Friday, January 21, 2000
Tristate's dominant HMOs evaluated
Most limited ranked best by employers
BY TIM BONFIELD
The Cincinnati Enquirer
For the fourth straight year, large Tristate employers say the two HMOs with the smallest hospital and doctor networks in town also offer the best values in town.
However, that finding runs counter to the latest trend in managed care: that many employees are willing to pay more to get a wider choice of health providers.
New data about HMOs came out today in the Cincinnati Health Plan Value Project, sponsored by the Employer Health Care Alliance. The study rates eight commercial HMOs that cover about 573,000 Tristate residents on a range of member satisfaction, health quality, plan management and cost factors.
The study found that Anthem HMP, offered through Anthem Blue Cross and Blue Shield, and ChoiceCare/Humana's NewHealth plan provided the Tristate's best value. The study also reported that HMOs as a group still need to do a better job at promoting certain medical services. For example, local doctors don't prescribe enough beta blockers after people have heart attacks.
NewHealth and Anthem HMP won high ratings for en couraging health screenings for members and fared well in membership satisfaction.
NewHealth offers eight hospitals, 900 primary care doctors and about 1,400 specialist physicians. Anthem HMP has 14 hospitals, 400 primary care doctors and 400 specialists.
Most of the other HMOs in the study offer at least 24 hospitals, more than 1,000 primary care doctors and more than 1,500 specialists.
“That smallness probably allows them to be more agile, and better able to respond to the needs of their customers,” said Sharron DiMario, executive director of the Employer Health Care Alliance.
However, a high score on the employer report card has not translated into much increased membership. NewHealth, with 56,500 members in 1999, gained about 1,200 members from 1998. Anthem HMP, with about 61,900 members, lost more than 2,900 enrollees last year.
In contrast, United Healthcare posted the area's largest membership gain from 54,500 members in 1998 to nearly 76,000 in 1999, though it was rated below average.
“I think this points out one of the conflicts between what employers value in a health plan and what consumers value in a health plan,” said Pam Davis, vice president of operations for United Healthcare.
United also contends its rating was hurt over data-reporting issues that did not reflect quality issues. United lost points for choosing not to submit data it considered inaccurate for a mental health services category.
Even though NewHealth aced the HMO report card, ChoiceCare/Humana has seen its strongest membership growth on the widest possible type of health plan — preferred provider networks that weren't rated in the HMO study.
“We have seen members migrate to more open access products, which is one of the reasons why we have invested heavily in improving the quality of those products,” said Larry Savage, executive director at ChoiceCare/Humana.
On the health promotions front, local HMOs exceed national averages for accredited HMOs in three services:
• About 88 percent of pregnant women are getting prenatal care in the first trimester, compared to an industry average of 84 percent.
• Nearly 77 percent of women ages 52 to 69 are getting mammograms every other year, compared to 72 percent nationwide.
• And 71 percent of women aged 21 to 64 are getting pap smears every three years, slightly above the 70 percent national average.
However, two key measures fall below national averages:
• About 74 percent of local heart attack victims were getting beta blockers, compared to an 80 percent national average.
• And 37 percent of diabetics are getting annual retinal exams; the national average is 41 percent.
• Meanwhile, local doctors are performing about 52 ear tube surgeries per 1,000 children, well above the national average of 35 per 1,000.
As in past years, the employer alliance criticized three HMOs that did business last year in Cincinnati but did not provide data for the study. Cigna and Prudential said they could not provide Cincinnati-specific data. PacifiCare of Ohio said it doesn't participate in local report card projects.
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