2005 HMO Report Card Office of the Patient Advocate Ed Mendoza Acting Director

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California Office of the Patient Advocate Business, Transportation & Housing Agency

2005 HMO Report Card

Office of the Patient Advocate

Ed Mendoza

Acting Director

John Zweifler, MD, MPH

Medical Consultant

National Pay for Performance Summit

CONSUMER ACCESS TO PUBLIC REPORTING ON P4P RESULTS

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MISSIONOffice of the Patient Advocate

To inform and educate consumers

about their rights and responsibilities

as HMO enrollees.

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5. Collaboration with Other Organizations

STATUTORY MANDATESOffice of the Patient Advocate

1. HMO Quality Report Card

2. Consumer Education

3. Advice and Assistance to HMO Enrollees

4. Recommendations to DMHC

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1. To provide comparative quality information for consumers, purchasers, regulators, and advocates.

2. To “incentivize” quality improvement through public disclosure.

3. To educate consumers about health care quality.

OBJECTIVESHMO Report Card

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1. Scope & Data Sources

2. Methodology

3. Presentation

4. Outreach and Distribution

BASIC FEATURESHMO Report Card

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SCOPE & DATA SOURCESHMO Report Card

California’s 10 largest HMOs -- 95% of all commercial enrollees (HEDIS & CAHPS)

200+ medical groups – 85% of all commercial and Medicare enrollees (HEDIS & CAS)

Language services information for 10 commercial and 18 Medi-Cal plans (OPA Survey)

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HEALTH PLAN METHODOLOGYHMO Report Card

Four Summary Star “Grades”

(30 individual clinical & patient satisfaction scores):

1.Staying Healthy (10 scores)

1.Getting Better (9 scores)

1.Living with Illness (10 scores)

1.Member Rating of Health Plan (1 score)

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MEDICAL GROUP METHODOLOGYHMO Report Card

Six Summary Star “Grades” (29 individual scores):

1. Getting the Right Medical Care (9 scores)

1. Patient Rating of Care (20 scores)

- Coordinating Patient Care (3 scores)

- Timely Care & Service (9 scores)

- Getting Treatment & Specialty Care (4 scores)

- Communicating with Patients (4 scores)

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Does the health plan provide:

Telephone interpretation services?

Access to face-to-face interpreters?

Bilingual provider lists?

Non-English written materials?

LANGUAGE SERVICES DATAHMO Report Card

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Web-Based

PRESENTATIONHMO Report Card

Comparative

Interactive

Printed Summary

English, Spanish, Chinese

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MAIN PAGE2005 HMO Report Card Website

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MAIN PAGE – HMO RATINGS2005 HMO Report Card

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MAIN PAGE – TOPICS2005 HMO Report Card

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MEDICAL GROUP COUNTY SELECTOR2005 HMO Report Card

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MEDICAL GROUP RATINGS SUMMARYSacramento County - 2005 HMO Report Card

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MEDICAL GROUP RATINGS SUMMARY West Los Angeles, 2005 HMO Report Card

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MEDICAL GROUP RATINGS SUMMARY Sacramento County, 2005 HMO Report Card

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MED GP DRILL DOWN – HEDIS SCORESSacramento County, 2005 HMO Report Card

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MED GP DRILL DOWN – CHLAMYDIASacramento County, 2005 HMO Report Card

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MEDICAL GROUP RATINGS SUMMARY Sacramento County, 2005 HMO Report Card

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MED GP DRILL DOWN – CAS SCORESSacramento County, 2005 HMO Report Card

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MED GP DRILL DOWN – TIMELY CARESacramento County, 2005 HMO Report Card

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MED GP DRILL DOWN – VISITS ON TIMESacramento County, 2005 HMO Report Card

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MED GP DRILL DOWN – DR EXPLAINSSacramento County, 2005 HMO Report Card

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PRINTED SUMMARY – FRONT 2005 HMO Report Card

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PRINTED SUMMARY – BACK 2005 HMO Report Card

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DISTRIBUTION OF PRINTED SUMMARIES2005 HMO Report Card

Local Pharmacies (574)

Public Libraries (500+)

Community-Based Organizations (500+ Events)

Website Downloading/Printing

Order Copies Toll-Free @ 1-866-HMO-8900

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Use

Usability

Usefulness

EVALUATION CRITERIAHMO Report Card

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ANNUAL USE DATA – WEB VERSIONHMO Report Card

Number of Visits and Visitors OPA Quality of Care Report Card Website

44,58430,372 31,528 23,802

166,413

50,13864,895

59,168

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

Year 1 Year 2 Year 3 Year 4

Visitors

Visits

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ANNUAL USE DATA – PRINTED SUMMARYHMO Report Card

Total Number of Copies Distributed OPA Quality of Care Report Card - Print Version

104,698

151,747

99,650

148,360

82,678*

0

20,000

40,000

60,000

80,000100,000

120,000

140,000

160,000

180,000

Year 1 Year 2 Year 3 Year 4 Year 5*

Copies Distributed

* Partial year data for Year 5

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EVALUATION DATA SOURCESHMO Report Card

1. Academic Research

2. User Focus Groups, Online Survey

3. Industry & Consumer Advocates

4. Report Card Partners

5. Formal Evaluation

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LESSONS LEARNED – USERSHMO Report Card

Consumers:

1) are not aware of quality differences

2) are more interested in plan service than quality

3) prefer the detailed website to the printed summary

4) prefer Health Topics to the 4 summary categories

5) want to be able to customize the data even more

6) want more plan data on the website (e.g., cost)

7) prefer data reporting from an “objective” 3rd party

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LESSONS LEARNED – INDUSTRYHMO Report Card

Health Plans and Medical Groups:

1) are very familiar with the Report Card

2) use the data to “benchmark” their performance and expect to improve over time

3) use the data for marketing and rate negotiations

4) believe the summary grades do not accurately reflect their performance

5) want separate/additional reporting for Medi-Cal

6) support the continuation of the Report Card

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OSHPD Hospital Discharge Data

Population-Based Surveys

- California Health Interview Survey

- Behavioral Risk Factor Surveillance Survey

OPA Surveys

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NEW SOURCES OF DATAHMO Report Card

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Efficiency Measures (HEDIS)

Health Disparities (HEDIS, CAHPS, CAS)

Preventable Hospitalizations (OSHPD, CHIS)

Disability Access Services (OPA)

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NEW USES OF DATAHMO Report Card

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SCOPE OF DATABehavioral Risk Factor Surveillance System

Sponsored by CDC and states

Telephone survey of 2,000-6,000 adults/state

Core questions; states can customize

Targets alcohol and drug use, health status, prevention, utilization, and access

Collects gender, age, education, race/ethnicity, household income, employment status, marital status, AND health plan membership

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HEALTH RISK & STATUS FINDINGSBRFSS 2004 (Oregon)

Have a Personal Doctor: White 71%, African American 64%, Hispanic 65%

Did Not Get Needed Care: White 18%, African American 27%, Hispanic 23%

Note: Little racial/ethnic variability for some measures – getting appointments as soon as wanted; physical and mental composite summary scores

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SCOPE OF DATA California Health Interview Survey (UCLA)

Biennial, population-based, telephone survey (sample: ~50,000 households)

Demographic, health status, utilization, AND health plan membership data

Ethnic/language sub-populations over-sampled to provide additional stratification capacity

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MENTAL HEALTH FINDINGSCHIS 2001

16% of Californians, and 20% of Latinos and African Americans reported needing mental health services

42% of Californians reporting needing mental health received mental health services

Minorities 30% less likely to receive mental health services

LEP 80% less likely to receive mental health services after controlling other variables

Lack of insurance reduced services by 50%

Sentell P.California Program on Access to Care Findings. February 10, 2005

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SOURCE OF DATA OSHPD Hospital Discharge Data

Racial and Ethnic Disparities in Healthcare in

California (November, 2003)

Blacks w/ higher admit rates than whites for CHF, asthma, diabetes, and hypertension

Hispanics w/ higher admit rates for perforated appendix, lower for pneumonia and dehydration

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DISPARITIES – ANGINA & MI ADMISSIONSCA OSHPD Data (1999-2001)

Angiography: Whites 23.4%, Blacks 20.6%, Hispanics 24.6%

Percutaneous Coronary Intervention: Whites 22.9%, Blacks 13.4%, Hispanics 17.7%

CABG: Whites 5.0%, Blacks 2.7%, Hispanics 4.4%

30 day mortality for MI: Whites 13.04%, Blacks 12.50%, Hispanics 12.91%

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Product Lines:

- Medi-Cal

- Healthy Families

- Medicare

Provider Types:

- Individual Physicians

- Hospitals - Skilled Nursing Facilities

OTHER POTENTIAL EXPANSIONSHMO Report Card

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CONSIDERATIONSEquity and Public Reporting

Transparency for Consumers

Comprehensive Information

Adjustment for Known Variables

Acknowledgement of Data Limitations

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5. Voluntary vs. Mandatory Participation

ISSUES & CONSIDERATIONSHMO Report Card

1. Absolute vs. Relative Scoring

2. Consumer Use vs. Industry Use

3. Data Usability vs. Data Precision

4. Consumer Usefulness vs. Available Data

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ACKNOWLEDGMENTSHMO Report Card Project

California Cooperative Healthcare Reporting Initiative

Integrated Healthcare Association

Pacific Business Group on Health & Sapient Corporation

OPA Cultural & Linguistic Services Work Group

Walgreens, Leader, Independent Pharmacies

California Association of Health Plans

Local Health Plans of California

Participating Health Plans and Medical Groups

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June 6, 2006

Crowne Plaza Hotel – LAX

Los Angeles, California

Challenges and Opportunities in Quality Reporting Statewide Policy Implications

SAVE THE DATEOPA Symposium on Public Disclosure

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hmoreportcard.ca.gov

VISIT

WEB ADDRESSHMO Report Card

2005 HMO Report Card Office of the Patient Advocate Ed Mendoza Acting Director

Documents