ANNAPOLIS – Fewer than half of Marylanders enrolled in the state’s largest health maintenance organizations said they always got care quickly when they needed it, according to a state report card issued Tuesday.
But only a quarter of all patients filed a complaint with their HMO last year and 71 percent gave their plan a score of seven or higher on a scale of 10, said the same survey by the state Health Care Access and Cost Commission.
Patient advocates chalked up the discrepancy between patient satisfaction and complaints to the difficulty in dealing the HMOs.
“You can’t deal with all of the bureaucracy and fill out a million forms when you’re sick,” said Pearl Lewis of the Maryland Patient Advocacy Group. “The HMOs make it as hard as they can to file a complaint.”
The third annual state report card covers all private HMOs that took in more than $1 million in premiums in Maryland last year. It surveyed 18,600 enrollees on doctor communication, customer service, information on choosing a physician and resolution of complaints.
It also measured how each plan delivered services in accordance with clinical guidelines, including immunizations, breast and cervical cancer screening, prenatal care, eye exams for diabetics and advising smokers to quit.
HCACC Executive Director John Colmers said the state makes the information available so consumers can make informed choices about their health plans.
“Some [HMOs] are on the honor roll, some are C+ students, and others need remedial help,” Colmer said.
Of 12 measures that have been examined for all three years, United Health Care is consistently below average on eight. Kaiser Permanente is consistently above average in nine areas and the George Washington University Health Plan has been above average in eight.
“Our goal is to provide high quality, affordable health care and this report shows we’re on the right track,” said Mona Miller, a spokeswoman for Kaiser Permanente.
She said the HMO uses a group model process to coordinate the care of all members, so there is better communication and clients are reminded to come in for preventative care.
In contrast, United Health Care uses the independent practice association model of care, which Chief Medical Officer David Yalowitz said gives his clients more access and choice.
“With a system like Kaiser, there is closer involvement and more scrutiny with the limited number of physicians they work with; with the IPA system larger HMOs use, the network is more far-flung,” Yalowitz said. “Consumers are interested in access, price, and quality, and we’re trying to meet that market demand.”
The survey reported that, overall, 28 percent of HMO patients said the information from their health plan was always helpful. But four plans fell below that average and 16 percent of CapitalCare HMO enrollees said they received no information on services and tests the plan would pay for.
United HealthCare was the only HMO that fell below the 70 percent average of advising smokers to quit, with a 60 percent rate.
Eye exams for people with diabetes were a weakness for most of the plans, with an average of only 40 percent of those patients receiving a retinal exam in 1998. Diabetes can result in several degenerative eye diseases.
“These are all services known to be of value in preventing further health care spending,” Colmers said. “It’s not rocket science to get it done.”
Colmers said that it is clearly possible for HMOs to meet the state average, since several perform above the average in every measure examined.
In other areas of preventive medicine, Kaiser Permanente was the leader in adolescent immunizations, with 35 percent, compared to zero percent for United HealthCare.
Kaiser Permanente also had an 80 percent rate for women who have had a mammogram compared to a 50 percent rate for United HealthCare. The average for all HMOs was 69 percent.
Carol Rohn, director of quality assurance at United Health Care, said it is taking measures to improve the plan’s provision of four preventive services, such as mammograms.
“We are concerned about our people,” Rohn said. “We want them to come in and get all of the care they need. We are constantly working to improve.”
Complete results of the survey are contained in the booklet, “Comparing the Quality of Maryland HMOs,” which is available at state public libraries and on the Internet at www.hcacc.state.md.us.