New Report Shows California’s HMOs Deficient in Providing Access to Adequate Substance Abuse Treatment

LOS ANGELES--(BUSINESS WIRE)-- A new report issued by the state of California reveals that California health plans are doing an exceedingly poor job of providing quality care to individuals in need of alcohol and drug dependency treatment.

The Healthcare Quality Report Card, issued by the California Office of the Patient Advocate, compares the quality scores of California’s eight largest HMOs against national performance and against each other in 38 clinical categories. While the report acknowledges that “Getting continuous care for substance abuse is critical to successful treatment,” it uncovers the reality that “Fewer than one in four people who abuse alcohol or drugs get treatment; and among those who begin treatment, more than half do complete their care.”

According to the report, only 13 percent of those adolescents or adults who were diagnosed with alcohol or other drug dependencies had the necessary treatment within 30 days of being diagnosed. This is compared to 92 percent who receive adequate care for asthma, 87 percent who receive cervical cancer screenings, and 88 percent of diabetics who get properly tested for cholesterol.

“This is the equivalent of getting 13 out of 100 on a test, and nobody should find that acceptable,” said Phillip Greer, executive director of the California Treatment Advocacy Foundation. “The score is disgraceful but sadly not a shock given that for so long health plans have routinely denied those suffering from substance abuse access to the care they need.”

As an example, the report revealed that only 10 percent of the California members of Anthem Blue Cross, the country’s largest health plan, received access to the substance abuse treatment they needed. Both Blue Shield of California and HealthNet didn’t fare much better at 11 percent each. Even the best performing health plan, Kaiser Permanente – Northern California, scored only 18 percent, still leaving 82 percent of their members lacking adequate substance abuse care.

“The health plans have had their chance to provide adequate care on a voluntary basis, and this report clearly demonstrates that they have failed miserably,” said Greer. “It is now time for the state to take action and stop health insurance companies from imposing barriers that reduce access to much-needed chemical dependency treatment.”

A bill (AB154), which broadens the mental health services covered by private insurance plans, was recently passed by the California State Assembly and is currently under review by the state Senate. CalTAF has proposed an amendment, modeled after Pennsylvania’s Drug and Alcohol Insurance Law, which would specifically expand that bill to protect those individuals who have been prescribed substance abuse treatment by their physicians but who have been denied care by their health insurance carrier. The prerequisite is certification and referral by a licensed physician or a licensed psychologist. The Act also requires most group health policies to include mandated minimum benefits for treatment of alcohol and drug addiction.

“Insurers continue to impose unreasonable deductibles and co-payments or impose care guidelines that keep patients from receiving the level and amount of treatment that is universally accepted as necessary,” says Greer. “When this happens the health and wellness of whole families are jeopardized, and the unnecessary costs to society ripple across California’s communities. By requiring health plans to make available treatment that is already included in most policies, costs to the state decrease and successful treatment increases,” says Greer.

The California Addiction Treatment Advocacy Foundation is dedicated to improving access to effective and affordable chemical dependency treatment throughout the state. Created in 2011 by a group of concerned California-based providers, CalTAF believes that through insurance reform, either voluntary or mandated, barriers to care can be eliminated, thus making it easier for individuals to get access to the treatment and professionals they need. Further information on the work of CalTAF may be obtained at [email protected].


For California Treatment Advocacy Foundation
Ross Goldberg
818-597-8453, x-1
[email protected]

KEYWORDS:   United States  North America  California

INDUSTRY KEYWORDS:   Health  Public Policy/Government  Healthcare Reform  Mental Health  Public Policy  State/Local  Professional Services  Insurance  General Health  Managed Care