Does Your Hmo Stack Up?

These ratings are the result of a survey designed by NEWSWEEK and the Foundation for Accountability, a nonprofit group based in Portland, Ore., to assess the quality of care offered by HMOs. The first group of categories, graded in the "Overall Quality Monitoring" column, tells you how willing an HMO is to measure and report its own effectiveness. The second, scored under "Overall Quality Results," tells you whether the HMO is keeping people healthy.

Fallon Community Health Plan, Mass. Number of members * 180 Complaint ratio low Meets industry standards excellent Measures satisfaction excellent Tracks members'health good Overall monitoring very good Prevention and screening excellent Maternity care very good Satisfied customers[a] excellent Overall quality results excellent Overall score excellent Comments Top prenatal and prevention scores, very complete disease monitoring. Harvard Community Health Plan, Mass. Number of members * 591 Complaint ratio high Meets industry standards excellent Measures satisfaction excellent Tracks members'health very good Overall monitoring excellent Prevention and screening excellent Maternity care excellent Satisfied customers[a] good Overall quality results excellent Overall score excellent Comments Among the most sophisticated trackers of health and disease. Kaiser Foundation Health Plan Inc. --Northern Calif. Region Number of members * 2,218 Complaint ratio n/a Meets industry standards very good Measures satisfaction excellent Tracks members'health very good Overall monitoring very good Prevention and screening excellent Maternity care very good Satisfied customers[a] excellent Overall quality results excellent Overall score excellent Comments Accreditation planned; excellent health, disease tracking. Kaiser Foundation Health Plan of Colorado Number of members * 308 Complaint ratio low Meets industry standards very good Measures satisfaction very good Tracks members'health very good Overall monitoring very good Prevention and screening excellent Maternity care very good Satisfied customers[a] excellent Overall quality results excellent Overall score excellent Comments Terrific prenatal care; holds itself accountable for members' health. CIGNA HealthCare of Arizona, Inc. Number of members * 150 Complaint ratio high Meets industry standards excellent Measures satisfaction very good Tracks members'health very good Overall monitoring very good Prevention and screening excellent Maternity care good Satisfied customers[a] good Overall quality results very good Overall score very good Comments Among the best at measuring disease and treatment results. Community Health Plan, N.Y. Number of members * 302 Complaint ratio low Meets industry standards excellent Measures satisfaction excellent Tracks members'health good Overall monitoring very good Prevention and screening good Maternity care excellent Satisfied customers[a] good Overall quality results very good Overall score very good Comments Very good prenatal record and C-section rate; too few vaccinations. FHP of Colorado, Inc. Number of members * 349 Complaint ratio high Meets industry standards very good Measures satisfaction excellent Tracks members'health good Overall monitoring very good Prevention and screening very good Maternity care very good Satisfied customers[a] excellent Overall quality results very good Overall score very good Comments Works hard at assessing member and doctor satisfaction. Group Health Cooperative of Puget Sound, Wash. Number of members * 634 Complaint ratio low Meets industry standards excellent Measures satisfaction very good Tracks members'health very good Overall monitoring very good Prevention and screening very good Maternity care excellent Satisfied customers[a] very good Overall quality results very good Overall score very good Comments One of the best at monitoring health, risk behaviors and disease outcomes. HealthAmerica Pennsylvania, Inc., Central Pa. Number of members * 204 Complaint ratio average Meets industry standards very good Measures satisfaction excellent Tracks members'health satisfactory Overall monitoring good Prevention and screening very good Maternity care very good Satisfied customers[a] very good Overall quality results very good Overall score very good Comments Good at prenatal care and C-sections, but not at assessing health risks. HealthAmerica Pennsylvania, Inc., Pittsburgh, Pa. Number of members * 270 Complaint ratio high Meets industry standards very good Measures satisfaction excellent Tracks members'health good Overall monitoring very good Prevention and screening good Maternity care good Satisfied customers[a] good Overall quality results good Overall score very good Comments Can report death rate for heart surgery; too few mammographies. Health Net, Calif. Number of members * 1,351 Complaint ratio n/a Meets industry standards very good Measures satisfaction very good Tracks members'health very good Overall monitoring very good Prevention and screening very good Maternity care satisfactory Satisfied customers[a] very good Overall quality results good Overall score very good Comments Excellent asthma, breast-cancer, diabetes tracking; weak on prenatal care. HMO Blue, Mass. Number of members * 850 Complaint ratio low Meets industry standards very good Measures satisfaction very good Tracks members'health excellent Overall monitoring excellent Prevention and screening excellent Maternity care satisfactory Satisfied customers[a] good Overall quality results good Overall score very good Comments Not accredited yet, but good at monitoring health and disease. HMO Pennsylvania--U.S. Healthcare Number of members * 807 Complaint ratio high Meets industry standards excellent Measures satisfaction very good Tracks members'health very good Overall monitoring very good Prevention and screening very good Maternity care satisfactory Satisfied customers[a] very good Overall quality results very good Overall score very good Comments Strong breast-cancer and heart -failure-management programs. Independent Health, N.Y. Number of members * 414 Complaint ratio low Meets industry standards satisfactory Measures satisfaction very good Tracks members'health very good Overall monitoring good Prevention and screening very good Maternity care good Satisfied customers[a] excellent Overall quality results very good Overall score very good Comments Accreditation denied but reapplying; good measurement of health levels. Kaiser Foundation Health Plan, Inc., Hawaii Number of members * 187 Complaint ratio n/a Meets industry standards very good Measures satisfaction very good Tracks members'health good Overall monitoring very good Prevention and screening very good Maternity care excellent Satisfied customers[a] very good Overall quality results excellent Overall score very good Comments Some of the happiest members; excellent vaccination and C-section rates. Kaiser Foundation Health Plan, Inc., Southern Calif. Region Number of members * 2,200 Complaint ratio n/a Meets industry standards excellent Measures satisfaction very good Tracks members'health very good Overall monitoring very good Prevention and screening good Maternity care very good Satisfied customers[a] excellent Overall quality results very good Overall score very good Comments Can report key heart-surgery rate; great at tracking members' health. Kaiser Foundation Health Plan of Georgia, Inc. Number of members * 201 Complaint ratio low Meets industry standards excellent Measures satisfaction satisfactory Tracks members'health good Overall monitoring good Prevention and screening very good Maternity care excellent Satisfied customers[a] excellent Overall quality results very good Overall score very good Comments Excellent maternity care; doesn't check on doctors' satisfaction. Kaiser Foundation Health Plan of Ohio Number of members * 188 Complaint ratio high Meets industry standards excellent Measures satisfaction very good Tracks members'health good Overall monitoring very good Prevention and screening excellent Maternity care satisfactory Satisfied customers[a] very good Overall quality results very good Overall score very good Comments Great prevention effort, lots of certified docs; too many C-sections. Kaiser Foundation Health Plan of the Mid-Atlantic States, Md. Number of members * 369 Complaint ratio low Meets industry standards excellent Measures satisfaction very good Tracks members'health satisfactory Overall monitoring good Prevention and screening very good Maternity care very good Satisfied customers[a] very good Overall quality results very good Overall score very good Comments Second highest percentage of certified docs; doesn't track outcomes. Kaiser Foundation Health Plan of the Northwest, Ore. Number of members * 391 Complaint ratio low Meets industry standards very good Measures satisfaction very good Tracks members'health good Overall monitoring good Prevention and screening very good Maternity care very good Satisfied customers[a] excellent Overall quality results very good Overall score very good Comments Very satisfied members; solid maternity care; fair health tracking MVP Health Plan, N.Y. Number of members * 525 Complaint ratio low Meets industry standards very good Measures satisfaction excellent Tracks members'health satisfactory Overall monitoring very good Prevention and screening very good Maternity care good Satisfied customers[a] excellent Overall quality results very good Overall score very good Comments Loyal members; no risk-behavior tracking and too few diabetic eye exams. NYLCare Health Plans of the Mid-Atlantic States, Md. Number of members * 364 Complaint ratio average Meets industry standards excellent Measures satisfaction very good Tracks members'health satisfactory Overall monitoring good Prevention and screening very good Maternity care good Satisfied customers[a] good Overall quality results very good Overall score very good Comments Can report key maternity numbers; disease tracking starts this year. Oxford Health Plans, N.Y. Number of members * 1,002 Complaint ratio low Meets industry standards very good Measures satisfaction very good Tracks members'health good Overall monitoring good Prevention and screening good Maternity care good Satisfied customers[a] excellent Overall quality results very good Overall score very good Comments Too many C-sections; very satisfied customers and doctors. Pilgrim Health Care, Inc., Mass. Number of members * 380 Complaint ratio low Meets industry standards very good Measures satisfaction excellent Tracks members'health very good Overall monitoring very good Prevention and screening excellent Maternity care very good Satisfied customers[a] excellent Overall quality results very good Overall score very good Comments Very satisfied members; has monitored mental health of members. Tufts Health Plan, Mass. Number of members * 448 Complaint ratio low Meets industry standards excellent Measures satisfaction very good Tracks members'health very good Overall monitoring very good Prevention and screening excellent Maternity care good Satisfied customers[a] excellent Overall quality results very good Overall score very good Comments Very good asthma and heart-disease tracking; too few certified doctors. U.S. Healthcare--HMO N.J. Number of members * 743 Complaint ratio low Meets industry standards excellent Measures satisfaction very good Tracks members'health good Overall monitoring very good Prevention and screening good Maternity care satisfactory Satisfied customers[a] very good Overall quality results good Overall score very good Comments Good health monitoring; unusually loyal members. AV-MED Health Plan, Fla. Number of members * 319 Complaint ratio average Meets industry standards very good Measures satisfaction good Tracks members'health satisfactory Overall monitoring good Prevention and screening satisfactory Maternity care satisfactory Satisfied customers[a] very good Overall quality results good Overall score good Comments Couldn't report Pap-smear rate, too many C-sections; members satisfied. ChoiceCare, Ohio Number of members * 203 Complaint ratio low Meets industry standards excellent Measures satisfaction excellent Tracks members'health satisfactory Overall monitoring good Prevention and screening good Maternity care satisfactory Satisfied customers[a] excellent Overall quality results good Overall score good Comments Couldn't report on prenatal care rate; too few vaccinations. CIGNA HealthCare of Florida Number of members * 180 Complaint ratio low Meets industry standards excellent Measures satisfaction very good Tracks members'health good Overall monitoring very good Prevention and screening good Maternity care good Satisfied customers[a] very good Overall quality results good Overall score good Comments Tied with Fallon for best prenatal score; too many C-sections. CIGNA Medical Group Healthplan, Calif. Number of members * 170 Complaint ratio n/a Meets industry standards very good Measures satisfaction very good Tracks members'health satisfactory Overall monitoring good Prevention and screening good Maternity care good Satisfied customers[a] good Overall quality results good Overall score good Comments Good start in tracking members' health but doesn't share results. FHP Health Care, Ariz. Number of members * 174 Complaint ratio high Meets industry standards good Measures satisfaction good Tracks members'health satisfactory Overall monitoring good Prevention and screening very good Maternity care very good Satisfied customers[a] good Overall quality results very good Overall score good Comments Tops in prenatal care and C-section rates; not enough certified doctors. FHP Inc, Calif. Number of members * 941 Complaint ratio n/a Meets industry standards good Measures satisfaction very good Tracks members'health satisfactory Overall monitoring good Prevention and screening very good Maternity care good Satisfied customers[a] satisfactory Overall quality results good Overall score good Comments Members report weak satisfaction; excellent C-section rating. Harris Methodist Health Plan, Texas Number of members * 229 Complaint ratio low Meets industry standards very good Measures satisfaction good Tracks members'health satisfactory Overall monitoring good Prevention and screening satisfactory Maternity care excellent Satisfied customers[a] excellent Overall quality results very good Overall score good Comments Very good prenatal care; too few vaccinations and mammographies. Health Insurance Plan of Greater New York Number of members * 853 Complaint ratio high Meets industry standards very good Measures satisfaction good Tracks members'health satisfactory Overall monitoring good Prevention and screening satisfactory Maternity care good Satisfied customers[a] satisfactory Overall quality results satisfactory Overall score good Comments Weak prevention results; members report low satisfaction. HMO--Oregon Number of members * 810 Complaint ratio average Meets industry standards good Measures satisfaction very good Tracks members'health satisfactory Overall monitoring good Prevention and screening good Maternity care very good Satisfied customers[a] good Overall quality results good Overall score good Comments Exceptional C-section rate; accreditation planned. Intergroup Healthcare Corp., Ariz Number of members * 268 Complaint ratio average Meets industry standards very good Measures satisfaction good Tracks members'health satisfactory Overall monitoring good Prevention and screening very good Maternity care very good Satisfied customers[a] good Overall quality results very good Overall score good Comments Doesn't track risk behaviors or regularly check if docs are satisfied. PacifiCare of California Number of members * 1,901 Complaint ratio n/a Meets industry standards very good Measures satisfaction very good Tracks members'health good Overall monitoring good Prevention and screening good Maternity care good Satisfied customers[a] good Overall quality results good Overall score good Comments Weak vaccination rate; tracks key maternity figures. PruCare of California Number of members * 615 Complaint ratio n/a Meets industry standards excellent Measures satisfaction very good Tracks members'health satisfactory Overall monitoring good Prevention and screening very good Maternity care good Satisfied customers[a] satisfactory Overall quality results good Overall score good Comments Meets all industry standards, but members give it low satisfaction scores. Rush Prudential HMO Inc., Ill. Number of members * 354 Complaint ratio low Meets industry standards very good Measures satisfaction very good Tracks members'health satisfactory Overall monitoring good Prevention and screening good Maternity care excellent Satisfied customers[a] satisfactory Overall quality results good Overall score good Comments Not paying enough attention to members' overall health. U.S. Healthcare, N.Y. Number of members * 581 Complaint ratio low Meets industry standards excellent Measures satisfaction very good Tracks members'health good Overall monitoring very good Prevention and screening good Maternity care satisfactory Satisfied customers[a] good Overall quality results good Overall score good Comments Weak in maternity care and disease-prevention activities. Aetna Health Plans of California, Inc. Number of members * 326 Complaint ratio n/a Meets industry standards excellent Measures satisfaction good Tracks members'health satisfactory Overall monitoring good Prevention and screening satisfactory Maternity care satisfactory Satisfied customers[a] satisfactory Overall quality results satisfactory Overall score satisfactory Comments Meets industry standards but doesn't track health or disease levels. CareAmrica Health Plans, Calif. Number of members * 218 Complaint ratio n/a Meets industry standards good Measures satisfaction satisfactory Tracks members'health satisfactory Overall monitoring good Prevention and screening satisfactory Maternity care satisfactory Satisfied customers[a] satisfactory Overall quality results satisfactory Overall score satisfactory Comments Didn't report on prevention, maternity care; doesn't check doc satisfaction. NYLCare Health Plan, Texas Number of members * 361 Complaint ratio high Meets industry standards good Measures satisfaction very good Tracks members'health satisfactory Overall monitoring good Prevention and screening satisfactory Maternity care good Satisfied customers[a] satisfactory Overall quality results satisfactory Overall score satisfactory Comments Accreditation planned; too few vaccinations and mammographies. * in thousands

Sources: 1996 Newsweek/Foundation for Accountability Survey; David Lansky, FACCT president; States' Departments of Insurance or Corporations. [a] Source: Caredata, Center for the Study of Services, Fortune 500 COs. The 43 HMOs listed above responded to the survey. The following 32 did not: CaliforniaCare Foundation Health, Calif.; Keystone Health Plan Est, Pa.; Allina Health Plan, Minn.; Blue Choice, N.Y.; Health Partners, Minn.; Health Alliance Plan of Michigan; M.D. Individual Practice Association, MD.; United Healthcare of Ohio; Health Options, Inc. Fla.; HMO Illinois; Tennessee Primary Care; Chicago HMO, Ltd.; United Healthcare, Ala.; PCA Family Health Plan, Fla.; Humana Medical Plan, Fla.; Humana Health Plan Inc., Ky.; Blue Shield of California HMO; HMO Health Ohio; Community Blue, the HMO of BC and BS of Western N.Y., Inc.; Humana Health Plan, Inc., Ill.; Heritage National Healthplan, Inc., Ill.; CAC-United Healthcare Plans of Fla., Inc.; Primecare Health Plan, Wis.; Keystone Health Plan West, Inc., Pa.; United Healthcare of Ohio, R.I.; Blue Care Network of Southeast Michigan; Physicians Health Plan, Mich.; United Health Plans of New England, Inc.; R.I.; HIP Health Plan of New Jersey; Capital District Physicians' Health Plan, N.Y.; Community Physician Network, Calif.

© 1996