Does Your Hmo Stack Up?

Satisfaction is slippery to interpret. So instead of relying on each plan's survey results, as originally planned, we used the data collected by three independent sources: CareData, a New York information company; the Center for the Study of Services, which publishes a Guide to Health Insurance Plans for Federal Employees, and a Fortune 500 company that has been a leader in evaluating HMOs on behalf of its employees. One caveat here: a high satisfaction rate doesn't necessarily mean the plan offers topnotch care. It may simply be a sign of excellent customer service. In a recent study of 17 HMOs by the Massachusetts Healthcare Purchaser Group, the plans ranked highest for quality were not the ones that won the highest satisfaction scores.

Complaints:

Every state cautioned against using complaints as a barometer of HMO quality. They cited a variety of reasons: grievances against self-insured plans aren't included; complaints may be coming from doctors and hospitals instead of consumers; and despite its gigantic HMO population, California hasn't yet published the data. So complaints aren't factored into our ratings, although they are broken out. We first calculated the number of complaints per 10,000 members, to adjust for different HMO sizes. Then we compared that complaint ratio with the average for all HMOs in the state. Only 10 of our group had higher than average complaints.

There's little reason to expect that evaluating HMOs will be a snap any time soon. As more consumer-advocate groups and corporations wrestle with the issue, disagreement about the definition will get louder. But it's important to keep trying. The best HMOs will want to provide even more data, because it helps their cause. Others will follow suit to stay competitive. And for consumers, picking an HMO will no longer be like throwing darts.

SURVEY

Rating 43 of America's Largest HMOs