PPO Report Card Shows California Lagging Behind Most Of The Nation On Quality Health Care

Mediocre performance data leaves enormous room for improvement

Today, Commissioner Poizner released the results of his second Preferred Provider Organization (PPO) quality of care report card. The results are both good news and bad news for consumers, and show that California's PPOs have much work to do in meeting customer needs.

"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. HMOs began reporting on quality in 2001, and I got PPOs to join the effort beginning last year. I am grateful for their cooperation, but this report card shows they will have to do better. This should be their wake-up call," said Commissioner Poizner. "These results show that insurers have a lot of room for improvement, particularly in the area of customer satisfaction. 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."

Commissioner Poizner pledged in August 2007 to make sure PPO patients had the same information HMO patients had. California's Department of Managed Health Care (DMHC) has provided a report card on Health Maintenance Organizations (HMO) since 2001. PPOs lacked a similar objective comparison. While other states collect similar data for PPOs, California is the only state to analyze it, and offer it in a consumer-friendly, interactive format that includes summary ratings as well as the more detailed underlying measurements.

None of the six PPOs on the report card received the highest four-star rating, but Aetna, CIGNA HealthCare of California and UnitedHealthcare (California) each received three stars overall for delivering quality clinical care. Anthem Blue Cross, Blue Shield of California and Health Net each received two stars overall in that category. Rating criteria included asthma care, checking for cancer, diabetes care and treatment of children. The ratings are based on a set of standard measures developed by the National Committee on Quality Assurance.

In addition to grades based on clinical best practices, the report also includes grades, for the first time, on customer satisfaction. While all PPOs got the mid-range 2-3 stars for getting care easily, all insurers except Aetna received the lowest, single-star rating for plan service. This is clearly where there is the greatest room for improvement. The Plan Service category includes customer ratings on things like helpful customer service, getting information about your costs and paying claims.

However, the grading methodology sets a very high bar for quality. In general, 8 out of every 10 PPO members have reported a favorable experience with their plan. And about 2/3 (64%) of patients are getting the right clinical care for their condition.

The PPO report card is available now at www.insurance.ca.gov. The companion report card on HMOs will be released separately early next year.


Please visit the Department of Insurance Web site at www.insurance.ca.gov. Non media inquiries should be directed  to the Consumer Hotline at 800.927.HELP. Callers from out of state, please  dial 213.897.8921. Telecommunications Devices for the Deaf (TDD), please dial 800.482.4833.