Does Your Hmo Stack Up?

Still, most folks would prefer to belong to an HMO that's sharp enough to be measuring such bottom-line results. That's why points were awarded to HMOs that could reveal their death rate from coronary artery-bypass graft surgeries. This mortality rate is the single best-studied outcome yardstick-one you'd undoubtedly want to ask about if your family had a history of heart disease. But only seven of the 43 plans could report the crude 30-day rate.

Prevention and Screening:

One of the easiest ways to keep people healthy is to avoid sickness or detect it early. This principle is so well established that any plan that scored poorly here is probably in the early stages of upgrading its care. Plans were judged on their rates of vaccination, mammography, cervical-cancer screening and diabetic retinal exams because they're such effective tools and because so many HMOs can report on them.

Maternity Care:

Here three measurements counted. The first tells you how many women received prenatal care during the first trimester of their pregnancy. Top scorers such as Harris Methodist Health Plan have healthier babies and less risky deliveries as a result. The second: the percentage of pregnancies that result in Caesarean sections. The best HMOs are working to lower their C-section rate because so many of the surgeries are unnecessary and expose women to extra danger. The national rate today is 22 percent, but it was just 11 percent in 1971. Only four plans, including HMO-Oregon, could boast rates under 14 percent. The last measurement: the percentage of women who had a normal delivery after a previous C-section. Plans that could simply report it were given points. Why? It wasn't long ago that the medical profession believed that women who had one C-section couldn't have a normal delivery later. Plans that pay attention to this so-called VBAC rate are more likely to go to extra lengths to reduce risk in childbirth.

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