Kaiser Permanente posted the most top scores in the state's annual HMO "report card" published yesterday - as it has done for most of the past decade - but two others, Coventry and UnitedHealthcare's M.D. IPA, were close behind.
Officials at the Maryland Health Care Commission, which prepares the annual consumer guide, said HMOs had been improving their performance since the state began making the data public, leading to a narrowing of differences.
"The state average has gone up, and the plans move in tandem," said Joyce Burton, the commission's chief of health plan quality and performance. "The good news is that there isn't one standout any longer. Several other plans are close behind."
Kaiser had eight above-average rankings on the 24 measures compiled from medical records (such as the percentage of new mothers who had follow-up appointments) and member surveys (such as the percentage of members who said their prescriptions cost less than they expected).
Coventry and M.D. IPA were right behind with seven above-average scores. The number of above-average scores for other HMOs was: CIGNA, five; CareFirst's BlueChoice, four; Optimum Choice, three, and Aetna, one. The HMOs got above-average scores if there was a statistically significant difference between their score and the state average.
The commission also announced that next year's report will for the first time cover preferred provider organizations (PPOs) as well as HMOs. Nationally, PPOs, which are less restrictive than HMOs, now enroll about three times as many people as HMOs.
The commission collected the PPO data this year as well, but wanted a year to correct glitches before publishing the results.
New to the report card this year is a separate set of scores compiled by the Mid-Atlantic Business Group on Health, whose 25 members are mostly large employers.
Based on questionnaires filled out by the HMOs, these scores, called eValue8, measure not just how much care was given, but the processes the HMO uses to send reminders to members about needed checkups.
The eValue8 questionnaire judged the HMOs in five areas. Kaiser got top scores in preventive care, disease management and prescription management, while Aetna had the highest scores in the two other areas, providing consumer information and mental health care.
John Miller, executive director of the business group, said that until now, eValue8 has been available only to large employers in his organization, such as McCormick & Co., Marriott International, Constellation Energy Group and the Baltimore County school system.
He said his group was happy the data would be available to small employers and individual consumers, since it wants to encourage purchasers of health insurance to consider quality as well as price. "It's not a commodity like sugar," he said. "It's not all the same."
The fact that employers and individual buyers focus on price explains why more than a decade of published data hasn't led to a shift of market share to the higher-scoring plans, he said. That's been true despite efforts by some plans, particularly Kaiser, to market star ratings.
While 11 years of reports haven't shifted market share, "The public release of data encourages plans to improve," said Bruce Kozlowski, director of the health care commission's center for health care financing and policy. "Everybody wants to be No. 1."
The result has been that average scores have gone up on many measures. For example, in the past three years, the share of adolescents getting checkup had increased from 38 percent to 45 percent; and the proportion of heart attack patients receiving recommended beta-blocker medication has gone from 66 percent to 75 percent.
An exception is the breast cancer screening rate, which has slipped from 73 percent to 69 percent over the past three years. Kozlowski and Burton said they weren't sure why.
Kevin Ruth, chief executive officer of UnitedHealthcare of the Mid-Atlantic, whose M.D. IPA HMO came close to matching Kaiser this year, said he looks at the scores each year and, while appreciating the high marks, focuses on areas for improvement.
"I probably am harder on my company than anybody. I turn my attention to where we can improve the business."
To get a copy
The report card is available online at http:--mhcc.maryland.gov/hmo/index.aspx. For printed or compact disc copies, call the commission at 410-764-3460 or toll-free at 877-245-1762.