In an attempt to help consumers decide on the right health plan, Covered California has compiled a star rating system for the health insurance carriers based on outdated information. Even worse than basing a report on old data is the disastrous customer service that many Californians have experienced from many of these health insurance companies, including Covered California, in the last two months. The horrible customer service and nightmare enrollment process is not reflected in the new quality rating results.
Outdated survey information
The data used to compile the Covered California health plan star ratings comes from surveys gathered by Consumer Assessment of Healthcare Providers and Systems (CAHPS). The latest information seems to be from surveys published in 2011 before any of the new Covered California health plans were even released or incorporated new California laws addressing health care coverage. In Covered California’s rush to provide a quality rating system ahead of the national mandate to do so, they have released star rating scores for the different health insurance carriers that are of little value to consumers.
Tighter networks and new plans
We have to remember that the health plans don’t deliver care; they merely facilitate health care services through a provider network of physicians, clinics, and hospitals. The new PPO and EPO plans offered through Covered California can be drastically different from plans that were surveyed in 2011. The new health plans are comprised of fewer doctors and hospitals along with tighter restrictions for out-of-network care imposed by the Exclusive Provider Organizations (EPO).
Current health plan quality rating absent
How is the quality of care and member satisfaction determined when a person finds out the new plan no longer includes their long time physician? What is a member’s experience when they find they have enrolled in an EPO with its restrictions on out-of-network coverage? How can Covered California rate the health plans on the support of new mandated coverage like transgender health benefits when they were just included in 2013? In short, the health plans being offered in 2014 are significantly different from the plans offered in 2011. It is foolish to extrapolate past performance of health plans into a radically different environment of the new ACA compliant plans.
Customer service would equal zero stars
The bedrock of a member’s experience with their insurance is customer service. If any of the plans had been rated by new enrollees in the last two months they all would have received zero star ratings for customer service. Many Californians have lived through a nightmare of attempting to pay for their plans and receiving ID cards. This has resulted in missed doctor appointments and problems filling vital prescription medications. And what would the star rating be for the government monopoly of Covered California? It would have been negative for their miserable call center wait time, but Covered California doesn’t have to report on their performance to the public.
Covered California notes outdated quality data
The health insurance company quality rating put forth by Covered California verges on being false and misleading advertising. The most honest part of the ratings is revealed on the star rating web pages-
The ratings are based on consumer surveys for the most recent year they are available, in most cases, from 2011. The surveyed members were reporting on care received before the launch of Covered California.
A better quality rating system already in place
A better rating system just released is from the Office of the Patient Advocate (OPA). While it is also based on surveys taken before the launch of Covered California health plans, it at least breaks the health plans into PPO and HMO groups and gives additional information on how patients rated their experience. But perhaps the best and most important part of the OPA information are ratings for the different physician groups and hospitals. With such comprehensive information from the OPA, why didn’t Covered California just link to this established California quality rating system?
Health plans don’t deliver care
The health plan is only as good as the providers it contracts with. You don’t see the CEO of Blue Shield of California about the pain in your neck. You see a doctor that accepts your Blue Shield health plan. A rating system that doesn’t acknowledge the role of doctors and hospitals in the delivery of health care is pretty worthless. So please, ignore the Covered California star rating system as the information is outdated and insufficient for making a real determination on which health plan is right for you and your family.
Covered California press release on new quality rating system
| Jan. 28, 2014 |
COVERED CALIFORNIA CONSUMERS CAN NOW USE
QUALITY RATING SYSTEM WHEN CHOOSING A HEALTH CARE PLAN
Simple-to-Understand Four-Star Rating System Gives Consumers
New Tool, Lays Foundation for Robust Scoring System
SACRAMENTO, Calif. — California consumers can now get performance ratings on the vast majority of health insurance plans offered through Covered California™. The state health insurance exchange recently added a quality rating system (QRS) to its website to aid consumers in their selection of plans.
The QRS gives an easy-to-understand rating of one to four stars, with four stars being the highest score. The system is in place well ahead of the 2016 federal mandate and will be improved over the next two years as the exchange gets more comprehensive performance ratings for plans.
“After several months of open and constructive debate with consumer advocates, health plans and stakeholders, Covered California is now among the first exchanges in the nation to offer its consumers a quality rating system,” said Covered California Executive Director Peter V. Lee.
Many states, along with the federal exchange, are awaiting federal guidelines for establishing a rating system, but Covered California wanted to give existing scoring information beginning in 2014.
“We want to give consumers all the available tools to help them assess and choose plans in their regions,” Lee said. “We are proud of the ratings in each of the exchange plans and recognize this is a preliminary look at exchange health plans.”
The ratings are based on reported experiences of members. Each health insurance plan is compared with results for health insurance plans across the western United States region.
A four-star plan means a plan placed in the top 25 percent of all rated plans. Three stars are given for those that landed in the 50- to 75-percent band, while a two-star plan means it scored in the 25- to 50-percent band of all plans. One star is given for those plans scoring in the bottom 25 percent.
Consumers can get QRS scores in their regions by visiting: https://www.CoveredCA.com/
The scores, from the nationally recognized Consumer Assessment of Healthcare Providers and Systems (CAHPS), asks plan members about access to care, including getting doctor appointments, tests and treatments; customer service; and medical care.
Consumers may access the quality ratings when they visit www.CoveredCA.com and browse health insurance plan options. The scores are displayed on the summary for each plan.
Covered California anticipates expanding its rating system to integrate the national standards when they are available, adding information on hospital, medical group and physician quality. The clinical performance scores will be based on claims data and patient records, in addition to member surveys about exchange plan services starting in 2014.
“These scores are just the beginning of a robust reporting and evaluation system planned for 2016,” said Lee.
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