[MOL] The 1st of a HMO Series....hope this helps you! [00697] Medicine On Line

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[MOL] The 1st of a HMO Series....hope this helps you!

       It's a '90s version of Let's Make a Deal: Behind Curtain No. 1 is a competent, friendly doctor who will spend enough time with you during an office visit to answer all your questions. Behind Curtain No. 2 is a faceless bureaucrat who makes you wait a month to see your physician and won't let you see a specialist until you're near death. You have to pick between them, but Monty Hall won't tell you which curtain hides which.
      Millions of Americans play this game each year when deciding which health plan will cover their family. Sure, they may get some slick brochures that talk about how much the health plan cares, but it's much harder to find out what really matters. Will you get the care you need when you need it?
       Believe it or not, there are legions of researchers working behind the scenes to come up with just that kind of useful information. Unfortunately, their efforts are only now beginning to bear fruit. Here's a primer on where to start picking.
      The big name in HMO quality is HEDIS. That stands for Health Plan Employer Data and Information Set, and it's a nifty and expanding list of questions the HMOs answer for an organization called the National Committee for Quality Assurance, which accredits health plans. The list has been evolving over the past few years and has the potential to provide some really useful information for consumers.
      The questions measure how well HMOs provide preventive care, such as immunization and prenatal care; how they handle common illnesses, such as using beta blocker drugs after a heart attack; the availability of care, including how long it takes to get a doctor's appointment; and how much care members actually get — for instance, how often people treated for a chemical dependency end up being readmitted to the hospital. HEDIS also calls for financial and administrative information, including doctors' credentials and member disenrollment rates.
      The good news is that last year more HMOs responded to the voluntary questionnaire than ever before — a total of 329 health plans. The bad news is that’s only half of the HMOs in the country. The ones that didn't respond have several reasons: Maybe they aren't under enough pressure from consumers and employers in their areas, they disagree with how the HEDIS is worded or they're afraid of how the results will look in public. It's hoped that more health plans will participate in this year's survey, whose results should be available in October.
      Unfortunately, the raw HEDIS information about individual health plans isn't available to consumers directly from the National Committee for Quality Assurance (though the organization's Web site has information about whether your plan has been accredited). But there are some other organizations that have put the information into a form you can use.
      One of them is U.S. News and World Report. The magazine's Web site features a report first published in October 1997 that compares the scores for all the health plans that responded to HEDIS that year. It's a useful resource if the plans you're considering happen to be on the list. But it suffers from the limitations of the whole HEDIS effort — that even among the plans that responded, some left important information out. Also, quality purists complain that the information is direct from the plans themselves, and should be audited to ensure its accuracy.
      If you happen to live in New Jersey or Maryland, you're in luck. Both those states have collected the HEDIS data from the HMOs in their jurisdictions and added to it the results of surveys of consumers who actually use the plans in the Maryland HMO Report Card and New Jersey HMO Report Card. The result is a richer, more relevant and useful set of comparisons. For instance, the HEDIS questions include such things as the percentage of children in the plan who are immunized or how many women of a certain age get mammograms. The consumer survey gets more specific, answering which plans have doctors who communicate well or spend enough time with patients.
      Californians also have access to some of the HEDIS information, thanks to an employer group called the Pacific Business Group on Health. This progressive, quality-conscious organization provides on its Web site information about customer satisfaction and preventive care for HMOs. It is the first organization to go beyond HMOs to where, increasingly, decisions are being made — in doctors' offices. The Healthscope site includes the results of a patient satisfaction survey for several dozen physician groups in California and the Pacific Northwest.
      Another source for HMO comparisons is Consumer Reports, which did its own assessment of health plans based largely on a survey of 20,000 readers' experiences with their own plans. The 1996 ratings are available to subscribers of the magazine's online version.
      Other organizations are looking for alternatives to HEDIS, which they see as too technical for the general public. For instance, the Foundation for Accountability is working on ways to build report cards that provide more helpful information, such as how a health plan helps people with chronic illness. That project isn't done yet, but you can find out more about it at the FACCT Web site.
      It's also smart to check with your own employer's human resources department, which chooses the health plans and may have quality information about them. In fact, it's a good idea to let human resources know whether you're satisfied with the information and services you get. Too many employees assume they have no voice in the process, but it's only when you bug the company to do better that they'll have any incentive to do so.
      Finally, don't forget to contact the health plan directly for information. Their response to your request may tell you a lot about whether they value your business.

Warmly, lillian
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