Californians enrolled in HMOs — and the entities that buy health insurance plans for them — now have a new way to compare medical groups by both quality and cost.
The state Office of the Patient Advocate has graded HMO doctors groups since 2002 on the quality of the care they provide and patient feedback, as part of its annual Medical Group Report Card for Commercial HMO Plan Members. This year it's adding another gauge to the more than 150 groups it assessed: cost.
Beth Abbott, who heads the office, calls it "probably the biggest and most ambitious effort to tie cost in along with the quality information."
The report card doesn't allow people to compare groups by how much they charge for specific procedures. Rather, it assigns scores based on the average annual payment per patient that the groups receive from patients and insurance plans. This figure takes into account a lot of factors, including the cost of doctors, lab fees and co-pays.
Groups get one to four stars, with one star signifying highest payment – or most expensive – and four stars signifying lowest payment.
Officials and consumer advocates said they hope the new report cards will help people choose doctors that provide quality care at a good value.
Consumers might mistakenly think they don't need to worry about cost, if their employer purchases their health insurance plan, Abbott said. But people often have to pay some amount out-of-pocket for their care. And, she said, employers are paying attention to health care spending.
"The employer may eventually say we can't cover your dependents, or we can't pay for you as a retiree, or we have to increase the cost that you pay as coinsurance or deductibles," Abbott said. "Consumers have to be wise, careful buyers in terms of cost and quality."
Abbott said consumers are the principle audience, but the report card will also provide more information to entities – like employers and unions - that purchase health insurance.