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HealthCare Checkup

The Seattle Times health-care team tracks the local impact of the Affordable Care Act.

July 16, 2014 at 9:52 PM

Plenty of room to improve, says report rating health plans

Group Health Cooperative was the overall top-scoring health plan among five graded by the Washington Health Alliance, a collaborative of employers and others working to improve health-care transparency through measurement.

What does the Alliance measure in its eValue8 report? For an insurance plan, it looks at processes aimed at ensuring patient safety, closing gaps in care, and improving consumers’ health and the health care they get. It also measures how well a plan controls costs, reduces waste, and whether it educates and encourages consumers to manage their own health well.

The five plans that have volunteered to be measured — and have their results displayed publicly — also provide details on how they measure performance of medical providers, and how they pay them.

The other plans, in order of how well they scored overall, were Cigna, followed by Aetna, United HealthCare, and Regence BlueShield. Both Group Health and Cigna improved significantly from last year’s scores, overall.

The report said Group Health was only 2 percentage points below the best performance in the nation on “helping members get/stay healthy;” it was just slightly below the national best in “helping members manage acute/episodic conditions and advanced care.”

Regence was the highest-scoring plan on giving members information on costs.

More than half of a plan’s score depends on how well it supports its members in helping get healthy, be good consumers and manage their own health, including acute, episodic or chronic conditions.

“Health plans have an important role to play in improving the quality and value of the health-care system, and understanding their performance — and where it can be improved — is also important,” said Susie Dade, deputy director of the Washington Health Alliance. Participation in the Alliance evaluation educates consumers and employers about performance, and about the willingness of each plan to allow their own efforts to be measure against national standards and to share the results publicly, she added.

Premera Blue Cross has declined to participate in the Alliance report since 2009.  Melanie Coon, Premera spokeswoman, said the insurer supports the Alliance on “nearly all” its initiatives, and participates in many of its programs. But Premera prefers to put its energy and resources into other organizations that measure health-plan performance, she said.

“We support transparency in health plan performance, and we demonstrate that by investing our resources in the National Committee on Quality Assurance (NCQA)” and the Consumer Assessment for Healthcare Providers and Systems, Coon said.

The Alliance report, she said, is redundant, and doesn’t add value for Premera’s customers, “compared to the additional administrative costs we would incur…and pass on to our customers.”

The Alliance report said most plans had “opportunities for improvement.” Those include improving programs on tobacco cessation and obesity management, broader support for providers to manage chronic conditions such as asthma, diabetes, heart disease, depression and substance abuse, and providing more information to members on costs.

Comments | Topics: Group Health Cooperative, Premera Blue Cross, Washington Health Alliance


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