Texas Issues New "Report Cards" Comparing HMOs

By Ronald L. Scott

With little fanfare, the state of Texas has issued a new type of "report card" comparing the top 34 HMOs that operate in Texas. The plans were selected based on market share and plan size within each service area, and the HMOs rated account for ninety percent of the Texas commercial enrollment for 1997.

Typically, health care plan report cards are a way to compare the quality of plans. Some report cards are issued by organizations such as U.S. News & World Report and Consumersí Checkbook. Such report cards review items such as rates of immunizations, cervical cancer screening, mammograms, and cholesterol screening provided by plans. Some report cards are prepared by the plans themselves, usually based on Health Plan Employer Data Information Set (HEDIS) data. HEDIS is a health plan survey that measures about 60 different health care areas to determine and quantify the quality of services offered by HMOs. HEDIS recently added member satisfaction to the areas measured. Some, but not all, plans have their report cards audited by the National Committee for Quality Assurance (NCQA). The NCQA is an independent, non-profit organization that assesses and reports on health plan quality of HMOs.

Texas legislation passed in 1997 required the Office of Public Insurance Counsel (OPIC) to collect a variety of quality data on Texas HMOs and prepare a report card comparing Texas plans. Although HEDIS has recently added patient ratings of quality and satisfaction, the OPIC survey utilized another survey instrument known as the Consumer Assessment of Health Plans Study (CAHPS). CAHPS is similar to HEDIS, but places a greater emphasis on patientsí assessment of the care process, including health care professionals, access, continuity, and coordination of care. The survey did not ask technical questions that would be difficult for patients to assess (such as how well a physician performs surgery) but instead focused on issues such as how quickly patients could obtain needed appointments, how well their physicians explain things in a way patients can understand, and whether patients are treated with respect and courtesy by office staff.

Plans are rated on a "star" system, with three stars being better than average, two stars average, and one star below average. The survey also contains charts showing how plans compare to Texas state averages on a variety of issues. For example, a section captioned Getting the care you need shows answers to survey questions that asked patients howoften they: (1) received tests or treatments they thought they needed; (2) saw a specialist when they thought they needed one; (3) were able to see their own physician when they wanted to, rather than someone else; and (4) received the medical help or advice they needed when they called a physicianís office during regular daytime hours. Overall, 62 percent of patients said they always received care when needed, 18 percent said they usually received needed care, and 20 percent said they "sometimes or never" received needed care. The full text of the report is available at the OPIC web site http://www.opic.state.tx.us/reportcard.html.