Price should not be the only determinant for patients, employers and doctors when choosing an HMO, according to the Colorado Business Group on Health.
Quality should count, but measuring an intangible has always been a problem. Since 1997, the CBGH, a coalition of 13 of the largest Colorado employers, has prepared an annual report card on the state's HMOs. This year's survey rates 10 HMOs based on seven criteria for measuring enrollee satisfaction, five for preventive care and four for acute and chronic care.
The group's private and public member employers, including AT&T, Coors Brewing Co., Lockheed Martin Astronomics, the University of Colorado and Denver and Colorado governments, cover 90,000 workers and 170,000 dependents.
"We really deplore the short-term mentality that employers and health plans have right now," says executive director Donna Marshall. "What they really need to look out for is the overall health of their employees over time."
Marshall says there is ample evidence a long-term strategy that includes high quality patient care pays off financially for employers in less worker time off and higher productivity.
The survey did not officially rank the 10 HMOs, but an analysis of its 25 tables and charts indicates that Kaiser Permanente HMO and Rocky Mountain HMO finished first and second in patient care. Rocky Mountain led its peers in patient satisfaction, while Kaiser dropped to seventh in that category.
Mike Weber, president and CEO of the 124,000-enrollee, 1,600-physician not-for-profit Rocky Mountain HMO, says for whatever reason, patients don't seem to make a big fuss over the widely distributed report. The high ratings for Grand Junction-based Rocky Mountain reflect what he says is "a culture that is rock solid embedded in `we have to help the member."'
Employers, however, do pay attention to the report cards, particularly at contract renewal time. The survey also is useful when the HMO contracts with doctors, Weber says.
"We present it to the physicians saying Rocky Mountain HMO is ranked by its members as the best in the state. If the members are appreciative of us, we're not intruding in their medical care. We use that as evidence that we're physician-friendly," he says.
James Hertel, publisher of Colorado Managed Care, an HMO newsletter, says the low patient satisfaction ranking for Kaiser is explained by occasional long waits by enrollees to get into a clinic, which are staffed by physicians who are Kaiser employees.
Kaiser Permanente HMO spokesperson Steve Krizman says the Colorado group is aware of its problems. Kaiser is improving scheduling bottlenecks, for example, but a shortage of specialists is a problem. Kaiser has been trying to recruit two cardiologists to its statewide network for more than a year, he says.
Access to information about HMO quality is key to the business group's strategy of improving the bottom line by raising quality of care, Marshall says. The report is given to business group members for distribution to their employees, to participating HMOs and to Colorado insurance brokers.
The Colorado group is one of about 30 U.S. business groups that prepare HMO report cards, says Kelli Moler, director of member services and government relations for the National Business Coalition on Health. Moler says the surveys give employers more leverage to improve quality when they negotiate contracts with HMOs.
Hertel says the report has had limited utility for patients in a state dominated by small employers who lack market power. He says Colorado HMOs are able to force smaller employers to accept exclusive contracts that limit their offerings to employees to only one HMO or, if more than one, to variations from a family of plans from the same HMO.
