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Harvard/Public Citizen Study Finds Voluntary HMO Quality Monitoring System Failing
As many as one half of all HMOs that participate in the nation�s principal quality monitoring system stopped publicly disclosing their quality scores in 1998 and 1999, according to a study to be published in tomorrow�s Journal of the American Medical Association. The study, conducted by researchers at Harvard Medical School and Public Citizen�s Health Research Group, found that poor quality HMOs were over 3 times more likely than the best plans to stop reporting their quality data. �Many HMOs are manipulating the system. They�re undermining quality assessment and misleading the public into believing that HMO quality is better than it is,� said Dr. Danny McCormick, a study author and Instructor in Medicine at Harvard Medical School.
The study analyzed data from the National Committee for Quality Assurance�s (NCQA) HEDIS (Health Plan Employer Data Set) program, the most influential HMO quality-monitoring program. Each year, HMOs voluntarily submit data on their performance on a defined set of quality indicators, such as the percentage of women receiving a mammogram, or children receiving immunizations. The NCQA then publishes HEDIS scores of participating HMOs. The authors examined whether HMOs� HEDIS scores in 1997 and 1998 predicted the likelihood of HMOs withdrawing from public disclosure of scores one year later.
�The selective withdrawal by lower scoring plans means that average published scores could improve even if actual quality were stable or even deteriorating,� said Dr. David Himmelstein, a study co-author and Associate Professor of Medicine at Harvard Medical School. �This means that the true quality of HMO care in the U.S. is currently unknowable.�
The study also found large differences in quality among HMOs disclosing data. For example, in 1997, patients enrolled in plans in the bottom one third were only half as likely to receive life saving beta-blocker drugs after suffering a heart attack as those HMOs in the top one third (42% compared with 83%). �This underscores why patients need information on the quality of their HMO if they are to make informed choices,� said Dr. McCormick.
�No other industry with so much impact on the public�s safety is so free of public oversight,� said Dr. Steffie Woolhandler, a study co-author, Associate Professor of Medicine at Harvard Medical School, and co-founder of Physicians for a National Health Program (PNHP). �Airlines and car manufacturers are required to disclose data on the safety of their products. The HMO industry is showing that it too needs public oversight. Voluntary participation does not seem to work.�
The following pages feature a list of the Health Maintenance Organizations who have dropped their quality reporting data.
(All data from the National Committee for Quality Assurance�s Quality Compass and Link-File databases).
1998
Aetna Health Plans of California, Inc. (Loma Linda)
Aetna U.S. Healthcare – Delaware
Aetna U.S. Healthcare – New Jersey
Aetna U.S. Healthcare – New Jersey
AvMed Health Plan – Ft. Lauderdale Plan Area
AvMed Health Plan – Gainesville Plan Area
AvMed Health Plan – Jacksonville Plan Area
AvMed Health Plan – Miami Plan Area
AvMed Health Plan – Orlando Plan Area
AvMed Health Plan – Tampa Plan Area
BlueChoice
BlueChoice
CIGNA HEALTHCARE OF AZ – TUCSON
CIGNA HEALTHCARE OF CLEVELAND
CIGNA HEALTHCARE OF CO – DENVER
CIGNA HEALTHCARE OF CONNECTICUT. INC.
CIGNA HEALTHCARE OF DE – WILMINGTON
CIGNA HEALTHCARE OF FL – JACKSONVILLE
CIGNA HEALTHCARE OF FL – ORLANDO
CIGNA HEALTHCARE OF FL – TAMPA
CIGNA HEALTHCARE OF GA – ATLANTA
CIGNA HEALTHCARE OF IL – CHICAGO
CIGNA HEALTHCARE OF KANSAS CITY, MISSOURI
CIGNA HEALTHCARE OF LOUISIANA – BATON ROUGE
CIGNA HEALTHCARE OF MA – SPRINGFIELD
CIGNA HEALTHCARE OF MID ATLANTIC
CIGNA HEALTHCARE OF NC – RALEIGH
CIGNA HEALTHCARE OF NEW YORK
CIGNA HEALTHCARE OF NO CALIFORNIA – SAN FRANCISCO
CIGNA HEALTHCARE OF NO. LA – SHREVEPORT
CIGNA HEALTHCARE OF NORTH NEW JERSEY
CIGNA HEALTHCARE OF OH – CINCINNATI
CIGNA HEALTHCARE OF OH – COLUMBUS
CIGNA HEALTHCARE OF OK – TULSA
CIGNA HEALTHCARE OF OKLAHOMA
CIGNA HEALTHCARE OF PA – PHILADELPHIA
CIGNA HEALTHCARE OF SAINT LOUIS
CIGNA HEALTHCARE OF SOUTH FLORIDA
CIGNA HEALTHCARE OF SOUTH NEW JERSEY
CIGNA HEALTHCARE OF TN – MEMPHIS
CIGNA HEALTHCARE OF TN – NASHVILLE
CIGNA HEALTHCARE OF TX – DALLAS
CIGNA HEALTHCARE OF TX – HOUSTON
CIGNA HEALTHCARE OF UTAH – SALT LAKE CITY
CIGNA HEALTHCARE OF VIRGINIA
CIGNA HealthCare of Arizona, Inc. – Staff Model
CIGNA HealthCare of Arizona-Private Practice Plan
CIGNA HealthCare of San Diego
CIGNA PRIVATE PRACTICE – LOS ANGELES IPA
ChoiceCare
ChoiceCare
Companion HealthCare Corp.
DayMed Health Maintenance Plan, Inc.
Delmarva Health Plan, Inc.
Exclusive Healthcare, Inc. – Nevada
Family Health Plan, Inc.
Foundation Health, A California Health Plan
Foundation Health, a Florida Health Plan, Inc.
Health Net
Health Options of Florida, Inc.
HealthPlus – Washington State
Healthsource HMO of New York (Patient’s Choice)
Healthsource Indiana, Inc.
Healthsource North Carolina
Healthsource South Carolina
Humana Health Care Plans – (Arizona)
Humana Health Plan of Ohio, Inc.
Quality Reporting Dropouts 1998 (cont�d)
Humana Health Plan of Texas (Corpus Christi)
Humana Health Plan of Texas (San Antonio)
Humana Health Plans (Chicago)
Humana Healthcare Plans (Lexington)
Humana Healthcare Plans (Louisville)
Humana Healthcare Plans (Louisville-KPPA)
Humana Medical Plan Inc. (Central Florida)
Humana Medical Plan Inc. (Daytona/ Jacksonville)
Humana Medical Plan Inc. (South Florida)
Humana Medical Plan, Inc. (Milwaukee)
Humana Medical Plan, Inc. (Tampa)
Humana Prime Health Plan (Kansas City)
Kaiser Foundation Health Plan, CHP
M.D. Health Plan
MDNY Healthcare, Inc.
Managed Health, Inc.
Managed Health, Inc.
NYLCare Health Plans of the Southwest, Inc.
NYLCare of the Mid-Atlantic
NYLCare of the New York Region
NYLCare of the New York Region
PACC Health Plans
PACC Health Plans
PCA Health Plans of Florida – North
PCA Health Plans of Florida – South
PCA Health Plans of Florida Central
PCA Health Plans of Texas, Inc
Prudential Health Care Plan of California, Inc.
Prudential Health Care Plan of California, Inc.
Prudential Health Care of Florida, Inc. – S. Florida
Prudential Health Care of Florida, Inc. – S. Florida
Prudential HealthCare – Amarillo
Prudential HealthCare – Arkansas
Prudential HealthCare – Arkansas
Prudential HealthCare – Atlanta
Prudential HealthCare – Atlanta
Prudential HealthCare – Austin/Central Texas
Prudential HealthCare – Austin/Central Texas
Prudential HealthCare – Central Florida
Prudential HealthCare – Central Florida
Prudential HealthCare – Central Ohio
Prudential HealthCare – Central Ohio
Prudential HealthCare – Charlotte
Prudential HealthCare – Charlotte
Prudential HealthCare – Colorado
Prudential HealthCare – Colorado
Prudential HealthCare – Corpus Christi
Prudential HealthCare – Houston
Prudential HealthCare – Houston
Prudential HealthCare – Indiana
Prudential HealthCare – Indiana
Prudential HealthCare – Jacksonville
Prudential HealthCare – Jacksonville
Prudential HealthCare – Kansas City
Prudential HealthCare – Kansas City
Prudential HealthCare – Memphis
Prudential HealthCare – Memphis
Prudential HealthCare – Mid Atlantic
Prudential HealthCare – Mid Atlantic
Prudential HealthCare – Nashville
Prudential HealthCare – Nashville
Prudential HealthCare – New York, New Jersey, Conn.
Prudential HealthCare – New York, New Jersey, Conn.
Prudential HealthCare – North Texas
Prudential HealthCare – North Texas
Prudential HealthCare – Northern Ohio
Prudential HealthCare – Northern Ohio
Prudential HealthCare – Oklahoma City
Prudential HealthCare – Oklahoma City
Prudential HealthCare – Pennsylvania – Delaware
Prudential HealthCare – Pennsylvania – Delaware
Prudential HealthCare – Raleigh/Durham
Prudential HealthCare – Raleigh/Durham
Prudential HealthCare – Richmond
Prudential HealthCare – Richmond
Prudential HealthCare – San Antonio
Prudential HealthCare – San Antonio
Prudential HealthCare – SouthWest Ohio/Northern Ke
Prudential HealthCare – SouthWest Ohio/Northern Ke
Prudential HealthCare – St. Louis
Prudential HealthCare – St. Louis
Prudential HealthCare – TAC -(Beaumont, C Christi,
Prudential HealthCare – Tampa Bay
Prudential HealthCare – Tampa Bay
Prudential HealthCare – Topeka
Prudential HealthCare – Tulsa
Prudential HealthCare – Tulsa
QualMed Philadelphia Health Plan, Inc.
Rush Prudential Health Plans
San Luis Valley HMO
Southern Health Services, Inc.
Trigon Blue Cross Blue Shield
Virginia Mason – Group Health Alliance, Inc.
Virginia Mason – Group Health Alliance, Inc.
1999
Aetna U.S. Healthcare – Eastern/Central Pennsylvania
Aetna U.S. Healthcare – Eastern/Central Pennsylvania
AmeriHealth HMO Delaware
Antero Healthplans
BCWA-Blue Choices, MSCCare
BlueLincs HMO
Community Health Plan of Ohio
Compcare – Wisconsin
Compcare – Wisconsin
Exclusive Healthcare, Inc. (Kansas City)
Exclusive Healthcare, Inc. (Kansas City)
Exclusive Healthcare, Inc. – Dallas
Exclusive Healthcare, Inc. – Dallas
Group Health Plan, Inc. – St. Louis
Group Health Plan, Inc. – St. Louis
Health Alliance Medical Plans, Inc.
Health Network of Colorado Springs, Inc.
Health Partners of the Midwest
HealthAssurance (Eastern Region)
HealthPartners Health Plans Phoenix
HealthPlus, MSC-PrimeCare
Healthsource Massachusetts – CIGNA
HomeTown Health Plan
Independent Health Western New York
InterValley Health Plan
Kaiser Foundation Health Plan of Texas
M-Care
M.D. Health Plan
Mutual of Omaha of South Dakota and Community Hlth
Mutual of Omaha of South Dakota and Community Hlth
NYLCare of the Gulf Coast
NYLCare of the Gulf Coast
PHN-HMO, Inc.
PHS, Inc. Tristate
Physicians Health Plan of South Michigan, Inc.
Physicians Health Plan of South Michigan, Inc. Plus
Physicians Health Plan of Southwest MI, Inc.
Physicians Health Plan of Southwest MI, Inc.
Premier Blue
Presbyterian Health Plan, Inc.
Principal Health Care of Delaware, Inc.
Priority Health – Michigan
QualChoice
QualChoice
QualChoice
SelectCare HMO
Southern Health Plan, Inc. (The Apple Plan)
Southern Health Plan, Inc. (The Apple Plan)
UHC – Dallas – POS
United HealthCare Choice Plus Plan
United HealthCare Inc. (Oregon)
United HealthCare Insurance Co. (Colorado)
United HealthCare Insurance Co. (NY) – Syracuse
United HealthCare Select +/Choice + (Kansas City)
United HealthCare Select Plus
United HealthCare Select of KY.
United HealthCare of Arizona
United HealthCare of Colorado Choice/Select
United HealthCare of Florida, Inc. (Orlando)
United HealthCare of Florida, Inc. (Orlando)
United HealthCare of Georgia, Inc.
United HealthCare of Georgia, Inc.
United HealthCare of Ohio, Inc. (Cleveland)
United HealthCare of Upstate New York, Inc.
United HealthCare of Utah, Inc.
United HealthCare of Utah, Inc.
United Select/Choice (Kansas City)