1. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency 2005 HMO Report Card Office of the Patient Advocate Ed Mendoza Acting Director John Zweifler, MD, MPH Medical Consultant National Pay for Performance Summit CONSUMER ACCESS TO PUBLIC REPORTING ON P4P RESULTS

2. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency MISSION Office of the Patient Advocate To inform and educate consumers about their rights and responsibilities as HMO enrollees.

3. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency 5.Collaboration with Other Organizations STATUTORY MANDATES Office of the Patient Advocate 1.HMO Quality Report Card 2.Consumer Education 3.Advice and Assistance to HMO Enrollees 4.Recommendations to DMHC

4. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency 1.To provide comparative quality information for consumers, purchasers, regulators, and advocates. 2.To “incentivize” quality improvement through public disclosure. 3.To educate consumers about health care quality. OBJECTIVES HMO Report Card

5. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency 1.Scope & Data Sources 2.Methodology 3.Presentation 4.Outreach and Distribution BASIC FEATURES HMO Report Card

6. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency SCOPE & DATA SOURCES HMO Report Card l California’s 10 largest HMOs -- 95% of all commercial enrollees (HEDIS & CAHPS) l 200+ medical groups – 85% of all commercial and Medicare enrollees (HEDIS & CAS) l Language services information for 10 commercial and 18 Medi-Cal plans (OPA Survey)

7. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency HEALTH PLAN METHODOLOGY HMO Report Card Four Summary Star “Grades” (30 individual clinical & patient satisfaction scores): 1.Staying Healthy (10 scores) 1.Getting Better (9 scores) 1.Living with Illness (10 scores) 1.Member Rating of Health Plan (1 score)

8. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency MEDICAL GROUP METHODOLOGY HMO Report Card Six Summary Star “Grades” (29 individual scores): 1.Getting the Right Medical Care (9 scores) 1.Patient Rating of Care (20 scores) - Coordinating Patient Care (3 scores) - Timely Care & Service (9 scores) - Getting Treatment & Specialty Care (4 scores) - Communicating with Patients (4 scores)

9. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency Does the health plan provide: Telephone interpretation services? Access to face-to-face interpreters? Bilingual provider lists? Non-English written materials? LANGUAGE SERVICES DATA HMO Report Card

10. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency  Web-Based PRESENTATION HMO Report Card  Comparative  Interactive  Printed Summary  English, Spanish, Chinese

11. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency MAIN PAGE 2005 HMO Report Card Website

12. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency MAIN PAGE – HMO RATINGS 2005 HMO Report Card

13. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency MAIN PAGE – TOPICS 2005 HMO Report Card

14. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency MEDICAL GROUP COUNTY SELECTOR 2005 HMO Report Card

15. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency MEDICAL GROUP RATINGS SUMMARY Sacramento County - 2005 HMO Report Card

16. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency MEDICAL GROUP RATINGS SUMMARY West Los Angeles, 2005 HMO Report Card

17. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency MEDICAL GROUP RATINGS SUMMARY Sacramento County, 2005 HMO Report Card

18. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency MED GP DRILL DOWN – HEDIS SCORES Sacramento County, 2005 HMO Report Card

19. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency MED GP DRILL DOWN – CHLAMYDIA Sacramento County, 2005 HMO Report Card

20. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency MEDICAL GROUP RATINGS SUMMARY Sacramento County, 2005 HMO Report Card

21. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency MED GP DRILL DOWN – CAS SCORES Sacramento County, 2005 HMO Report Card

22. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency MED GP DRILL DOWN – TIMELY CARE Sacramento County, 2005 HMO Report Card

23. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency MED GP DRILL DOWN – VISITS ON TIME Sacramento County, 2005 HMO Report Card

24. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency MED GP DRILL DOWN – DR EXPLAINS Sacramento County, 2005 HMO Report Card

25. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency PRINTED SUMMARY – FRONT 2005 HMO Report Card

26. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency PRINTED SUMMARY – BACK 2005 HMO Report Card

27. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency DISTRIBUTION OF PRINTED SUMMARIES 2005 HMO Report Card  Local Pharmacies (574)  Public Libraries (500+)  Community-Based Organizations (500+ Events)  Website Downloading/Printing  Order Copies Toll-Free @ 1-866-HMO-8900

28. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency Use Usability Usefulness EVALUATION CRITERIA HMO Report Card

29. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency ANNUAL USE DATA – WEB VERSION HMO Report Card

30. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency ANNUAL USE DATA – PRINTED SUMMARY HMO Report Card * Partial year data for Year 5

31. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency EVALUATION DATA SOURCES HMO Report Card 1.Academic Research 2.User Focus Groups, Online Survey 3.Industry & Consumer Advocates 4.Report Card Partners 5.Formal Evaluation

32. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency LESSONS LEARNED – USERS HMO Report Card Consumers: 1)are not aware of quality differences 2)are more interested in plan service than quality 3)prefer the detailed website to the printed summary 4)prefer Health Topics to the 4 summary categories 5)want to be able to customize the data even more 6)want more plan data on the website (e.g., cost) 7)prefer data reporting from an “objective” 3rd party

33. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency LESSONS LEARNED – INDUSTRY HMO Report Card Health Plans and Medical Groups: 1)are very familiar with the Report Card 2)use the data to “benchmark” their performance and expect to improve over time 3)use the data for marketing and rate negotiations 4)believe the summary grades do not accurately reflect their performance 5)want separate/additional reporting for Medi-Cal 6)support the continuation of the Report Card

34. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency  OSHPD Hospital Discharge Data  Population-Based Surveys - California Health Interview Survey - Behavioral Risk Factor Surveillance Survey  OPA Surveys - NEW SOURCES OF DATA HMO Report Card

35. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency  Efficiency Measures (HEDIS)  Health Disparities (HEDIS, CAHPS, CAS)  Preventable Hospitalizations (OSHPD, CHIS)  Disability Access Services (OPA) - NEW USES OF DATA HMO Report Card

36. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency SCOPE OF DATA Behavioral Risk Factor Surveillance System  Sponsored by CDC and states  Telephone survey of 2,000-6,000 adults/state  Core questions; states can customize  Targets alcohol and drug use, health status, prevention, utilization, and access  Collects gender, age, education, race/ethnicity, household income, employment status, marital status, AND health plan membership

37. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency HEALTH RISK & STATUS FINDINGS BRFSS 2004 (Oregon) Have a Personal Doctor: White 71%, African American 64%, Hispanic 65% Did Not Get Needed Care: White 18%, African American 27%, Hispanic 23% Note: Little racial/ethnic variability for some measures – getting appointments as soon as wanted; physical and mental composite summary scores

38. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency SCOPE OF DATA California Health Interview Survey (UCLA) l Biennial, population-based, telephone survey (sample: ~50,000 households) l Demographic, health status, utilization, AND health plan membership data l Ethnic/language sub-populations over-sampled to provide additional stratification capacity

39. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency MENTAL HEALTH FINDINGS CHIS 2001 16% of Californians, and 20% of Latinos and African Americans reported needing mental health services 42% of Californians reporting needing mental health received mental health services Minorities 30% less likely to receive mental health services LEP 80% less likely to receive mental health services after controlling other variables Lack of insurance reduced services by 50% Sentell P.California Program on Access to Care Findings. February 10, 2005

40. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency SOURCE OF DATA OSHPD Hospital Discharge Data Racial and Ethnic Disparities in Healthcare in California (November, 2003) Blacks w/ higher admit rates than whites for CHF, asthma, diabetes, and hypertension Hispanics w/ higher admit rates for perforated appendix, lower for pneumonia and dehydration

41. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency DISPARITIES – ANGINA & MI ADMISSIONS CA OSHPD Data (1999-2001) Angiography: Whites 23.4%, Blacks 20.6%, Hispanics 24.6% Percutaneous Coronary Intervention: Whites 22.9%, Blacks 13.4%, Hispanics 17.7% CABG: Whites 5.0%, Blacks 2.7%, Hispanics 4.4% 30 day mortality for MI: Whites 13.04%, Blacks 12.50%, Hispanics 12.91%

42. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency  Product Lines: - Medi-Cal - Healthy Families - Medicare  Provider Types: - Individual Physicians - Hospitals - Skilled Nursing Facilities OTHER POTENTIAL EXPANSIONS HMO Report Card

43. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency CONSIDERATIONS Equity and Public Reporting  Transparency for Consumers  Comprehensive Information  Adjustment for Known Variables  Acknowledgement of Data Limitations

44. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency 5.Voluntary vs. Mandatory Participation ISSUES & CONSIDERATIONS HMO Report Card 1.Absolute vs. Relative Scoring 2.Consumer Use vs. Industry Use 3.Data Usability vs. Data Precision 4.Consumer Usefulness vs. Available Data

45. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency ACKNOWLEDGMENTS HMO Report Card Project  California Cooperative Healthcare Reporting Initiative  Integrated Healthcare Association  Pacific Business Group on Health & Sapient Corporation  OPA Cultural & Linguistic Services Work Group  Walgreens, Leader, Independent Pharmacies  California Association of Health Plans  Local Health Plans of California  Participating Health Plans and Medical Groups

46. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency June 6, 2006 Crowne Plaza Hotel – LAX Los Angeles, California Challenges and Opportunities in Quality Reporting Statewide Policy Implications SAVE THE DATE OPA Symposium on Public Disclosure

47. __________________________________________________ California Office of the Patient Advocate Business, Transportation & Housing Agency hmoreportcard.ca.gov VISIT WEB ADDRESS HMO Report Card