HMOs Earn High Reviews Marks

December 2, 2002
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GRAND RAPIDS — Priority Health and Grand Valley Health Plan scored high marks in disease management, although they and other HMOs could do a better job on safety and quality issues in regards to prescription medications.

That's the import of an annual review of managed-care companies.

Overall, the managed-care companies evaluated in the Alliance for Health's Value Improvement Partners generally showed improvement in key areas used to measure quality — performance and value — although there were some drop-offs, said Bridget White, who coordinates the annual evaluation process.

White, a senior consultant for Varnum Consulting in Grand Rapids, said performance and quality improvements that HMOs made during the past year were not as great as in previous years, a reflection of the past strides that have been made in the VIP's seven years.

"It's getting a little harder to achieve incremental improvements," said White, citing a need to refine the annual review process and delve into new areas to measure — perhaps physicians and hospitals.

"We're getting to the plateau of incremental improvements and we're at the point of making the next leap," she said.

For this year, Priority Health and Grand Valley Health Plan led the field in disease management.

The annual VIP evaluation found the two managed-care plans rated well above average when compared to other participating HMOs in managing the high-cost and utilization diseases asthma and diabetes, White said.

That was not unexpected, since both HMOs have received national awards for disease-management initiatives.

The Grand Rapids-based Priority Health, the market leader with more than 366,000 subscribers in a 27-county region of western Michigan, received an innovation award from the National Business Coalition on Health in managing asthma.

The coalition cited Priority Health for lowering inpatient rates and emergency room visits by 60 percent for the 3,000 people enrolled in the asthma management program. The program also recorded reducing medical costs by $2,100 per member.

White said Grand Valley Health Plan has achieved one of the nation's best outcomes in diabetes management. The Grand Rapids-based HMO has about 20,000 members.

"We really do have two excellent HMOs in this community," White added.

Priority Health and Grand Valley Health Plan, as well as Blue Cross Blue Shield of Michigan's Blue Care Network, scored well in each of the categories in which HMOs were rated: accreditation, physician communication and service, access and customer service, keeping people healthy, and how well they help people recover when they're sick or injured.

Fourteen HMOs statewide participated in the annual VIP review, conducted in collaboration with the Greater Detroit Area Health Council.

Though the HMOs with leading shares of the Grand Rapids-area market scored highly, White did offer two concerns.

She said the decision of two HMOs — Care Choices and PHP in Muskegon — to leave the West Michigan market reduces competition locally, and Grand Valley Health Plan has a limited in-house care network.

Priority Health — majority-owned by Spectrum Health with a minority stake by Holland Community Hospital — also scored at the top of the six preferred-provider organizations, or PPOs, that were evaluated.

Priority Health's PPO scored well above average in access and customer and administrative services. Blue Cross Blue Shield's Community Blue PPO rated well above average in access issues and performance reporting.

In an era of soaring health-care costs, initiatives such as the VIP are growing in importance, White said.

Disclosure of performance data by managed-care companies will enable consumers and purchasers to better understand what they are buying, balance the cost with the outcome, and ultimately begin to help control costs, she said.

"At least, it's going to control the things we can control," White said. "We need that kind of disclosure and accountability. We feel that is going to be the underlying way to control costs."

Despite overall performance improvements, the 2002 VIP results show managed-care companies could perform better at managing depression and helping members quit smoking.  Blue Care Network was the top performer for tobacco cessation, according to VIP results.

Priority Health and Grand Valley Health Plan, despite their high ratings in disease management, "kind of fell off the mark in tobacco cessation," White said.

"Both of them have great ground to do better," she said.

There's also "opportunity for everybody" in the HMO and PPO arena to improve how they manage pharmacy. Blue Care Network, Priority Health and Grand Valley Health Plan all earned scores near the average in pharmacy management measures that include how benefits are designed, efficiency issues such as generic dispensing rates and the use of optimal doses, and quality and safety issues like electronic prescribing.

Having their participating physicians do electronic prescribing "is the single biggest thing people can do to reduce errors," White said. "And not many people are doing that."

In looking to the future, White says measuring the performance of hospitals and physicians alongside managed-care plans is a natural extension of the VIP program.

"The physicians have not been engaged enough," White said. "We want to look into the providers and the networks the plans are selling."

For more on the annual Valued Improvement Partners 2002 reports on HMOs ands PPOs, go to the Alliance for Health's Web site at www.afh.org 

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