Does Your Hmo Stack Up?

There were two other measures that were nobrainers: HMOs should be affiliated with hospitals accredited by the Joint Commission on Accreditation of Healthcare Organizations and employ a high percentage of doctors who have been "board certified." That means they've had extra training and passed a rigorous exam. Kaiser Foundation of the Mid-Atlantic States had the highest percentage of board-certified doctors, at 95 percent, while FHP Health Care, Ariz., had the lowest, at 67. Also HMOs that tie doctors' compensation to meeting quality and satisfaction targets received extra points.

Measures Satisfaction:

Most HMOs try to figure out how contented their members are. But for the results to be believable, an HMO has to hire an independent firm to conduct the satisfaction survey, use a standardized set of questions and release the results to the public. HMOs that followed all of those steps received higher scores than plans that didn't. Points were also awarded to plans that will shift to the NCQA's standardized survey this year. That signals an HMO's willingness to have its members' satisfaction levels compared with its competitors'--a huge service. Successful HMOs should also keep their doctors happy. Who wants to go to an unhappy one? So HMOs that asked doctors about their satisfaction with the plan got credit.

Tracks Members' Health:

Would it surprise you that most HMOs couldn't tell you exactly how healthy or unhealthy their members are? Or how many enrollees smoke, abuse alcohol or engage in unsafe sex? Only one plan merited a four-star rating in this category, which was weighted twice as heavily as the previous two: HMO Blue of Massachusetts. It hasn't been known for delivering exceptional quality. But it turns out our ratings have pinpointed an important development: the HMO is dramatically overhauling its quality programs. "It's one of the best turnarounds I've seen," says consultant Sue Sheffler.

The best plans use hard-nosed measures called "outcomes." Outcomes show the ugly side of health care: how many diabetics had to undergo an amputation; how many women died of breast cancer. HMOs haven't been eager to embrace these measures, largely because an HMO with a high number of diabetic enrollees is bound to look bad next to a plan with very few.