Health Care Quality Report Card 2007 HMO Ratings A note to users of this text file: Section heading and topic headings are labeled through out this guide. Print page numbers are included. Contents Introduction – Page 1 HMO Ratings At-a-Glance – Page 3 Meeting National Standards of Care Asthma Care – Page 4 Checking for Cancer – Page 6 Diabetes Care – Page 8 Heart Care – Page 12 Maternity Care – Page 16 Mental Health Care – Page 18 Sexually Transmitted Infections – Page 22 Testing for Cause of Back Pain – Page 24 Treating Adults: Getting the Right Care – Page 26 Treating Children: Infections and Immunizations – Page 28 Members Rate Their HMO – Page 32 Helping Smokers Quit HMO Customer Service Member Complaints Members Rate HMO Doctors and Care Language Services – Page 40 Scoring and Rating Methods – Page 42 THE PATIENT ADVOCATE [Page 1] Introduction Dear Friend: Thank you for requesting California’s 2007 Health Care Quality Report Card - HMO Ratings. The Office of the Patient Advocate makes these HMO Ratings available in a consumer-friendly way to inform and assist Californians with their health care decisions. In this booklet, you’ll find ratings for the nine largest HMOs on topics such as: • Patient experience • Meeting clinical standards • Health conditions such as asthma, cancer and heart care. The data reported are the most widely used set of performance measures in the managed care industry and measure performance that promotes good health and quality medical care. The processes and guidelines undergo a rigorous audit by an independent third party. We measure the quality of care by evaluating member experiences and effectiveness of clinical care for large groups of people. While these measures can give you an overall idea of the performance of a health plan, the quality of care you experience may depend on your health care needs, expectations, behavior and provider and treatment choices. What we do as consumers has a huge impact on our health. Each of us can participate as a health care consumer to improve the quality and value of health care. Keep informed and seek the right care. Look at the scores for each plan and then, for information on your rights, responsibilities and how to get the most out of your health plan, visit opa.ca.gov If you would like to view all of the HMO Ratings and the entire Health Care Quality Report Card, please visit us at HealthCareQuality.ca.gov or, if you would like to order materials, please feel free to call us toll-free at 1-866-466-8900 or visit our home website at opa.ca.gov Thank you and congratulations for taking the time to focus on your health! Sincerely, Sandra Perez Director State of California Office of the Patient Advocate [Page 2] This booklet contains just a portion of the information you will find on the Health Care Quality Report Card website. Visit HealthCareQuality.ca.gov to find information about: • Health Plans • Doctors and Medical Groups • Hospitals and Long-Term Care • Language Services • Research and Background [Page 3 HMO Ratings At-a-Glance Meeting National Standards of Care: We compared HMO members' records to a set of national standards for quality of care. Members Rate Their HMO: We compared how HMO members rate their care and services. Meeting National Standards of Care - Members Rate Their HMO Aetna Health of California Inc. ** - * Blue Cross HMO – CaliforniaCare ** - ** Blue Shield of California HMO ** - *** CIGNA HMO ** - ** Health Net of California, Inc. *** - *** Kaiser Permanente - Northern California Region *** - *** Kaiser Permanente - Southern California Region *** - *** PacifiCare of California ** - *** Western Health Advantage ** - *** [Page 4] HMO Ratings | Meeting National Standards of Care Asthma Care At-a-Glance Why Is It Important? Top HMOs make sure that adults and children with asthma get the right medicine and know when and how to take their medicine. These medicines help people avoid the wheezing, coughing, and shortness of breath of an asthma attack. **** - Excellent *** - Good ** - Fair * - Poor Asthma Care We compared HMO members' records to a set of national standards for quality of care. Aetna Health of California Inc. ** Blue Cross HMO – CaliforniaCare ** Blue Shield of California HMO *** CIGNA HMO ** Health Net of California, Inc. ** Kaiser Permanente - Northern California Region *** Kaiser Permanente - Southern California Region *** PacifiCare of California ** Western Health Advantage ** HMO Ratings | Meeting National Standards of Care | Asthma Care Asthma Medicine for Adults What Was Measured? What percentage of adults in the HMO who have asthma got the right medicine — called anti-inflammatories or controller drugs — for their asthma? These results are based on a sample of HMO patient administrative records. Why Is It Important? People who have asthma can have asthma attacks that are painful and frightening and even deadly. Using asthma medicines regularly can help prevent these attacks and avoid the wheezing, coughing, and shortness of breath that the attacks bring. Look for differences of at least 4%. Smaller differences usually are not significant Asthma Medicine for Adults We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) – (Better) 100% Kaiser Permanente Southern California Region - 95% Kaiser Permanente Northern California Region - 94% Health Net of California, Inc. - 91% Blue Cross HMO CaliforniaCare - 90% Blue Shield of California HMO - 90% Western Health Advantage - 90% CIGNA HMO – 89% PacifiCare of California – 89% Aetna Health of California Inc. – 87% [Page 5] HMO Ratings | Meeting National Standards of Care | Asthma Care Asthma Medicine for Teenagers What Was Measured? What percentage of adolescents in the HMO who have asthma got the right medicine — called anti-inflammatories or controller drugs — for their asthma? These results are based on a sample of HMO patient administrative records. Why Is It Important? Teenagers who have asthma can have asthma attacks that are painful and frightening and even deadly. Using asthma medicines regularly can help prevent these attacks and avoid the wheezing, coughing, and shortness of breath that the attacks bring. Look for differences of at least 4%. Smaller differences usually are not significant Asthma Medicine for Teenagers We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% Kaiser Permanente Northern California Region - 97% Blue Shield of California HMO - 94% Kaiser Permanente Southern California Region - 93% Blue Cross HMO CaliforniaCare - 91% Health Net of California, Inc. - 91% Western Health Advantage - 91% Aetna Health of California Inc. - 90% CIGNA HMO - 90% PacifiCare of California - 89% HMO Ratings | Meeting National Standards of Care | Asthma Care Asthma Medicine for Children What Was Measured? What percentage of children in the HMO who have asthma got the right medicine — called anti-inflammatories or controller drugs — for their asthma? These results are based on a sample of HMO patient administrative records. Why Is It Important? Children who have asthma can have asthma attacks that are painful and frightening and even deadly. Using asthma medicines regularly can help prevent these attacks and avoid the wheezing, coughing, and shortness of breath that the attacks bring. Look for differences of at least 4%. Smaller differences usually are not significant Asthma Medicine for Children We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% Kaiser Permanente Northern California Region - 98% Western Health Advantage - 98% Blue Shield of California HMO - 97% Health Net of California, Inc. - 97% Blue Cross HMO CaliforniaCare - 96% Kaiser Permanente Southern California Region - 96% CIGNA HMO - 95% PacifiCare of California - 94% Aetna Health of California Inc. - 93% [Page 6] HMO Ratings | Meeting National Standards of Care Checking for Cancer At-a-Glance Why Is It Important? The best HMOs and their doctors screen members for deadly diseases like breast, cervical, and colorectal cancer. When cancers are found early treatments are usually more successful and fewer patients die. **** - Excellent *** - Good ** - Fair * - Poor Checking for Cancer We compared HMO members' records to a set of national standards for quality of care. Aetna Health of California Inc. - * Blue Cross HMO – CaliforniaCare - ** Blue Shield of California HMO - *** CIGNA HMO - *** Health Net of California, Inc. - *** Kaiser Permanente - Northern California Region - *** Kaiser Permanente - Southern California Region - *** PacifiCare of California - ** Western Health Advantage - *** HMO Ratings | Meeting National Standards of Care | Checking for Cancer Breast Cancer Screening What Was Measured? What percentage of women in the HMO, ages 42-69, had a mammogram to test for breast cancer during the past two years? These results are based on a sample of HMO patient administrative records. Why Is It Important? Checking women for breast cancer helps save lives. When cancer is found early there is a much better chance that it can be cured. A test called a "mammogram" is the best way to find breast cancer early. Good care means that you have a mammogram as often as it is recommended for a woman your age. Look for differences of at least 4%. Smaller differences usually are not significant Breast Cancer Screening We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% Kaiser Permanente Northern California Region - 77% Kaiser Permanente Southern California Region - 76% Western Health Advantage - 70% Health Net of California, Inc. - 68% Blue Cross HMO CaliforniaCare - 67% Blue Shield of California HMO - 67% CIGNA HMO - 66% PacifiCare of California - 66% Aetna Health of California Inc. - 61% [Page 7] HMO Ratings | Meeting National Standards of Care | Checking for Cancer Cervical Cancer Screening What Was Measured? What percentage of women in the HMO, ages 21-64, had a Pap Smear to test for cervical cancer during the past three years? These results are based on a sample of HMO patient administrative and medical records. Why Is It Important? Checking women for cervical cancer helps save lives. When cancer is found early, there is a much better chance that it can be cured. A test called a "Pap Smear" is the best way to find cervical cancer early. Good care means that you have a Pap Smear as often as it is recommended for a woman your age. Look for differences of at least 4%. Smaller differences usually are not significant Cervical Cancer Screening We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% Health Net of California, Inc. - 86% Blue Shield of California HMO - 84% CIGNA HMO - 84% PacifiCare of California - 84% Western Health Advantage - 84% Blue Cross HMO CaliforniaCare - 83% Kaiser Permanente Northern California Region - 82% Kaiser Permanente Southern California Region - 82% Aetna Health of California Inc. - 80% HMO Ratings | Meeting National Standards of Care | Checking for Cancer Colorectal Cancer Screening What Was Measured? What percentage of HMO members, ages 50-80, have been tested for colorectal cancer? Patients may be tested for the cancer using any one of four tests — the frequency of these tests vary from every year to once every ten years. These results are based on a sample of HMO patient administrative and medical records. Why Is It Important? If you have colorectal cancer, and your doctor finds it early, you have a very good chance of being cured. When the cancer is found late fewer than half of patients live. Good care means that you are tested, using one of several available tests, as is recommended for an adult your age. Look for differences of at least 4%. Smaller differences usually are not significant Colorectal Cancer Screening We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% Health Net of California, - 58% Inc. CIGNA HMO - 55% Blue Shield of California HMO - 53% Kaiser Permanente Southern California Region - 51% PacifiCare of California - 51% Blue Cross HMO CaliforniaCare - 50% Kaiser Permanente Northern California Region - 50% Western Health Advantage - 49% Aetna Health of California Inc. - 48% [Page 8] HMO Ratings | Meeting National Standards of Care Diabetes Care At-a-Glance Why Is It Important? The best HMOs work with members who have diabetes to prevent health problems. The doctors check members’ blood sugar and blood pressure and cholesterol levels often and help to keep them controlled. They also test regularly for early signs of complications, like kidney failure and blindness. **** - Excellent *** - Good ** - Fair * - Poor Diabetes Care We compared HMO members' records to a set of national standards for quality of care. Aetna Health of California Inc. - *** Blue Cross HMO – CaliforniaCare - *** Blue Shield of California HMO - *** CIGNA HMO - *** Health Net of California, Inc. - *** Kaiser Permanente - Northern California Region - *** Kaiser Permanente - Southern California Region - *** PacifiCare of California - ** Western Health Advantage - ** HMO Ratings | Meeting National Standards of Care | Diabetes Care Eye Exam for Diabetes Patients What Was Measured? What percentage of HMO patients with diabetes had an eye exam to watch for disease that can lead to blindness? These results are based on a sample of HMO patient administrative and medical records. Why Is It Important? High blood sugar can cause bleeding in the blood vessels in your eyes and lead to blindness. You should have annual eye exams, as part of your diabetes care, to watch for any signs of damage to the blood vessels in your eyes. Look for differences of at least 4%. Smaller differences usually are not significant Eye Exam for Diabetes Patients We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) - 100% Kaiser Permanente Southern California Region - 76% Kaiser Permanente Northern California Region - 66% Health Net of California, Inc. - 61% Blue Cross HMO CaliforniaCare - 60% Blue Shield of California HMO - 59% Aetna Health of California Inc. - 58% CIGNA HMO - 57% PacifiCare of California - 56% Western Health Advantage - 47% [Page 9] HMO Ratings | Meeting National Standards of Care | Diabetes Care Testing Blood Sugar for Diabetes Patients What Was Measured? What percentage of HMO members with diabetes had their blood sugar level tested to help manage their disease? These results are based on a sample of HMO patient administrative and medical records. Why Is It Important? High blood sugar is harmful to your body. If you have diabetes, testing your blood sugar tells you how well you are controlling it. Good care means that you are taught how to test your blood sugar and to test it often. Look for differences of at least 4%. Smaller differences usually are not significant Testing Blood Sugar for Diabetes Patients We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% Health Net of California, Inc. - 92% Kaiser Permanente Northern California Region - 90% CIGNA HMO - 88% Aetna Health of California Inc. - 86% Blue Cross HMO CaliforniaCare - 86% Blue Shield of California HMO - 86% Kaiser Permanente Southern California Region - 86% PacifiCare of California - 86% Western Health Advantage - 86% HMO Ratings | Meeting National Standards of Care | Diabetes Care Controlling Blood Sugar for Diabetes Patients What Was Measured? What percentage of HMO members with diabetes had well-controlled blood sugar levels — hemoglobin A1C level of less than 9? Lower hemoglobin A1C levels indicate better long term diabetes control. These results are based on a sample of HMO patient administrative and medical records. Why Is It Important? High blood sugar is harmful to your body. Controlling your blood sugar helps you avoid serious health problems like blindness and heart disease. Good care means that you get help to control your blood sugar level by: planning proper meals, exercising, testing your blood sugar at home and taking your medicine. Look for differences of at least 4%. Smaller differences usually are not significant Controlling Blood Sugar for Diabetes Patients We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% Health Net of California, Inc. - 78% Kaiser Permanente Northern California Region - 77% Blue Shield of California HMO - 75% CIGNA HMO - 72% Kaiser Permanente Southern California Region - 72% Aetna Health of California Inc. - 70% Blue Cross HMO CaliforniaCare - 70% PacifiCare of California - 67% Western Health Advantage - 66% [Page 10] HMO Ratings | Meeting National Standards of Care | Diabetes Care Testing Cholesterol for Diabetes Patients What Was Measured? What percentage of HMO members with diabetes had their cholesterol level checked to find risk factors for heart disease. These results are based on a sample of HMO patient administrative and medical records. Why Is It Important? High blood sugar is harmful to the blood vessels. So is high cholesterol. Controlling cholesterol is an important part of controlling diabetes. Testing your cholesterol regularly can help keep you from having a heart attack or a stroke. Look for differences of at least 4%. Smaller differences usually are not significant Testing Cholesterol for Diabetes Patients We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% Kaiser Permanente Northern California Region - 89% Health Net of California, - 87% Inc. Kaiser Permanente Southern California Region - 86% Blue Cross HMO CaliforniaCare - 85% CIGNA HMO - 85% Aetna Health of California Inc. - 84% Blue Shield of California HMO - 83% PacifiCare of California - 82% Western Health Advantage - 82% HMO Ratings | Meeting National Standards of Care | Diabetes Care Controlling Cholesterol for Diabetes Patients What Was Measured? What percentage of HMO members with diabetes had a LDL cholesterol level of less than 100 indicating good control? These results are based on a sample of HMO patient administrative and medical records. Why Is It Important? High blood sugar is harmful to the blood vessels. So is high cholesterol. Controlling cholesterol is important to avoiding heart and blood vessel disease and complications like stroke. Your care should help you lower your cholesterol by eating less saturated fat, exercising regularly and taking medicine if you need it. Look for differences of at least 4%. Smaller differences usually are not significant Controlling Cholesterol for Diabetes Patients We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% Kaiser Permanente Northern California Region - 55% Kaiser Permanente Southern California Region - 51% Health Net of California, Inc. - 49% Blue Shield of California HMO - 45% Blue Cross HMO CaliforniaCare - 42% Aetna Health of California Inc. - 41% CIGNA HMO - 41% Western Health Advantage - 41% PacifiCare of California - 40% [Page 11] HMO Ratings | Meeting National Standards of Care | Diabetes Care Testing Kidney Function for Diabetes Patients What Was Measured? What percentage of HMO members with diabetes had their kidneys tested to watch for signs of kidney damage? These results are based on a sample of HMO patient administrative and medical records. Why Is It Important? High blood sugar is harmful to the kidneys and can stop them from working. Testing your urine often is the main way to check for signs of kidney problems. Early signs alert you and your doctor to take steps to prevent your kidneys from failing. Look for differences of at least 4%. Smaller differences usually are not significant Testing Kidney Function for Diabetes Patients We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% Kaiser Permanente Southern California Region - 93% Kaiser Permanente Northern California Region - 91% Aetna Health of California Inc. - 83% Health Net of California, Inc. - 83% PacifiCare of California - 82% Blue Shield of California HMO - 80% CIGNA HMO - 79% Blue Cross HMO CaliforniaCare - 78% Western Health Advantage - 77% [Page 12] HMO Ratings | Meeting National Standards of Care Heart Care At-a-Glance Why Is It Important? The best HMOs help members with heart disease keep their condition from getting worse. The doctors check members’ cholesterol levels and try to keep them controlled. This helps prevent heart attacks and strokes. The doctors also make sure that members who have had a serious heart problem, such as a heart attack, get the right medications to ease heart pain and help avoid another heart attack. **** - Excellent *** - Good ** - Fair * - Poor Heart Care We compared HMO members' records to a set of national standards for quality of care. Aetna Health of California Inc. - ** Blue Cross HMO – CaliforniaCare - *** Blue Shield of California HMO - *** CIGNA HMO - ** Health Net of California, Inc. - *** Kaiser Permanente - Northern California Region - **** Kaiser Permanente - Southern California Region - **** PacifiCare of California - ** Western Health Advantage - *** HMO Ratings | Meeting National Standards of Care | Heart Care Controlling High Blood Pressure What Was Measured? What percentage of HMO members with high blood pressure had their blood pressure brought under control? These results are based on a sample of HMO patient administrative and medical records. These results are based on a sample of HMO patient administrative and medical records. Why Is It Important? High blood pressure can lead to heart disease and stroke. Good care means helping you control your blood pressure below 140/90. Ways to lower your blood pressure include: eating little or no salt, losing weight, staying active, and taking medicine if you need it. Look for differences of at least 4%. Smaller differences usually are not significant Controlling High Blood Pressure We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% Kaiser Permanente Southern California Region - 74% Kaiser Permanente Northern California Region - 73% CIGNA HMO - 64% Health Net of California, Inc. - 62% Aetna Health of California Inc. - 61% Western Health Advantage - 61% Blue Cross HMO CaliforniaCare - 60% Blue Shield of California HMO - 59% PacifiCare of California - 54% [Page 13] HMO Ratings | Meeting National Standards of Care | Heart Care Testing Cholesterol What Was Measured? What percentage of HMO members had their cholesterol level checked after a heart attack, heart surgery or for their cardiovascular disease? Why Is It Important? Persons with heart disease should have their cholesterol levels tested regularly as a step to avoid a repeat heart attack, a stroke or death. Look for differences of at least 4%. Smaller differences usually are not significant Testing Cholesterol We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% Kaiser Permanente Southern California Region - 95% Kaiser Permanente Northern California Region - 92% Aetna Health of California Inc. - 91% Western Health Advantage - 91% Blue Cross HMO CaliforniaCare - 90% Blue Shield of California HMO - 90% CIGNA HMO - 90% Health Net of California, Inc. - 90% PacifiCare of California - 88% HMO Ratings | Meeting National Standards of Care | Heart Care Controlling Cholesterol What Was Measured? What percentage of HMO members had a LDL cholesterol level of less than 100 indicating good control after having a heart attack or heart surgery or who have cardiovascular disease? Why Is It Important? Controlling cholesterol for people with heart disease is key to seeing that the disease does not get worse and avoiding heart attacks or other complications like stroke. Getting the right care to control cholesterol means help with eating right, exercise and medication. Look for differences of at least 4%. Smaller differences usually are not significant Controlling Cholesterol We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% Blue Cross HMO CaliforniaCare – 66% Kaiser Permanente Northern California Region – 66% CIGNA HMO – 64% Blue Shield of California HMO – 63% Health Net of California, Inc. – 63% Kaiser Permanente Southern California Region – 63% Aetna Health of California Inc. – 61% Western Health Advantage – 60% PacifiCare of California – 57% [Page 14] HMO Ratings | Meeting National Standards of Care | Heart Care Heart Attack Medication What Was Measured? What percentage of HMO members who were hospitalized for a heart attack continued to receive beta blocker drugs, for the six months following the heart attack, to ease heart pain and help avoid a repeat attack or stroke? These results are based on a sample of HMO patient administrative and medical records. Why Is It Important? Anyone who has had a heart attack is at a higher risk of having another heart attack or a stroke. Medicines called beta-blockers help prevent a repeat heart attack or stroke. These drugs ease how hard the heart has to work — one mark of good care is seeing that patients continue to use this heart medication for a period of time after the damage of a heart attack. Look for differences of at least 4%. Smaller differences usually are not significant Heart Attack Medication We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% Kaiser Permanente Southern California Region - 85% Kaiser Permanente Northern California Region - 84% Blue Cross HMO CaliforniaCare - 75% Western Health Advantage - 74% Health Net of California, Inc. - 73% Blue Shield of California HMO - 71% PacifiCare of California - 69% Aetna Health of California Inc. - 60% CIGNA HMO 14 - 55% [Page 15] THE PATIENT ADVOCATE [Page 16] HMO Ratings | Meeting National Standards of Care Maternity Care At-a-Glance Why Is It Important? The best HMOs make sure that both the mother and the baby stay healthy during pregnancy and after the birth. Regular check-ups during pregnancy help uncover problems, like high blood pressure or diabetes, that can threaten the health of the mother or the baby. Check-ups shortly after the birth can help the mom take care of herself and the new baby. **** - Excellent *** - Good ** - Fair * - Poor Maternity Care We compared HMO members' records to a set of national standards for quality of care. Aetna Health of California Inc. - ** Blue Cross HMO – CaliforniaCare - *** Blue Shield of California HMO - *** CIGNA HMO – *** Health Net of California, Inc. - *** Kaiser Permanente - Northern California Region - *** Kaiser Permanente - Southern California Region - ** PacifiCare of California - *** Western Health Advantage - ** HMO Ratings | Meeting National Standards of Care | Maternity Care Visits During Pregnancy What Was Measured? What percentage of pregnant women in the HMO began prenatal care during the first 13 weeks of pregnancy? These results are based on a sample of HMO patient billing and medical records. Why Is It Important? Regular check-ups are important for pregnant women. During prenatal visits, your doctor can look for problems, like high blood pressure, which can cause problems for you and your baby. You can also learn how to eat right, get the right vitamins and exercise to protect your health and your baby’s. Look for differences of at least 4%. Smaller differences usually are not significant Visits During Pregnancy We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% Blue Cross HMO CaliforniaCare - 97% Blue Shield of California HMO - 97% CIGNA HMO - 96% Health Net of California, Inc. - 95% PacifiCare of California - 95% Aetna Health of California Inc. - 93% Kaiser Permanente Northern California Region - 93% Kaiser Permanente Southern California Region - 87% Western Health Advantage - 85% [Page 17] HMO Ratings | Meeting National Standards of Care | Maternity Care Visits After Giving Birth What Was Measured? What percentage of HMO members who are women that gave birth had a checkup visit 21-56 days after delivery? These results are based on a sample of HMO patient billing and medical records. Why Is It Important? Women need care after giving birth. You may have trouble adjusting to changes in your body, your feelings or your relationships. If you are a new mother, you may need help learning how to care for your infant and yourself. A visit with your doctor after giving birth is an important step in your care. Look for differences of at least 4%. Smaller differences usually are not significant Visits After Giving Birth We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% CIGNA HMO - 89% Kaiser Permanente Northern California Region - 87% Blue Cross HMO CaliforniaCare - 85% Health Net of California, Inc. - 85% Blue Shield of California HMO - 84% PacifiCare of California - 82% Aetna Health of California Inc. - 79% Kaiser Permanente Southern California Region - 79% Western Health Advantage - 79% [Page 18] HMO Ratings | Meeting National Standards of Care Mental Health Care At-a-Glance Why Is It Important? The best HMOs make sure that members who have major depression can see a doctor regularly and get the right medications. They also make sure that a patient has a follow-up visit after a hospital stay for mental illness. **** - Excellent *** - Good ** - Fair * - Poor Mental Health Care We compared HMO members' records to a set of national standards for quality of care. Aetna Health of California Inc. - ** Blue Cross HMO – CaliforniaCare - *** Blue Shield of California HMO - ** CIGNA HMO - ** Health Net of California, Inc. - ** Kaiser Permanente - Northern California Region - **** Kaiser Permanente - Southern California Region - **** PacifiCare of California - *** Western Health Advantage - *** HMO Ratings | Meeting National Standards of Care | Mental Health Care Treatment Visits for Depression What Was Measured? What percentage of HMO members who were treated for depression were seen at least 3 times during the 12-week initial treatment phase? These results are based on a sample of HMO patient administrative records. Why Is It Important? Depression can be treated. But, about half of patients don’t get or don't continue their depression treatment. With regular visits your doctor can check that your treatment is working and see if you need to change any of your medicines. Look for differences of at least 4%. Smaller differences usually are not significant Treatment Visits for Depression We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% Kaiser Permanente Southern California Region - 30% Blue Cross HMO CaliforniaCare - 26% Aetna Health of California Inc. - 22% CIGNA HMO - 21% Health Net of California, Inc. - 21% PacifiCare of California - 21% Blue Shield of California HMO - 19% Kaiser Permanente Northern California Region - 19% Western Health Advantage - 17% [Page 19] HMO Ratings | Meeting National Standards of Care | Mental Health Care Anti-depressant Medication — Initial Treatment What Was Measured? What percentage of HMO members who were treated for depression remained on anti-depressant medication for their 12-week initial treatment? These results are based on a sample of HMO patient administrative records. Why Is It Important? People who are depressed can be treated with medicines called antidepressants. These medicines usually work well. Making sure you that you get the right anti-depressant medicine and that you continue to take it correctly is an important part of your care. Look for differences of at least 4%. Smaller differences usually are not significant Anti-depressant Medication — Initial Treatment We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% Kaiser Permanente Southern California Region - 86% Kaiser Permanente Northern California Region - 82% Western Health Advantage - 61% Blue Cross HMO CaliforniaCare - 60% Blue Shield of California HMO - 57% Health Net of California, Inc. - 57% PacifiCare of California - 57% Aetna Health of California Inc. - 56% CIGNA HMO - 56% HMO Ratings | Meeting National Standards of Care | Mental Health Care Anti-depressant Medication — Ongoing Treatment What Was Measured? What percentage of HMO members who were treated for depression remained on anti-depressant medication for 6 months of ongoing care following their initial treatment? These results are based on a sample of HMO patient administrative records. Why Is It Important? People who are depressed can be treated with medicines called antidepressants. Good care means checking that patients follow their doctor’s instructions about taking medicines. About half of the people who take antidepressants do not finish all of their medicine or take it incorrectly. Look for differences of at least 4%. Smaller differences usually are not significant Anti-depressant Medication — Ongoing Treatment We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% Kaiser Permanente Southern California Region - 67% Kaiser Permanente Northern California Region - 59% Blue Cross HMO CaliforniaCare - 45% Blue Shield of California HMO - 44% Western Health Advantage - 44% Aetna Health of California Inc. - 43% CIGNA HMO - 43% Health Net of California, Inc. - 42% PacifiCare of California - 40% [Page 20] HMO Ratings | Meeting National Standards of Care | Mental Health Care Follow-up Visit After Mental Illness Hospital Stay What Was Measured? What percentage of HMO members who have been hospitalized for a mental illness were seen by a mental health provider within 30 days after leaving the hospital? These results are based on a sample of HMO patient administrative records. Why Is It Important? Patients who have been in the hospital for a mental illness need follow-up care. It is important to make sure that they are getting the right treatment and if using medicine that they are taking it correctly. Look for differences of at least 4%. Smaller differences usually are not significant Follow-up Visit After Mental Illness Hospital Stay We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% Kaiser Permanente Northern California Region - 84% PacifiCare of California - 83% Western Health Advantage - 83% Kaiser Permanente Southern California Region - 80% Health Net of California, Inc. - 78% Blue Cross HMO CaliforniaCare - 75% Aetna Health of California Inc. - 74% CIGNA HMO - 74% Blue Shield of CaliforniaHMO - 70% [Page 21] THE PATIENT ADVOCATE [Page 22] HMO Ratings | Meeting National Standards of Care Sexually Transmitted Infections At-a-Glance Why Is It Important? The best HMOs and their doctors communicate with patients about common health risks. For example, a common health risk is sexually transmitted infections in younger, sexually active women. HMOs and their doctors should test younger, sexually active women for sexually transmitted infections like Chlamydia. **** - Excellent *** - Good ** - Fair * - Poor Sexually Transmitted Infections We compared HMO members' records to a set of national standards for quality of care. Aetna Health of California Inc. - *** Blue Cross HMO – CaliforniaCare - ** Blue Shield of California HMO - ** CIGNA HMO - *** Health Net of California, Inc. - *** Kaiser Permanente - Northern California Region - **** Kaiser Permanente - Southern California Region - **** PacifiCare of California - *** Western Health Advantage - *** HMO Ratings | Meeting National Standards of Care | Sexually Transmitted Infections Chlamydia Screening Age 16-20 What Was Measured? What percentage of women in the HMO, who are ages 16-20 and sexually active, were tested for chlamydia? These results are based on a sample of HMO patient administrative records. Why Is It Important? Finding sexually transmitted infections — also known as STIs or STDs — like Chlamydia early is the best way to cure them. It also helps keep them from spreading to other people. Women can use medicine to get rid of the infection. The medicine can help you avoid complications including pelvic inflammatory disease (PID) that could keep you from being able to get pregnant. Look for differences of at least 4%. Smaller differences usually are not significant Chlamydia Screening Age 16-20 We compared HMO members' records to a set of national standards for quality of care. 0% (Worse)- (Better) 100% Kaiser Permanente Southern California Region - 66% Kaiser Permanente Northern California Region - 61% Western Health Advantage - 41% CIGNA HMO - 40% Health Net of California, Inc. - 37% PacifiCare of California - 36% Aetna Health of California Inc. - 35% Blue Shield of California HMO - 34% Blue Cross HMO CaliforniaCare - 30% [Page 23] HMO Ratings | Meeting National Standards of Care | Sexually Transmitted Infections Chlamydia Screening Age 21-25 What Was Measured? What percentage of women in the HMO, who are ages 21-25 and sexually active, were tested for Chlamydia? These results are based on a sample of HMO patient administrative records. Why Is It Important? Finding sexually transmitted infections — also known as STIs or STDs — like Chlamydia early is the best way to cure them. It also helps keep them from spreading to other people. Women can use medicine to get rid of the infection. The medicine can help you avoid complications including pelvic inflammatory disease (PID) that could keep you from being able to get pregnant. Look for differences of at least 4%. Smaller differences usually are not significant Chlamydia Screening Age 21-25 We compared HMO members' records to a set of national standards for quality of care. 0% (Worse)- -(Better) 100% Kaiser Permanente Southern California Region69% Kaiser Permanente Northern California Region66% Western Health Advantage48% CIGNA HMO47% PacifiCare of California - 43% Health Net of California, Inc. - 42% Aetna Health of California Inc. - 41% Blue Shield of California HMO - 39% Blue Cross HMO CaliforniaCare - 34% [Page 24] HMO Ratings | Meeting National Standards of Care Testing for Cause of Back Pain At-a-Glance There is no “At-a-Glance” chart for this topic. Please refer to the following individual measure instead. HMO Ratings | Meeting National Standards of Care | Testing for Cause of Back Pain Testing for Cause of Back Pain What Was Measured? What percentage of HMO members, with low back pain, got an evaluation for the condition that met recommended standards for use of high cost x-ray services. These results are based on a sample of HMO patient administrative records. Why Is It Important? How patients are treated for back pain signals how well HMOs and their doctors see that patients get care that is proven to work. Millions of people suffer from low back pain. Although low back pain can limit your activities, the symptoms usually get better within a month. Unless you have clear signs of a spinal problem, typically you do not need to have costly tests like an MRI or a CT scan, or even x-rays. Look for differences of at least 4%. Smaller differences usually are not significant Testing for Cause of Back Pain We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% Blue Cross HMO CaliforniaCare - 86% Kaiser Permanente Southern California Region - 82% Western Health Advantage - 81% Aetna Health of California Inc. - 80% Health Net of California, Inc. - 80% Blue Shield of California HMO - 78% Kaiser Permanente Northern California Region - 78% CIGNA HMO - 77% PacifiCare of California - 77% [Page 25] THE PATIENT ADVOCATE [Page 26] HMO Ratings | Meeting National Standards of Care Treating Adults: Getting the Right Care At-a-Glance Why Is It Important? The best HMOs see that their members get the right care at the right time. Good care means getting treatments that are proven to work. Highly rated HMOs make sure that you don’t get treatments that do not help you get better and that may cause injury or illness. **** - Excellent *** - Good ** - Fair * - Poor Treating Adults: Getting the Right Care We compared HMO members' records to a set of national standards for quality of care. Aetna Health of California Inc. - * Blue Cross HMO – CaliforniaCare - * Blue Shield of California HMO - ** CIGNA HMO - * Health Net of California, Inc. – ** Kaiser Permanente - Northern California Region - ** Kaiser Permanente - Southern California Region - ** PacifiCare of California - * Western Health Advantage - * HMO Ratings | Meeting National Standards of Care | Treating Adults: Getting the Right Care Checking Patients on Long-Term Medications What Was Measured? What percentage of adults, who are prescribed medications long-term, are tested to check that the ongoing use of the drug is not harming the patient. Why Is It Important? Patients on medications long-term are at higher risk for health problems from the drugs like harmful side-effects or damage due to improper doses. Periodic lab tests are used to check the drug levels in the body and for other signs that a patient’s health is threatened. Look for differences of at least 4%. Smaller differences usually are not significant Checking Patients on Long-Term Medications We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% CIGNA HMO - 71%% Western Health Advantage - 71% Health Net of California, Inc. - 70% Kaiser Permanente Northern California Region - 70% Kaiser Permanente Southern California Region - 70% PacifiCare of California - 70% Blue Shield of California HMO - 68% Aetna Health of California Inc. - 66% Blue Cross HMO CaliforniaCare - 60 [Page 27] HMO Ratings | Meeting National Standards of Care | Treating Adults: Getting the Right Care Treating Arthritis With Medications What Was Measured? What percentage of adults, who have rheumatoid arthritis, got a prescription for an anti-rheumatic drug. Why Is It Important? These disease modifying anti-rheumatic drugs (DMARD) help slow the progression of arthritis which if untreated leads to tissue damage and loss of tissue and bone. By helping people avoid flare-ups of the disease, these medications can prevent destruction of the joints and help people continue their day-to-day activities. Look for differences of at least 4%. Smaller differences usually are not significant Treating Arthritis With Medications We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% Kaiser Permanente Northern California Region - 91% Aetna Health of California Inc. - 86% Blue Shield of California HMO - 85% Kaiser Permanente Southern California Region - 84% Health Net of California, Inc. - 83% PacifiCare of California -82% CIGNA HMO - 79% Western Health Advantage - 78% Blue Cross HMO CaliforniaCare - 67% [Page 28] HMO Ratings | Meeting National Standards of Care Treating Children: Getting the Right Care At-a-Glance Why Is It Important? The best HMOs work to prevent childhood diseases. Doctors make sure that children and adolescents get the shots they need. And, when a child or adolescent is ill, doctors only prescribe antibiotics when they are truly necessary. **** - Excellent *** - Goof ** - Fair * - Poor Treating Children: Getting the Right Care We compared HMO members' records to a set of national standards for quality of care. Aetna Health of California Inc. - * Blue Cross HMO - CaliforniaCare - * Blue Shield of California HMO - ** CIGNA HMO - * Health Net of California, Inc. - ** Kaiser Permanente - Northern California Region - *** Kaiser Permanente - Southern California Region - *** PacifiCare of California - * Western Health Advantage – ** HMO Ratings | Meeting National Standards of Care | Treating Children: Getting the Right Care Care for Attention Deficit Disorder What Was Measured? What percentage of children, who were prescribed a medication for ADHD, had a follow-up visit within four weeks after starting their medication. Why Is It Important? Attention Deficit/Hyperactivity Disorder (ADHD) is the most common behavior disorder in school-age children. Medication is a proven treatment for ADHD but regular monitoring of the child’s medication is key to minimizing side-effects including headaches, poor appetite and trouble sleeping. Look for differences of at least 4%. Smaller differences usually are not significant Care for Attention Deficit Disorder We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% Western Health Advantage - 36% Blue Shield of California HMO - 35% Kaiser Permanente Southern California Region - 28% Blue Cross HMO CaliforniaCare - 27% CIGNA HMO - 27% Kaiser Permanente Northern California Region - 27% Aetna Health of California Inc. - 21% Health Net of California, Inc. - 20% PacifiCare of California - 20% [Page 29] HMO Ratings | Meeting National Standards of Care | Treating Children: Getting the Right Care Child Immunizations What Was Measured? What percentage of children in the HMO received, by age two, the seven vaccinations recommended by the Centers for Disease Control and the American Academy of Pediatrics? Why Is It Important? Shots, also called vaccines or immunizations, are an easy and proven way to protect your children from serious illness. Without shots, children can die from diseases like measles, tetanus, hepatitis B and meningitis. Good care includes sending reminders when your children need the shots and making it easy to get the shots. Look for differences of at least 4%. Smaller differences usually are not significant Child Immunizations We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% Kaiser Permanente Northern California Region - 82% Kaiser Permanente Southern California Region82% Health Net of California, Inc. - 75% Blue Shield of California HMO - 74% PacifiCare of California - 66% Western Health Advantage - 58% CIGNA HMO - 54% Blue Cross HMO CaliforniaCare - 52% Aetna Health of California Inc. - 49% HMO Ratings | Meeting National Standards of Care | Treating Children: Getting the Right Care Adolescent Immunizations What Was Measured? What percentage of adolescents enrolled in the HMO received, by age 13, the recommended measles, mumps and rubella (MMR), chicken pox and Hepatitis B vaccinations? Why Is It Important? Children need shots, also called vaccines or immunizations, to protect them from serious diseases, like measles, tetanus, hepatitis B and meningitis. Even if they had shots as a child, they still need booster shots for continued protection. Good care includes sending reminders when your children need the shots and making it easy to get the shots. Look for differences of at least 4%. Smaller differences usually are not significant Adolescent Immunizations We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% Kaiser Permanente Southern California Region - 74% Kaiser Permanente Northern California Region - 71% Blue Cross HMO CaliforniaCare 65% Health Net of California, Inc. 64% Aetna Health of California Inc. 59% CIGNA HMO59% PacifiCare of California - 53% Blue Shield of California HMO - 52% Western Health Advantage - 38% [Page 30] HMO Ratings | Meeting National Standards of Care | Treating Children: Getting the Right Care Treating Children with Throat Infections What Was Measured? What percentage of children in the HMO, ages 2-18, who were diagnosed with pharyngitis (throat infection) and given an antibiotic medication, were tested for strep throat. These results are based on a sample of HMO patient administrative records. Why Is It Important? A child who has a throat infection should be tested for strep throat before being treated. A throat culture is the test that tells the doctor whether or not your child has a strep infection and whether or not to prescribe antibiotics. Without the test, your child may be given an antibiotic when it is not needed. Good care means making sure children are tested for a strep infection before they are given antibiotics. Look for differences of at least 4%. Smaller differences usually are not significant Treating Children with Throat Infections We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% Kaiser Permanente Northern California Region - 86% Kaiser Permanente Southern California Region - 80% Western Health Advantage - 61% Health Net of California, Inc. - 43% CIGNA HMO - 38% Blue Shield of California HMO - 37% PacifiCare of California - 37% Aetna Health of California Inc. - 33% Blue Cross HMO CaliforniaCare - 32% HMO Ratings | Meeting National Standards of Care | Treating Children: Getting the Right Care Treating Children with Upper Respiratory Infections What Was Measured? What percentage of children in the HMO, ages 3 months to 18 years, who had an upper respiratory infection (common cold) were not given an antibiotic — medicines that don’t work for these viral infections. These results are based on a sample of HMO patient administrative records. Why Is It Important? If your child has a cold, he or she probably does not need an antibiotic. Colds are viruses, and antibiotics do not work for viral infections. Antibiotics treat infections caused by bacteria. Each year, about 1 out of 5 children wrongly receives antibiotics for a cold. Taking antibiotics when they are not necessary puts your child at risk for the medicine’s side effects. Also, if your child uses antibiotics too often, they can be less effective for treating infections in the future. Look for differences of at least 4%. Smaller differences usually are not significant Treating Children with Upper Respiratory Infections We compared HMO members' records to a set of national standards for quality of care. 0% (Worse) - (Better) 100% Kaiser Permanente Northern California Region - 95% Kaiser Permanente Southern California Region - 92% CIGNA HMO - 86% Western Health Advantage - 86% Health Net of California, Inc. - 82% PacifiCare of California - 81% Blue Cross HMO CaliforniaCare - 80% Blue Shield of California HMO - 80% Aetna Health of California Inc. - 78% [Page 31] THE PATIENT ADVOCATE [Page 32] HMO Ratings Members Rate Their HMO Eleven measures make up a HMO’s “Members Rate Their HMO” score. These measures fall into four topics: Helping Smokers Quit • Doctor Advises Patient to Quit Smoking • Doctor Discusses Medications to Help Smokers Quit • Doctor Discusses Ways to Help Smokers Quit HMO Customer Service • Answer Customer Phone Calls Quickly • Customer Service • Finding a Personal Doctor • Getting Doctors and Care Easily Paying Claims Member Complaints • Member Complaints Members Rate HMO Doctors and Care • Doctor Communications • Getting Appointments and Care Quickly • Health Care Highly Rated There are no “At-a-Glance” charts for these topics. HMO Ratings | Members Rate Their HMO | Helping Smokers Quit Doctor Advises Patient to Quit Smoking What Was Measured? What percentage of HMO members who smoke or quit recently got information from their doctor about ways to quit smoking in the past year? These results are based on a survey of a sample of HMO members. Why Is It Important? Most smokers know they should stop. Many try to stop but cannot. You are more likely to be able to stop if your doctor talks to you about quitting. Good care means your doctor knows which patients smoke, tells them about ways to quit, and follows up with them regularly. Look for differences of at least 4%. Smaller differences usually are not significant Doctor Advises Patient to Quit Smoking We compared how HMO members rate their care and services. 0% (Worse) - (Better) 100% Kaiser Permanente Northern California Region - 83% Western Health Advantage - 78% Kaiser Permanente Southern California Region - 66% Aetna Health of California Inc. - Too few patients in sample to report Blue Cross HMO CaliforniaCare - Too few patients in sample to report Blue Shield of California HMO - Too few patients in sample to report CIGNA HMO - Too few patients in sample to report Health Net of California, Inc. - Too few patients in sample to report PacifiCare of California - Too few patients in sample to report [Page 33] HMO Ratings | Members Rate Their HMO | Helping Smokers Quit Doctor Discusses Medications to Help Smokers Quit What Was Measured? What percentage of HMO members who smoke or quit recently got information from their doctor about medications to help them quit smoking in the past year? These results are based on a survey of a sample of HMO members. Why Is It Important? Many smokers try to stop but cannot. You are more likely to be able to stop if your doctor talks to you about quitting and tells you about medications, such as pills or the nicotine patch, that can help you stop smoking. Good care means that your doctor knows which patients smoke, tells them about medications and other ways to quit, and follows up with them regularly. Look for differences of at least 4%. Smaller differences usually are not significant Doctor Discusses Medications to Help Smokers Quit We compared how HMO members rate their care and services. 0% (Worse) - (Better) 100% Western Health Advantage - 53% Kaiser Permanente Northern California Region - 51% Kaiser Permanente Southern California Region - 37% Aetna Health of California Inc. - Too few patients in sample to report Blue Cross HMO CaliforniaCare - Too few patients in sample to report Blue Shield of California HMO - Too few patients in sample to report CIGNA HMO - Too few patients in sample to report Health Net of California, Inc. - Too few patients in sample to report PacifiCare of California - Too few patients in sample to report HMO Ratings | Members Rate Their HMO | Helping Smokers Quit Doctor Discusses Ways to Help Smokers Quit What Was Measured? What percentage of HMO members who smoke or quit recently got information from their doctor about ways to quit smoking in the past year? These results are based on a survey of a sample of HMO members. Why Is It Important? Many smokers try to stop but cannot. You are more likely to be able to stop if your doctor talks to you about quitting and tells you about programs to help you stop. Good care means that your doctor knows which patients smoke, tells them about medications and other ways to quit, and follows up with them regularly. Look for differences of at least 4%. Smaller differences usually are not significant Doctor Discusses Ways to Help Smokers Quit We compared how HMO members rate their care and services. 0% (Worse) - (Better) 100% Kaiser Permanente Northern California Region - 58% Western Health Advantage - 52% Kaiser Permanente Southern California Region - 41% Aetna Health of California Inc. - Too few patients in sample to report Blue Cross HMO CaliforniaCare - Too few patients in sample to report Blue Shield of California HMO - Too few patients in sample to report CIGNA HMO - Too few patients in sample to report Health Net of California, Inc. - Too few patients in sample to report PacifiCare of California - Too few patients in sample to report [Page 34] HMO Ratings | Members Rate Their HMO | HMO Customer Service Answer Customer Phone Calls Quickly What Was Measured? What percentage of members' phone calls to their HMO were answered by a person within the first 30 seconds. These results are based on the HMO’s phone system records. Why Is It Important? HMOs that received a high rating for answering customers’ phone calls quickly means that most calls are answered within 30 seconds and a person who members can talk to answers the calls. Look for differences of at least 4%. Smaller differences usually are not significant Answer Customer Phone Calls Quickly We compared how HMO members rate their care and services. 0% (Worse) - (Better) 100% Western Health Advantage - 98% Kaiser Permanente Southern California Region - 82% Aetna Health of California Inc. - 79% Kaiser Permanente Northern California Region - 78% PacifiCare of California - 75% Health Net of California, Inc. -74% Blue Shield of California HMO - 70% CIGNA HMO - 69% Blue Cross HMO CaliforniaCare - Not reported HMO Ratings | Members Rate Their HMO | HMO Customer Service Customer Service What Was Measured? What percentage of HMO members highly rated their HMO on its customer service? These results are based on a survey of a sample of HMO members. Why Is It Important? High scores mean that the HMO's customer service staff was helpful and members got the information that they needed. Look for differences of at least 4%. Smaller differences usually are not significant Customer Service We compared how HMO members rate their care and services. 0% (Worse) - (Better) 100% Blue Shield of California HMO - 78% Western Health Advantage - 72% Blue Cross HMO CaliforniaCare - 68% Kaiser Permanente Northern California Region - 68% Kaiser Permanente Southern California Region - 66% Health Net of California, Inc. 63% Aetna Health of California Inc. Too few patients in sample to report CIGNA HMO Too few patients in sample to report PacifiCare of California Too few patients in sample to report [Page 35] HMO Ratings | Members Rate Their HMO | HMO Customer Service Finding a Personal Doctor What Was Measured? What percentage of HMO members said that it was easy to find a personal doctor who they are happy with? These results are based on a survey of a sample of HMO members. Why Is It Important? High scores mean that it was easy for HMO members to find a personal doctor from the plan’s list and they are happy with this doctor. Look for differences of at least 4%. Smaller differences usually are not significant Finding a Personal Doctor We compared how HMO members rate their care and services. 0% (Worse) - (Better) 100% PacifiCare of California - 78% Kaiser Permanente Northern California Region - 74% Western Health Advantage - 73% Health Net of California, Inc. - 70% Blue Shield of California HMO - 68% Blue Cross HMO CaliforniaCare - 65% Aetna Health of California Inc. - Too few patients in sample to report CIGNA HMO - Too few patients in sample to report Kaiser Permanente Southern California Region - Too few patients in sample to report HMO Ratings | Members Rate Their HMO | HMO Customer Service Getting Doctors and Care Easily What Was Measured? What percentage of HMO members’ highly rated the plan for helping them get the care they need? These results are based on a survey of a sample of HMO members. Why Is It Important? High scores mean the members didn’t face delays or hassles in seeing a specialist or getting tests or treatment. Look for differences of at least 4%. Smaller differences usually are not significant Getting Doctors and Care Easily We compared how HMO members rate their care and services. 0% (Worse) - (Better) 100% PacifiCare of California – 84% Western Health Advantage – 82% Health Net of California, Inc. – 80% Kaiser Permanente Northern California Region – 80% Blue Shield of California HMO – 79% CIGNA HMO – 78% Kaiser Permanente Southern California Region – 77% Blue Cross HMO CaliforniaCare – 75% Aetna Health of California Inc. – 74% [Page 36] HMO Ratings | Members Rate Their HMO | HMO Customer Service Paying Claims What Was Measured? What percentage of HMO members highly rated their HMO on paying claims correctly and quickly? These results are based on a survey of a sample of HMO members. Why Is It Important? High scores mean that HMO members’ reported that claims were paid correctly and quickly. Look for differences of at least 4%. Smaller differences usually are not significant Paying Claims We compared how HMO members rate their care and services. Look for differences of at least 4%. Smaller differences usually are not significant 0% (Worse) - (Better) 100% Blue Shield of California HMO83% PacifiCare of California - 83% CIGNA HMO - 81% Blue Cross HMO CaliforniaCare - 79% Kaiser Permanente Northern California Region - 78% Kaiser Permanente Southern California Region - 76% Aetna Health of California Inc. - 74% Health Net of California, Inc. - 72% Western Health Advantage - Too few patients in sample to report HMO Ratings | Members Rate Their HMO | Member Complaints Member Complaints What Was Measured? What percentage of HMO members reported that they did not have a complaint that lead them to call or write their HMO? These results are based on a survey of a sample of HMO members. Why Is It Important? HMOs that score highly do a better job of explaining the rules and features of the plan and fewer members face unexpected costs or problems getting care. Look for differences of at least 4%. Smaller differences usually are not significant Member Complaints We compared how HMO members rate their care and services. 0% (Worse) - (Better) 100% Western Health Advantage - 90% Blue Cross HMO CaliforniaCare - 88% PacifiCare of California - 88% Blue Shield of California HMO - 87% Health Net of California, Inc. - 79% Aetna Health of California Inc. - Too few patients in sample to report CIGNA HMO - Too few patients in sample to report Kaiser Permanente Northern California Region - Too few patients in sample to report Kaiser Permanente Southern California Region - Too few patients in sample to report [Page 37] HMO Ratings | Members Rate Their HMO | Members Rate HMO Doctors and Care Doctor Communications What Was Measured? What percentage of HMO members’ highly rated their doctors’ communication skills? These results are based on a survey of a sample of HMO members. Why Is It Important? Doctors’ communications with their patients are important to good health care. Patients better follow their doctor’s instructions when the doctor treats them respectfully, gives them time and attention, listens carefully and explains things clearly. Look for differences of at least 4%. Smaller differences usually are not significant Doctor Communications We compared how HMO members rate their care and services. 0% (Worse) - (Better) 100% Kaiser Permanente Southern California Region - 92% CIGNA HMO - 91% PacifiCare of California - 91% Health Net of California, Inc. - 90% Kaiser Permanente Northern California Region - 89% Aetna Health of California Inc. - 88% Blue Cross HMO CaliforniaCare - 88% Western Health Advantage - 88% Blue Shield of California HMO - 87% HMO Ratings | Members Rate Their HMO | Members Rate HMO Doctors and Care Getting Appointments and Care Quickly What Was Measured? What percentage of HMO members’ highly rated their HMO on how quickly and easily they got care and service from their doctors and office staff? These results are based on a survey of a sample of HMO members. Why Is It Important? Getting care when you need it is important to everyone. High scores mean that HMO members got care as soon as they needed when ill or injured and got appointments for routine care when they wanted them. Look for differences of at least 4%. Smaller differences usually are not significant Getting Appointments and Care Quickly We compared how HMO members rate their care and services. 0% (Worse) - (Better) 100% Kaiser Permanente Northern California Region - 83% CIGNA HMO - 82% PacifiCare of California - 82% Blue Shield of California HMO - 80% Western Health Advantage - 80% Health Net of California, Inc. - 77% Blue Cross HMO CaliforniaCare - 75% Kaiser Permanente Southern California Region - 75% Aetna Health of California Inc. - 73% [Page 38] HMO Ratings | Members Rate Their HMO | Members Rate HMO Doctors and Care Health Care Highly Rated What Was Measured? What percentage of HMO members highly rated their health care — 8, 9 or 10 on a 0-10 scale. These results are based on a survey of a sample of HMO members. Why Is It Important? How you feel about your health plan depends on your experiences with the doctors and the staff. HMOs that have a high rating for health care make it easy for their members to get the care they need. They also have doctors and staff who listen to patients, explain things clearly and treat them with respect. Look for differences of at least 4%. Smaller differences usually are not significant Health Care Highly Rated We compared how HMO members rate their care and services. 0% (Worse) - (Better) - 100% PacifiCare of California - 73% Blue Shield of California HMO - 71% Western Health Advantage - 71% Kaiser Permanente Northern California Region - 69% CIGNA HMO - 68% Health Net of California, Inc. - 68% Kaiser Permanente Southern California Region - 67% Blue Cross HMO CaliforniaCare - 65% Aetna Health of California Inc. - 61% [Page 39] THE PATIENT ADVOCATE [Page 40] Language Services What Are Language Assistance Services? Language assistance services are services available from your HMO if you or a family member use American Sign Language (ASL) or do not speak or understand English as well as another language. These services, such as an interpreter to help you talk with your doctors or materials that are written in your preferred language, may assist you with obtaining and making the most of the medical care and treatment you receive. How Did We Obtain This Information? The Office of the Patient Advocate (OPA) sent a survey in 2006 to most of California’s largest HMOs asking them about their language services. The language assistance services charts and rating are based on the HMOs’ answers to questions about: • How members communicate with their HMO and their doctors. • How members get information in non-English languages. • How members get information on services and costs. • How important the HMO thinks language services are. What Information is Available? Visit the expanded version of the Health Care Quality Report Card at HealthCareQuality.ca.gov to find out what language assistance services HMOs offer. Go to the “Language Services” section and select your type of insurance and preferred language. Information is available on the following topics: • Interpreter Services and Bilingual Staff • Translated Written Materials and Web Site Information • Plan Monitors Language Services Complaints • Plan Staff and Provider Training • Language Services Operations and Plan Policies There is data available for the following languages: • Armenian • American Sign Language (ASL) • Chinese • Korean • Russian • Spanish • Tagalog • Vietnamese [Page 41] A check in a box means that the HMO offers the service. If you do not see a check, you may still ask your HMO if they can make the service available to you in your preferred language. Example: Spanish speaking member services staff available ( Plan provides access to telephone advice nurse ( Plan arranges for access to face-to-face interpreters during business hours ( Members informed about interpreter services in member handbook ( The language services an HMO offers routinely may be different depending on your insurance coverage. For example, an HMO may offer different language services to members who have health insurance through their employer than it offers to members who have Medi-Cal. You will also find a rating showing how the language services offered by HMOs compare to each other. A rating of More means that the HMO says it offers more language services than other HMOs. A rating of Less means that the HMO says it offers fewer language services than other HMOs. Members informed about interpreter services in plan newsletter How Can I Get More Information? To find out more about language services, call your HMO. You can fi nd the phone number and web site for each HMO on the Directory page at HealthCareQuality.ca.gov. If you have a problem getting language services, call the Offi ce of the Patient Advocate at 1-866-466-8900. There is no charge for this call. [Page 42] Scoring and Rating Methods HMO quality scores were constructed using the HEDIS® and CAHPS® quality performance systems. The quality measures are based on the services, care, and experiences of samples of commercial HMO members who were enrolled in the HMO throughout 2006. Medical chart and service records were collected and HMO members were surveyed in a standardized way through the coordination of the California Cooperative Healthcare Reporting Initiative (CCHRI). A “buffer zone” adjustment is used for the summary measures Meeting National Standards of Care and Members Rate HMO. This adjustment accounts for the error that occurs in measurement and scoring when the formula is based on samples of members rather than all the members in an HMO. This “buffer zone” gives the benefi t of the doubt to the HMO — if a score falls below a performance threshold, but within a half-point of that threshold, the HMO is assigned that next highest grade. The Meeting National Standards of Care scores represent the percent of members who got the right care. Scoring a topic requires several steps. First, scores are calculated for a number of important measures of good medical care - like are patients with harmful, high blood pressure seeing good results in lowering their blood pressure. Next, a number of these measures, that concern related aspects of a health condition, are combined into a topic score. The measures are combined by giving them equal weight and calculating an average score. Last, the topic scores are combined into a single summary rating using the same “equal weight and average score formula.” The score is given one of four performance grades that are indicated in the report card with stars. The possible grades for the single summary rating Meeting National Standards of Care are: Excellent: This means that about 8 of every 10 or more HMO members got the right care. Good: This means that about 3 of every 4 HMO members got the right care. Fair: This means that about 2 of every 3 HMO members got the right care. Poor: This means that fewer than 3 of every 5 HMO members got the right care. The Members Rate Their HMO rating is based on a single CAHPS® survey question that asks members to rate all of their experience with the health plan. Members are asked to rate their overall experience on a 0-10 scale. The score is the number of members who rated the plan 8, 9 or 10 as a proportion of all members who answered the question. Scores for the various CAHPS® topics are based on the proportion of the members’ who gave a positive response (“always” or “usually” for most questions) to the survey question. For most questions, responses are scored using one of four possible answers ranging from the member “always” had a positive experience with a particular need like getting an appointment to the member “never” had a positive experience. Each member’s responses for a set of related questions like “paying claims” are combined to create a per-member topic score; then the average of all of the members’ scores is calculated to create an HMO score for that topic. The scores represent the average or typical experience that the HMO’s members reported. The score for the single summary rating Members Rate Their HMO is given one of four performance grades that are indicated in the report card with stars. The possible grades are: Excellent: This means that about 3 of every 4 or more HMO members rated the health plan highly. Good: This means that about 2 of every 3 HMO members rated the health plan highly. Fair: This means that about 3 of every 5 HMO members rated the health plan highly. Poor: This means that only about half of HMO members rated the health plan highly. [Back Cover] We at OPA hope you found this booklet informative and helpful. If you have questions or comments about the 2007 Health Care Quality Report Card, please contact us at: Office of the Patient Advocate 980 9th Street, Suite 500 Sacramento, CA 95814 1-866-466-8900 www.opa.ca.gov