Some Covered California plans have no report cards
At the time of this post, I could not find any review or rating for Chinese Community Health Plan, Valley Health Plan or Ventura County Health Plan. The Covered California contract requires that all plans either be accredited with NCQA or URAC. Some plans are in the process of being evaluated by one of these third party accreditation sites.
Not all plans or reports are equal
In addition, not all of the plans have experience in managing individual health insurance plans in the commercial market. While we would like to think that all health insurance is created equal – commercial, Medi-Cal, Medicare, PPO, HMO – they are not. Let these report cards inform your decision making process with the understanding that these report cards don’t reflect the new Covered California plan benefits or management.
The following is the compilation of the various report card quality ratings for the different plans. The information and formats may have been condensed from the original. For instance, I use numbers to indicate the number of stars given in some categories.
State of California Office of the Patient Advocate
Health Maintenance Organization, HMO, Quality Ratings Summary 2013
- 4 = Excellent About the HMO Ratings
- 3 = Good
- 2 = Fair
- 1 = Poor
| Kaiser Northern California | Kaiser Southern California | SharpHealth Plan | WesternHealth Advantage | |
| Patients Rate Their Experience | ||||
| HMO Plan overall | 4 | 4 | 4 | 4 |
| Getting Care Easily | 2 | 1 | 1 | 2 |
| Answers Questions | 1 | 2 | 2 | 2 |
| HMO Provides Recommended Care | 4 | 4 | 3 | 3 |
| Clinical Performance | ||||
| Asthma/Lung Disease | 4 | 4 | 3 | 2 |
| Checking for Cancer | 4 | 4 | 3 | 3 |
| Chlamydia Screening | 4 | 4 | 3 | 3 |
| Diabetes Care | 4 | 4 | 3 | 3 |
| Heart Care | 4 | 4 | 3 | 3 |
| Maternity Care | 4 | 4 | 2 | 3 |
| Mental Health Care | 4 | 4 | 2 | 2 |
| Treating Adults | 4 | 4 | 3 | 3 |
| Treating Children | 4 | 4 | 3 | 3 |
Preferred Provider Organization, PPO, Quality Rating Summary 2013
- 4 = Excellent About the PPO Ratings
- 3 = Good
- 2 = Fair
- 1 = Poor
| Anthem Blue Cross | Blue Shield of California | Health Net | |
| Patients Rate Their Experience | |||
| Highly Recommend Plan | 62% | 53% | 46% |
| Getting Care Easily | 3 | 3 | 1 |
| Answers Questions | 1 | 1 | 1 |
| PPO Provides Recommended Care | 2 | 2 | 2 |
| Clinical Performance | |||
| Asthma/Lung Disease | 2 | 2 | 2 |
| Checking for Cancer | 2 | 2 | 1 |
| Chlamydia Screening | 3 | 2 | 2 |
| Diabetes Care | 2 | 1 | 2 |
| Heart Care | 3 | 1 | 4 |
| Maternity Care | 2 | 2 | 3 |
| Mental Health Care | 2 | 2 | 1 |
| Treating Adults | 1 | 1 | 1 |
| Treating Children | 2 | 2 | 2 |
Medi-Cal plan ratings
The following plans will be offering HMO individual plans through Covered California, but have been reviewed for their Medi-Cal plans. This information is available through the Office of Patient Advocate. Medi-Cal plans, like Medicare, are by county.
Plan is rated against the average of all Medi-Cal plans reviewed.
- Higher than average = 3
- Equal to the average = 2
- Lower than average = 1
| Alameda Alliance for Health | Contra Costa Health Plan | L.A. Care Los Angeles County | Molina, Sacramento County | |
| Medi-Cal Health Plan Quality Ratings | ||||
| Getting needed Care | 2 | 1 | 2 | 2 |
| Getting care quickly | 2 | 3 | 2 | 2 |
| How well Dr.s communicate | 2 | 3 | 2 | 2 |
| Shared Decision Making | 2 | 2 | 2 | 2 |
| Customer Service | 2 | 2 | 2 | 2 |
| Vaccines | 2 | 3 | 2 | 1 |
| Check-ups for teenagers | 1 | 1 | 2 | 3 |
| Check-ups for children | 2 | 2 | 2 | 2 |
National Committee for Quality Assurance
Accreditation Status
- Excellent = meets or exceeds requirements
- Commendable = meets requirements
- Accredited = meets basic requirements
Ratings: 0 – 4 Stars, with 4 being the highest and best.
| Accreditation Status | Access and Service | Qualified Providers | Staying Healthy | Getting Better | Living with Illness | Next Review | |
| Blue Cross PPO | Commendable | 3 | 4 | 2 | 3 | 2 | 9/2014 |
| Blue Shield PPO | Accredited | 4 | 3 | 0 | 2 | 2 | 8/2014 |
| Health Net PPO | Commendable | 3 | 4 | 0 | 2 | 2 | 2/2013 |
| Kaiser NorCal HMO | Excellent | 4 | 4 | 4 | 4 | 4 | 12/2014 |
| Kaiser SoCal HMO | Excellent | 4 | 4 | 4 | 4 | 4 | 12/2013 |
| L.A. Care HMO Medicaid | Accredited | 3 | 2 | 2 | 2 | 2 | 4/2014 |
| Molina HMO Medicaid | Accredited | 4 | 3 | 1 | 2 | 1 | 7/2014 |
| Western Hth. Adv. HMO | Excellent | 4 | 4 | 3 | 4 | 3 | 9/2014 |
For additional information on some of the differences of the reporting agencies read my post: Comparing health plans offered by Covered California.
HMO over PPO
The only real conclusion that I have been able to make from looking at all the report cards is that people are generally more satisfied with an HMO over a PPO. The significant difference between them, from a consumer standpoint, is that you must choose a primary care physician (PCP) and usually see that person for a referral to a specialist, lab or imaging. It might be that the primary care physician is helping answer more questions and making navigation of the health care maze easier for many patients. When the patient is happy, ratings are generally higher.
Happier patients doesn’t explain the higher clinical ratings of the Kaiser HMO model from either the Office of Patient Advocate or NCQA. The Kaiser high ratings seems to be a function of better integration and communication between physicians, insurance and hospital. While Kaiser may look like one big corporate blob, the doctors, insurance and hospitals are all separate entities; just like Hills Physician Group, Western Health Advantage and UC Davis hospital are all separate but work together.
New plans aren’t the old plans
I can’t emphasize enough that there is a disparity in the report cards because of the type of plans being reviewed. Plus, patient experience will likely be better under the Covered California plans because the benefits are uniform from plan to plan. Many elements of a health insurance plan, like customer service, may change very little from the current plan reviews to new plan offerings. So, some of the plans may perform better than past reviews or be the same in some areas of administration that are more corporate cultural versus meeting new requirements.