Comparing California Health Plans based on consumer complaints, enrollment, fines, penalties, and enforcement actions.
The Department of Managed Health Care (DMHC), who regulates most of the individual and family plans offered through Covered California, has developed a website to allow consumers to compare health insurance companies. The Health Plan Dashboard website does not assign any performance review ratings. But it does give consumers a high level view of some of the data collect on the health plans such as enrollment, complaints, and enforcement actions for medical, dental, and vision plans.
DMHC primarily regulates HMO plans in California. The exception to this is that they also regulate Anthem Blue Cross and Blue of California individual and family PPO plans. They regulate all the plans offered through Covered California and most of the off-exchange individual and family plans except the Health Net and Cigna PPOs. Those plans are regulated by the California Department of Insurance.
Comparing Health Insurance Companies with Health Plan Dashboard
The Health Plan Dashboard aggregates the data across all of the different plan types for the companies. For instance, on the enrollment page, DHMC segments the membership into Commercial, Government, and Other plans.
- Commercial: consists of Large Group, Small Group, and Individual enrollment.
- Government: consists of Medi-Cal and Medicare enrollment.
- Other: consists of Medicare Supplements, ASO, Healthy Kids, Discount, Plan-to-Plan, and Medicare Part D enrollment.
DMHC Health Plan Dashboard snapshot of Anthem Blue Cross health plan enrollment by sector: Commercial, Government, and Other.
Multiple plan types and markets represented for each company
The breakdown of the different enrollment groups is important from the stand point that complaints about the health plans may be treated differently by both the insurance company and DMHC. One example is that Medicare plans are more tightly regulated and monitored by the Centers for Medicare and Medicaid (CMS). CMS levies fines on Medicare Advantage plans and can force the company to suspend all enrollment through sanction action. Consequently, insurance companies marketing Medicare Advantage plans can be more responsive to problems their members may encounter.
The insurance companies usually have dedicated staff assigned to the different plan types to handle member problems and complaints. Some Large Group plans will have one unit within in the insurance company solely to service that organization. Dedicated staff helps reduce the number of problems that ultimately may get referred to DMHC or the Department of Insurance.
Consumer Complaints for California health insurance companies
The Consumer Complaints & Independent Medical Reviews section gives the total number and type of complaints filed by the consumers. Some of the complaint issues that DMHC tracks are enrollment, claims, coverage, coordination of care, provider attitude and access. The specific number of each type of complaint is shown along with the percentage that complaint makes up of the total complaints. For example, in 2015, Kaiser Permanente had 922 complaints about enrollment representing 29.9% of all complaints about Kaiser filed. What the Health Plan Dashboard doesn’t show is the complaint types as a percentage of overall enrollment by plan type. We don’t know if those complaints were concentrated in Large Group, Small Group, Individual, Medi-Cal or the Medicare plans.
California Department of Managed Health Care Health Plan Dashboard will show Consumer Complaints and requests for Independent Medical Reviews by health plan.
Independent Medical Reviews Upheld, Overturned, Reversed
The number and percentage of Independent Medical Reviews (IMR) are also listed on the Health Plan Dashboard for each company. IMRs are filed by consumers who have been denied coverage for a health care procedure. Sometimes the health plan might deny a procedure because they believe it to be experimental or other less invasive or costly treatment options may exist. Similar to the consumer complaints, the IMR are not represented as a percentage of the overall enrollment. It would also be helpful to have another data set comparing complaints and IMR between the different plan types the insurance company may offer such as EPO, HMO, HSP, and PPO.
Enforcement Actions, Fines, Penalties
Enforcement Actions are also displayed on the Health Plan Dashboard. Enforcement Actions are comprised of the regulator forcing the health plan to change their operation and fines. The health plan may have been told they had to correct a procedure or they had to cease implementing some part of their health plan. Fines are levied for violations.
DMHC Enforcement Actions and Fines against Health Net over several years.
You can compare to health plans side by side on the Market Place Dashboard. By selecting the List of All Plans link, and clicking on the Compare link of the plan you want to view, you will be given a pop-window to select another plan. By selecting a second plan, you are given a side-by-side comparison.
DMHC Health Plan Dashboard allows consumers to compare two health plans side-by-side for consumer complaints.
In this example, I compared Anthem Blue Cross to Blue Shield of California. What is particularly important is that the Consumer Complaints are measured per 10,000 enrolled members. This helps adjust for overall membership differences. But the data still doesn’t tell the consumer which plan type (employer group, individual, Medicare, Medi-Cal, etc.) the complaints are associated with. We don’t know if of the 750 Blue Shield complaints were in the group, individual, or Medicare market. However, we know that none of the complaints came from Medi-Cal because Blue Shield had not yet entered that market.
The DHMC Market Place Dashboard gives a better comparison data between health plans. For 2016, the Market Place Dashboard indicates that Anthem Blue Cross has had the greatest number of Enforcement Actions of any other health plan. Clicking on the more enforcement actions? link takes the viewer to another page show all enforcement actions, the violation, and penalty amount.
Aggregate data of Enforcement Actions by California Department of Managed Health Care of health insurance companies for consumer comparisons.
Erroneous consumer conclusions with raw data
Sometimes raw data such as presented on the DMHC Health Plan Dashboard can lead to erroneous consumer conclusions. The data really needs to be put into context relative to the market type, enrollment, and how long the plan has been in existence. A consumer may see 579 complaints about claims and think that is a high number. The health plan in question may have an enrollment that is ten times larger than a plan it is being compared to. The second plan may only have had 300 complaints but only 10% of the enrollment membership. In this case, the second plan has a higher percentage of complaints per membership base than the first plan.
The new health insurance information and comparison tool by DMHC is good for consumers. But it should be used with caution in comparing health insurance plans. There just isn’t enough data to know if a Covered California individual and family plan is accurately represented by some of the data presented in the Health Plan Dashboard.
Health, Dental, and Vision plans on the Health Plan Dashboard
- Access Dental Plan
- Access Senior HealthCare, Inc.
- ACN Group of California, Inc. ( OptumHealth Physical Health of California )
- Adventist Health Plan, Inc.
- Aetna Dental of California Inc.
- Aetna Health of California, Inc.
- AIDS Healthcare Foundation ( Positive Healthcare )
- Alameda Alliance For Health
- Alignment Health Plan
- American Specialty Health Plans, Inc. ( ASHP )
- AmericasHealth Plan, Inc.
- Arcadian Health Plan, Inc.
- Aspire Health Plan
- Association Health Care Management, Inc. ( Family Care )
- Avante Behavioral Health Plan
- UDC Dental California, Inc. ( United Dental Care of California, Inc. )
- United Concordia Dental Plans of CA, Inc.
- Western Dental Services, Inc. ( Western Dental Plan )
- Delta Dental of California
- SafeGuard Health Plans, Inc. ( MetLife )
- Association Health Care Management, Inc. ( Family Care )
- First Dental Health (New Dental Choice)
- The CDI Group, Inc.
- Access Senior HealthCare, Inc.
- Adventist Health Plan, Inc.
- Aetna Health of California, Inc.
- AIDS Healthcare Foundation ( Positive Healthcare )
- Alameda Alliance For Health
- Alignment Health Plan
- AmericasHealth Plan, Inc.
- Arcadian Health Plan, Inc.
- Aspire Health Plan
- Bay Area Accountable Care Network, Inc. ( Canopy Health )
- Blue Cross of California ( Anthem Blue Cross )
- Brown and Toland Health Services
- California Health and Wellness Plan ( CA Health & Wellness )
- California Physicians’ Service ( Blue Shield of California )
- Care 1st Health Plan
- CareMore Health Plan
- Central Health Plan of California, Inc.
- Chinese Community Health Plan
- Choice Physicians Network, Inc.
- Cigna HealthCare of California, Inc.
- Community Care Health Plan, Inc.
- Community Health Group
- Contra Costa County Medical Services ( Contra Costa Health Plan )
- County of Los Angeles-Dept of Health Srvcs. ( Community Health Plan )
- County of Ventura ( Ventura County Health Care Plan )
- DaVita Healthcare Partners Plan
- Dignity Health Provider Resources, Inc.
- EASY CHOICE HEALTH PLAN, Inc.
- EPIC Health Plan
- Fresno-Kings-Madera Regional Health Authority ( CalViva Health )
- GEMCare Health Plan, Inc. ( Physicians Choice by GEMCare Health Plan )
- Golden State Medicare Health Plan
- Health Net Community Solutions, Inc.
- Health Net of California, Inc.
- Heritage Provider Network, Inc.
- Humana Health Plan of California, Inc.
- Imperial Health Plan of California, Inc.
- Inland Empire Health Plan ( IEHP )
- Inter Valley Health Plan
- Kaiser Foundation Health Plan, Inc. ( Kaiser Permanente )
- Kern Health Systems
- Local Initiative Health Authority For L.A. County ( L.A. Care Health Plan )
- Medi-Excel, SA de CV ( MediExcel Health Plan )
- Molina Healthcare of California
- Monarch Health Plan
- On Lok Senior Health Services
- Orange County Health Authority ( CalOptima )
- Oscar Health Plan of California
- Partnership HealthPlan of California
- PIH Health Care Solutions
- Premier Health Plan Services, Inc.
- PRIMECARE Medical Network, Inc.
- Prospect Health Plan, Inc.
- Providence Health Network
- San Francisco Community Health Authority
- San Joaquin County Health Commission ( The Health Plan of San Joaquin )
- San Mateo Health Commission ( Health Plan of San Mateo )
- Santa Barbara San Luis Obispo Regional Health Auth ( CenCal Health )
- Santa Clara County ( Valley Health Plan )
- Santa Clara County Health Authority ( Santa Clara Family Health Plan )
- Santa Cruz-Monterey-Merced Managed Med. Care Comm. ( Central California Alliance for Health )
- Satellite Health Plan, Inc.
- Scan Health Plan
- Scripps Health Plan Services, Inc.
- Seaside Health Plan
- Sharp Health Plan
- Sistemas Medicos Nacionales, S.A.de C.V.
- Stanford Health Care Advantage
- Sutter Health Plan ( Sutter Health Plus )
- UHC of California ( UnitedHealthcare of California )
- UnitedHealthcare Benefits Plan of California
- UnitedHealthcare Community Plan of California, Inc
- Universal Care ( Brand New Day )
- Western Health Advantage
- Envision Insurance Company
- HealthSpring Life & Health Insurance Company, Inc.
- SilverScript Insurance Company
- WellCare Prescription Insurance, Inc.
- Avante Behavioral Health Plan
- Cigna Behavioral Health of California, Inc.
- CONCERN: Employee Assistance Program
- Empathia Pacific, Inc. ( LifeMatters )
- Health and Human Resource Center ( Aetna Resources for Living )
- Holman Professional Counseling Centers
- Human Affairs International of California
- Magellan Health Services of California-EmployerSvc
- Managed Health Network
- S. Behavioral Health Plan, California ( OptumHealth Behavioral Solutions of California )
- ValueOptions of California, Inc. ( Value Behavioral Health of CA )
- WellCall, Inc.
- Envolve Vision, Inc. ( Envolve Benefit Options )
- EYEXAM of California, Inc.
- FirstSight Vision Services, Inc.
- For Eyes Vision Plan, Inc.
- March Vision Care, Inc.
- Medical Eye Services, Inc.
- Premier Eye Care, Inc.
- Vision First Eye Care, Inc.
- Vision Plan of America
- Vision Service Plan
- VisionCare of California ( Sterling Visioncare )
DMHC Press Release, October 6, 2016
DMHC Launches Health Plan Dashboard, Making Data & Information More Transparent, Accessible
(Sacramento) – The Department of Managed Health Care (DMHC) today launched the Health Plan Dashboard, an online tool to make health plan data more transparent and accessible to the public.
“The DMHC is excited to launch the Health Plan Dashboard, increasing transparency and access to health plan data,” said DMHC Director Shelley Rouillard. “This online tool will make it easier for the public to find information on health plans in California, and will also help the Department make better use of our data internally.”
The Health Plan Dashboard aggregates more than a dozen public data sets reported by health plans and the DMHC. Data on health plans licensed by the DMHC, such as health plan enrollment by market type, financial reports and premium rates, consumer complaints, audit reports and Department enforcement actions, is now searchable in one easy-to-find location on the Health Plan Dashboard.
The Health Plan Dashboard also creates easy-to-understand charts and graphs out of the data. The image below shows an enrollment graph for a health plan in the Dashboard.
In addition to the ability to look up data on a specific health plan, the Health Plan Dashboard includes an overall look at the health plan industry regulated by the DMHC. This section of the Health Plan Dashboard aggregates industry level data using the same data sets, such as health plan enrollment, consumer complaints, Department enforcement actions and premium rates. The image below shows a line graph illustrating how health plan finances have changed from 2005 to 2015 in the Health Plan Dashboard.
Another useful feature of the Health Plan Dashboard lets the public compare health plans directly or sort the DMHC aggregate data to see how health plans compare to other plans.
To view the Health Plan Dashboard please visit DMHC’s website at www.HealthHelp.ca.gov.