How California health plans fare on quality and patient experience: 9 things to know

California's Office of the Patient Advocate has released the 2016-17 edition of its healthcare quality report cards on health plans and medical groups.

The report cards rate the state's 10 largest HMO plans and five largest preferred provider organization plans, based on quality of care and patient experience, according to California Healthline. The report cards also rate 205 physician groups.

Measures considered for quality of care include making sure patients' blood pressure is well-managed and that children receive their immunizations.

Additionally, the most recent OPA report cards for the first time include cost of care information in its medical group ratings, according to California Healthline. The publication notes cost of care is based on the average amount that health plans and patients paid each group for care in the past year.

The report cards came out Friday, just ahead of the fourth annual open enrollment period, which kicks off Nov. 1 and runs through Jan. 31.

Here are nine things to know about the ratings.

1. Health plans received ratings of "poor," "fair," "good" or "excellent," with "excellent" representing the top rating.

2. Kaiser Permanente-Southern California and Kaiser Permanente-Northern California had the highest quality ratings in the HMO report card. Both achieved a rating of "excellent."

3. Aetna Health of California received a "poor" rating, the lowest quality rating for HMOs.

4. Blue Shield of California, Anthem Blue Cross, Cigna HMO, Health Net of California, Sharp Health Plan and Western Health Advantage all received a "good" rating in quality. UnitedHealthcare of California was the only HMO to receive to receive a "fair" quality rating.

5. As far as patient experience, most HMOs received a "good" rating, with the exception of Aetna Health of California, Health Net of California and UnitedHealthcare of California, which received "fair" ratings.

6. All HMO plans except Kaiser Permanente- Northern California and Western Health Advantage were rated "poor" on timely access to care under patient experience.

7. All five PPO plans — Aetna PPO, Anthem Blue Cross PPO, Blue Shield of California/Blue Shield Life PPO, Cigna PPO and UnitedHealthcare Insurance Co. — scored "fair" quality ratings.

8. Only one PPO plan — Blue Shield of California/Blue Shield Life PPO — scored a "poor" patient experience rating. Anthem Blue Cross PPO scored a "good" rating, while Aetna PPO, Cigna PPO and UnitedHealthcare Insurance Co. received "fair" ratings.

9. The 2016-17 report cards show most health plans in California perform better than the national average in care for diabetes, mental health and respiratory infections, among other conditions, according to California Healthline.

 

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