Press Release July 14, 1999	Contact: Consumers Union

 

YONKERS, NY - A survey of 54 of the largest HMOs in America, to be published in the August issue of Consumer Reports, found that, in terms of readers' satisfaction with service, the best HMOs are non-profit plans with years of experience managing care, while the poorest performers are mostly for-profit HMOs that are part of large chains run by hospitals or insurance companies.

Consumer Reports found that many HMOs are unwilling to divulge much information about themselves. Of the 54 plans surveyed, 21 refused to allow the National Committee for Quality Assurance, the national non-profit organization that accredits HMOs, to publicize consumer satisfaction data. And Consumer Reports found that fewer than half would discuss the payment structure for their point-of-service plans (which allow people to go out of the network and still receive some coverage), and only 13 would describe their initiatives to improve medical quality.

"We found that HMOs that refuse to reveal satisfaction data to consumers are also the plans that consistently rank near the bottom of our ratings," said Trudy Lieberman, Health Policy Editor at Consumer Reports, "and if an HMO won't disclose satisfaction data, consumers ought to wonder why."

The survey, based on how 19,000 subscribers evaluated their interactions with their doctors and HMOs, found few overall problems getting treatment or care. However, members in plans at the bottom of the ratings were three times more likely than those in the plans at the top to say they did not get the care they needed. While satisfaction surveys typically reflect the experiences of the healthy, the Consumer Reports survey also asked how the sick fare in managed care: The least satisfied were those in poor or fair health in low-ranked plans.

Other findings of the Consumer Reports HMO Survey include:

• On average, 57 percent said they were completely or very satisfied with their plan.
• But only 33 percent of those who said they were ill were completely or very satisfied.
• A plan's ability to effectively respond to members' questions and complaints was the element most closely correlated with overall satisfaction. One-quarter of respondents said resolving complaints was a struggle.
• Nearly half of those surveyed reported one or more problems with their primary care provider. More than 20 percent of respondents reported that the doctor kept them waiting too long or didn't follow up on their progress.
• Those surveyed tended to like their plans if they had a wide choice of primary-care doctors and specialists, and if they got the care they felt was necessary. On average, 11 percent said they had trouble getting that care, but plan scores varied markedly.
• Readers with a serious health problem had more trouble getting care-especially from a low-ranked plan.
  Not Making the Grade: HMO Report Cards Are More Confusing than Helpful
  

Consumer Reports also examined 30 HMO report cards employers sometimes provide to help employees and Medicare and Medicaid recipients pick an HMO. Most provided a dizzying array of graphs and symbols, but failed to tell consumers how to judge the most important aspects of a plan, such as cost information to help users make trade-offs between price and the quality of service. The greatest shortcoming of report cards is that they often don't explain how to use the data they provide. For best results sorting through report cards of widely varying quality, Consumer Reports recommends:

• Know whether the report card is comparing plans or physicians; a comparison of the latter may be more useful.
• Identify measures that are important to you. Data on member satisfaction may be more important than scores of how plans performed on some preventive measures.
• Examine available complaint data. They can help corroborate other information about a plan.
• Avoid HMOs that do not report data either to the organization issuing the report card or to the National Committee for Quality Assurance. Most report cards do note when a plan doesn't provide data; that should be a warning that it may be hiding something.
  

Consumer Reports found that HMOs and employers often don't share out-of-plan payment information with members, and that consumers can amass unexpected medical bills when they go out of the network, even if they expect their plan to cover part of the bill. Even those who stay in the network can face unexpected bills, such as when a member chooses an in-network hospital only to receive bills for the services of an anesthesiologist or a radiologist who is outside the network. To avoid unexpected bills:

• If you plan to go out of network for a procedure, ask your HMO about its allowable charge for the services you need. Then, find out what the out-of-network doctor will charge. Consider asking the doctor to reduce his or her fee.
• If you get a bill for in-network care, don't automatically pay it. Ask the HMO to tell the provider to stop billing you.
• If you will be using an in-network hospital or doctors' group, make sure all providers who will be treating you are in the network, or negotiate the fee with an out-of-network doctor.
  

The August issue of Consumer Reports will be available July 27 wherever magazines are sold. To subscribe to Consumer Reports, call 1-800-765-1845. In addition, information and articles from Consumer Reports can be accessed online at www.ConsumerReports.org.

The material above is intended for use by legitimate news entities only; it may not be used for commercial or promotional purposes. Consumer Reports is published by Consumers Union, an independent, nonprofit testing and information-gathering organization, serving only the consumer. We are a comprehensive source of unbiased advice about products and services, personal finance, health, nutrition, and other consumer concerns. Since 1936, our mission has been to test products, inform the public, and protect consumers.