noted that the lower scores for Anthem Blue Cross' PPO plan are "not truly reflective of the excellent service our members received due to data issues that have been identified and will be resolved in time for next year's report card."

To learn more:
- access the California health plan ratings
- read the Los Angeles Times article
- see the San Jose Mercury News article
- check out the Ventura County Star article

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