California Offers PPO Ratings on the Web

November 18, 2009

The California Department of Insurance has launched of a new report card on its Web site (www.insurance.ca.gov) that will allow consumers to make more informed choices about which Preferred Provider Organization (PPO) is best for them.

The report card will allow everyone to monitor how well the health care system is doing in assuring the right care is given to the right patients, Commissioner Steve Poizner said in a statement.

“Consumers need the best possible information and transparency when choosing their health insurance provider,” Poizner said. “This report card will provide information that has been lacking for too many years. It is based on a four-star rating system that is easy to understand, yet gives consumers the ability to dig deeper and find how well each insurer does on dozens of specific best practices. The report card provides a one-stop shopping experience for California’s major PPO providers.”

Commissioner Poizner pledged back in August 2007 to make sure PPO patients had the same information HMO patients currently have. California’s Department of Managed Health Care (DMHC) has provided a report card on Health Maintenance Organizations (HMO) since 2002.Other states collect similar data, however California is the only state to analyze it, and offer it in a consumer-friendly, interactive format that includes summary ratings as well as the more detailed underlying measurements.

None of the five PPOs on the report card received the highest four-star rating, but Aetna, CIGNA HealthCare of California and Health Net of California each received three stars overall. United Healthcare and Anthem Blue Cross each received two stars overall. Blue Shield of California did not report findings due to technical issues, but expects to report data next year.

Rating criteria included asthma care, checking for cancer, diabetes care and treatment of children. The ratings are based on a set of standard measures developed by the National Committee on Quality Assurance. In addition to grades based on the clinical best practices, the report also includes results of a voluntary survey completed by plan members related to consumer satisfaction.

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