Does Your Hmo Stack Up?

But don't be too alarmed. HMOs, for the most part, are willing to be held accountable. That was impossible under your old indemnity plan, when the insurance company paid the bills no matter which doctor you used. Who knew if your doctor was performing too many Caesarean sections?

As you scan the table on page 60, keep two things in mind. First, the ratings are a snapshot of HMO quality, not a permanent grade. Over the coming months HMOs will be reporting their 1995 quality results, which may reflect significant changes. A key way to track those will be through Quality Compass, a database that will be published in August by the National Committee for Quality Assurance, a Washington, D.C., group that accredits HMOs. Also: even low-scoring plans are to be commended for putting their reputation on the line.

NEWSWEEK's highest-scoring HMOs were Harvard Community Health Plan, Fallon Community Health Plan, Kaiser Foundation Health Plan of Colorado and Kaiser Foundation Health Plan-Northern California region. All have close, collaborative relationships with their doctors and a long-established mechanism for keeping people healthier. Low-scoring plans had more distant relationships with doctors, which made them less able to influence the kind of care given to their members. Here are the six criteria NEWSWEEK used to rate all the HMOs:

Meets Industry Standards:

At the very least, your health plan should pass certain objective standards. While there's no universally revered stamp of approval, accreditation by the NCQA comes close. To get it, a plan is judged on 50 different characteristics, like how well it checks out doctors' credentials. Of the 222 plans in the country that have been reviewed by the NCQA, only 37 percent won full accreditation. An additional 39 percent got partial accreditation, 11 percent received provisional accreditation and 12 percent were denied accreditation, including Aetna Health Plan of California and California Care. Who wouldn't prefer a fully accredited plan? The higher a plan's accreditation status, the more points it received. Points were also given to HMOs planning to seek accreditation.

It was also important to know if a plan published the results of a set of measures called HEDIS, for Health Plan Employer Data and Information Set. HEDIS was developed in 1989 by corporations like Xerox and GE, which wanted to compare plans. Any plan that seriously seeks better quality should be making that information public. Most on our list do.