RSS Feed
Print Story
E-mail Story
State HMO report card grades GEMCare 'fair'
2 Kern medical groups get 'good' rating from agency
| Wednesday, Sep 27 2006 10:20 PM
Last Updated: Thursday, Sep 28 2006 10:30 AM
e-mail: ehagedorn@bakersfield.com
BAKERSFIELD.COM HOT TOPICS:
Loading Stories
Advertisement
Patients have new information to help them evaluate their HMOs and physician groups.
The California Office of the Patient Advocate on Wednesday released its 2006 Healthcare Quality Report Card, which assessed the state's top-managed care organizations. The patient office, an independent state agency, gave ratings of one to four stars for patient satisfaction and meeting national standards.
Bakersfield's GEMCare got a two-star, "fair" rating, while Bakersfield Family Medical Center and Kern County's Kaiser Permanente both got three stars, or "good."
"I don't know what happened this year," said Robert Severs, CEO of GEMCare, which has 50,000 members. "I put stock in who the patients put stock in, and our membership is growing."
Information from the HMOs' records and members' medical charts was culled by the individual HMOs and overseen by the National Committee for Quality Assurance, which accredits managed care plans. The patient office then groups the measures into similar topics and calculates a rating, said Ed Mendoza, deputy director of the patient office.
On his office's Web site and in booklets available in pharmacies and libraries, health consumers can see how well the HMOs met standard care expectations for conditions like cancer, diabetes and childhood infections. For example, the organizations were rated on what percentage of adults got the right anti-inflammatory medicine for asthma.
All the participating groups financially support the report card by helping fund the California Cooperative Healthcare Reporting Initiative, a group of employers, health plans and providers that directed the phone and mail patient surveys. Between 100 and about 300 people were contacted from each group, Mendoza said.
Some 350 of GEMCare's members were surveyed, which Severs said could have skewed results.
"If they surveyed 5,000 members, I might have another opinion," he said.
HMOs, which are a form of health insurance, volunteer to be included in the ratings, as do medical groups, the groups of doctors that contract with HMOs to provide medical care. The nine California HMOs assessed -- including Blue Cross and PacifiCare -- comprise about 95 percent of HMO enrollees in the state. Only 182 of about 250 medical groups in the state took part. The ones that did not participate are generally smaller or do not want their ratings publicized, Mendoza said.
Despite its low rating, GEMCare's scores in the more specific patient satisfaction categories differed from the other groups by only a few percentage points.
Representatives from Kaiser Permanente and Bakersfield Family Medical Center were proud of their ratings.
"We're certainly encouraged about the fact that we beat GEMCare," said Robert O'Keefe, CEO of Bakersfield Family Medical Center, which has 35,000 members. "We are just beginning to tap into our potential."
Cristy Cortez-Sackrider, director of public affairs for the 95,000-member Kaiser Permanente-Kern County, views patient-driven ratings such as these as part of a positive shift toward health consumerism.
"This encourages people not to sit back and say, 'Fix me,' but to encourage people to say, 'I have the power to influence my health,'" she said.