Tuesday, March 02, 1999
Health care plans ranked
But many won't give information
BY TIM BONFIELD
The Cincinnati Enquirer
When it comes to health plan “report cards,” showing up for the test can be just as important as the grades that result.
Two local plans — Anthem HMP and ChoiceCare New Health — aced a comparison of nine managed care health plans conducted for a group of large Tristate employers. But five other managed care companies got incompletes after blowing off the exam.
The Cincinnati Health Care Value Project is the third and most-detailed managed care report card to date from the Employer Health Care Alliance, a group that includes 75 large and mid-sized local businesses.
Employers use the report, plus other information gained during direct negotiations, in deciding which health plans to offer. For the general public, the report card offers many useful comparisons, including member satisfaction and disenrollment rates and whether the plans meet national “benchmarks” or goals for cancer screenings, childhood immunization and other services.
Of the nine plans in the study, only one — United Healthcare's HMO — was ranked “below average” in overall performance. But the study sponsors were far less concerned about United than with the companies that provided no data at all — CIGNA, Humana, PacifiCare, Prudential and Medical Mutual of Ohio.
The four main sponsors of the study — Procter & Gamble, Kroger, GE Aircraft Engines and Federated Department Stores — have made their position clear. They will not accept proposals from health plans that don't participate.
“It's disturbing that these plans are in town, doing business, but aren't willing to provide data,” said Ernie Smith, a principal with the Cincinnati office of Towers Perrin, the consulting company that compiled the study.
The symbolic value of being open to evaluation on terms the health plans cannot control may say more than the hard numbers, especially for small employers that often lack the time or expertise to analyze health plans in detail.
“Are people using this data?” Mr. Smith said. “We think so. But it's hard to predict what will happen when the CEO reads the paper and says, "How come our health plan isn't on this list?'”
The latest report card is based on 1997 data comparing nine local health plans that cover more than 470,000 Tristate residents. It offers plan-by-plan ratings on more than 40 factors about administrative costs, member satisfaction, health care services and utilization.
The report reveals several trends:
• Big employers are getting the best “value” (blend of cost and quality) from the smallest, most tightly controlled HMO networks, a finding that runs counter to trends in managed care to offer expanded choices of physician and hospital.
In 1997, ChoiceCare's New Health product covered care at only eight hospitals, compared with six plans that offered more than 20 hospitals. Anthem's HMP plan offers 393 primary care doctors (compared with 800 to 1,100 at other plans) and just 364 specialists (compared with 1,200 to 2,100 at other plans).
• Health plans are getting better at promoting health screening tests for cancer and other diseases, but some services still fall well short of national goals.
For example, seven of nine plans hit the lofty goal of providing prenatal care to more than 90 percent of pregnant members in their first trimester. Most plans also met breast cancer screening goals.
But none of the plans came close to the cervical cancer prevention goal, which calls for 85 percent of women ages 21-64 getting a Pap smear every three years. The average rate for the nine plans was 33 percent.
Nearly all plans also got poor marks for retinal eye exams for diabetics, chemical dependency services and follow-up care for people hospitalized for mental illness.
• On the cost side, employers were disappointed to see that prescription drug costs per member were 70 percent higher in Greater Cincinnati than national averages for the managed care industry.
• Despite individual horror stories and political controversies, overall member satisfaction with managed care plans remains high. For example, seven of nine plans reported that 80 percent or more of their members would recommend their health plan to family or friends.
Reasons for not providing data varied. CIGNA decided at a national level not to participate in local report card projects. Prudential reported that it could provide state-level data, but not local data. PacifiCare said it was too busy with an acquisition.
Humana, which acquired ChoiceCare in late 1997, was willing to provide data about old ChoiceCare plans, but not for the local Humana plan. Medical Mutual, which offers only some of its products in Cincinnati, hasn't participated for at least two years.
Lack of cooperation is not welcome among employers, especially after most managed care plans jacked up premiums this year by an average of 7 to 9 percent — the largest price increase in several years.
“These kinds of reports will become more of a factor in decision-making,” said Roger Sims, director of employee relations and benefits at Mosler Inc. “If (a health plan) wants to become a major player, you better be in this survey.”
To obtain a copy of the Cincinnati Health Care Plan Value Project report — cost is $20 — contact the Employer Health Care Alliance, 794-9324.
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