By Joyce Kryszak
Buffalo, NY – A new report released Tuesday shows most New Yorkers give high marks to their HMO's. This is the fifth report card issued by the New York State Health Accountability Foundation, a private-public partnership dedicated to improving health care.
About 7,500 HMO members from across the state were asked to evaluate the quality of their medical coverage.
The state' health maintenance organizations scored an average of 65 percent from surveyed members who said they would give them a high ranking. That's three points more than the national average.
Western New York's three HMO's all scored within a few points of that state average. In overall patient satisfaction, Independent Health was rated the highest, followed by Community Blue, then Univera Healthcare.
Doctor Anthony Shih is with IPRO, one of the not-for-profit survey sponsors. Shih says the report card is a useful tool if looked at with a critical eye.
"Just because a plan ranks higher than other plan doesn't mean they are providing excellent care," said Shih.
Overall, the report, which analyzed data from 2001, found that the majority of health plans statewide either showed no change or a decline in performance. Twelve performance areas were evaluated, based on responses and data from both patients and the HMOs.
Locally, Independent Health ranked highest in a number of areas. Patients scored the HMO well above the state and national averages when asked if they were satisfied with their primary care doctor, and if they were able to get the care needed, and to get it quickly. Dr. Michael Cropp, chief medical officer for Independent Health, says helping patients cut through the complexity of health care is the biggest challenge for HMOs.
"And that starts with the different products that we offer as a health plan and it goes right through to the complexity in the health care system that people encounter," said Cropp. "And trying to satisfy our members has to be able to navigate the complexity at multiple levels."
Community Blue implemented a new policy last year that they hope will eliminate one frustrating level for their members. Patients with Community Blue are no longer required to get a referral for treatment by a specialist. Cheryl Howe is vice president for Health Services with Community Blue. She says they decided the referrals were an unnecessary and burdensome layer of red tape.
"The members love it, the physicians love it. It seems as though everybody is pleased," said Howe. "They felt that was a barrier for getting timely care. And when we tracked we saw that by having the referral in place, we really weren't gaining anything."
Howe says Community Blue hopes the "no referral" policy and other measures to address patient concerns will further improve the HMOs rating next year. The HMO's all say that kind of responsiveness is crucial to their reputation and standing with their members.
Univera Healthcare, which is embroiled in a controversial legal battle, scored below the other two local HMOs in a few areas of patient satisfaction. After a two year dispute, Univera recently reversed an earlier decision to drop thirty of it's former Promedicus Group doctors from the HMO. The plan had infuriated thousands of Univera members who would have had to suddenly switch doctors. Dr. Jay Pomerantz is chief medical officer for Univera. Despite damage control, Pomerantz expects there will be backlash in next year's survey results.
"I think any time there's disagreement between the organization and the network, you're going to see changes in the satisfaction scores," said Pomerantz. "It's our hope that what we've done to maintain contact with our members, to maintain that they are assured access to the providers they need, and that their health care issues are not lost and not dropped -- that we shouldn't expect to see significant drop. But I wouldn't be surprised if there was some impact on it."
Univera scored the highest locally in one area getting increased focus -- treatment for depression. Laura Pickering, executive director of New York Business Group on Health, says businesses are concerned because new studies show that depression costs them valuable employee time.
But overall, Pickering says the survey once again confirms that patient access and satisfaction are the two areas where businesses hear the most "noise" from their employees. And she says that's why the Foundation will continue to track HMO performance.
"We continue to publish our HMO report card because employers really do need information on quality to help them select the best health plan for their employees," said Pickering. "And they need an objective way of looking at the plans. They can't just depend on health care literature and advertising for information."
Employers and HMO members can now access details of the HMO report card online. Just surf over to www.AboutHealthQuality.org. Then click on the HMO report card link where you will be able to compare companies and find additional information.