On reporting and rules

In 2009, courtesy of the Department of Insurance, California will have the first-in-the-nation PPO Report Card, allowing consumers to see how how well (or not-so-well) their insurance companies perform on key measures — such as keeping you from getting sick, maintaining your illnesses (like diabetes), and helping you after you get sick. How well health plans respond to complaints and consumer input will also be measured.

(The PPO report card should not be confused with the HMO report card, which is compiled by the Office of the Patient Advocate at the Department of Managed Health Care. )

Being a Consumer Reports junkie, I do think it will be somewhat helpful for consumers to get a glimpse of health quality issues, such as whether the health plan is good at controlling blood pressure, testing for cholesterol in diabetes patients and is responsive to patient concerns. And as more and more consumers defect to PPO plans (30% of the insured are covered by PPOs), it makes sense to have a parallel report card.

But let’s not kid ourselves into believing that this will be the tool to help consumers make choices about health coverage. To begin, many consumers don’t really have a “choice.” More than half of Californians receive health coverage through their jobs — so their “choices” are limited to whatever their employers offer (so if your employer only offers one plan — the report card will only tell you how happy or glum you should be about the quality of the insurer).

God help the person who is forced to look for insurance on their own: anyone who has tried to wade through the 109 choices on ehealthinsurance.com knows it’s darn near impossible to compare the plans. And if the PPO report card is anything like the HMO report card, it will give very general ratings on how well health plans perform at different measures — but it’s not going to tell you whether Blue Cross PPO 3500-HSA-Compatible is a better plan than Blue Shield’s Essential Plan 3000.

This won’t help consumers compare provider networks (and the quality of those providers), it won’t give a full view of deductibles and other cost-sharing — all very important factors for consumers.

In the name of consumer friendliness and quality improvement — this moves us in a good direction, but we’re certainly not there yet.

Health Access California promotes quality, affordable health care for all Californians.

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