California Office of Patient’s Advocate Releases Healthcare Quality Scores

California Office of Patient’s Advocate Releases Healthcare Quality Scores

Students are graded on their schoolwork, and many employees are evaluated based upon their work performance. So, it makes sense that health insurance carriers are also graded to help consumers make educated decisions about which medical insurance carrier to choose for themselves and their families.

For the past seven years, the State of California’s Office of the Patient Advocate (OPA) has released its Health Care Quality Report Card, which grades those HMOs and health providers statewide. As a result, Californians can now make an educated decision about which health insurance carrier is best for their needs rather than basing the decision solely on cost.

To determine the grades of California HMOs and medical groups in the state, the Office of the Patient’s Advocate evaluates the performance of the services that are provided, including patient care, the lag time between making an appointment and the actual appointment, and how quickly receptionists answer the phone. In total, there are 30 criteria on which grades are based.

The Health Care Quality Report Card was released at the same time Governor Arnold Schwarzenegger announced that he plans to make reforms to the healthcare system in California in an attempt to ensure all Californians have access to affordable healthcare. If this year’s report card is any indication, however, Governor Schwarzenegger, HMOs and medical groups have a lot of work ahead of them.

Unfortunately, California’s HMOs performed below par in the past year, according to the Health Care Quality Report Card, which found that more than 500,000 Californians with diabetes in HMO programs are simply not getting the proper care: In fact, the care they are receiving falls far below the national standards. The numbers are staggering: An estimated two out of every four HMO members with diabetes have out-of-control cholesterol levels, which is a common cause of both heart disease and death in diabetics.

Overall, obese Californians are also receiving the short end of the stick by Californian HMOs. Obesity is a common onset of diabetes, yet less than 40 percent of obese Californians are advised by their physicians on how to change their diet and add exercise to their daily routines. In addition, 40 percent of all diabetics in California were not tested for retinal disease last year, even though blindness is common in those with diabetes.

The report also cites that one in three HMO members are dissatisfied with their health plans. While overall doctors receive favorable ratings for actual exam room experiences, a third of all California’s patients rate the overall experience, which includes appointment scheduling and coordination of care, unsatisfactory.

Not everything was dismal, however, on this year’s report card. In fact, a survey found that HMOs and medical groups made progress in several areas, including treating children, and screening for both sexually transmitted diseases and colorectal cancer.

Care of patients with asthma received the best scores across the board, as the Report Card reveals that nine out of every ten asthma patients were prescribed the proper asthma medication.