Maryland to Expand Insurance Evaluations

Consumers Will Get Report Cards on PPO Plans

Consumers in Maryland trying to puzzle through the myriad health-care options available to them will soon have one more tool to aid in making decisions.

Beginning late next year, Maryland will become the first state to give consumers independent evaluations of Preferred Provider Organization (PPO) health plans offered by four of the state's largest health-care providers: Aetna, CareFirst BlueCross BlueShield, CIGNA and United Healthcare.

The report card "adds another dimension to make an informed decision,'' said Joyce Burton, chief of health-plan quality and performance for the Maryland Center for Health Care Financing and Policy. "It broadens your circle of friends -- the 'What do you think of Aetna?' or 'Have you tried CIGNA?' -- all those questions that people ask their colleagues."

Burton said Maryland has led the nation in its efforts to give consumers information about health-care plans. More than a decade ago, the state launched a program to evaluate Health Maintenance Organization (HMO) and Point of Service (POS) plans.

But as PPOs have become the dominant choice among consumers in the state, members of the Maryland Health Care Commission decided it was time to offer information about them as well, Burton said. California announced this year that it, too, will offer report cards for PPOs beginning in 2009.

In a PPO plan, patients have the option of visiting physicians in and out of their insurance networks and don't necessarily need a referral to see a specialist. In HMOs, patients are often required to choose a primary-care doctor, who serves as a gatekeeper to determine whether a patient needs to see a specialist or requires additional care or services. Most often, those who participate in an HMO plan are required to stay within a network to have their expenses covered. POS plans combine elements of PPOs and HMOs.

Burton said the annual report cards have been popular with consumers at HMO and PPO plans because they offer information that goes beyond simply listing the benefits under certain plans and their cost to a person or business.

As with the HMO and POS evaluations, consumers will be able to get information about the quality of care offered by a PPO health-plan provider, the number of complaints received and how customers are treated. State officials use a nationally recognized system of evaluation, the Healthcare Effectiveness Data and Information Set (HEDIS) to measure plan quality, Burton said.

State officials say they hope to roll out the first PPO report card next fall, shortly before many employees begin the process of choosing a health-care plan. Burton said providers may also use the information to check their quality assurance tools.

"Feedback is very important to us," said Karyn Wills, medical director for Aetna in Maryland and the District. "It gives us an idea of how we are doing and helps us make some changes to improve care for our patients."

Leslie Campbell, vice president of quality management for CIGNA, said the Maryland program helps expand efforts the company has in place to measure quality and customer satisfaction. She said CIGNA will benefit from the state-specific measure because it will allow CIGNA to better tailor care to health concerns and needs of Maryland residents.

"CIGNA has really been a leader in this area,'' Campbell said, noting that the company began collecting data on its PPO plans in 2004 to share with the National Committee for Quality Assurance, a District-based nonprofit organization that focuses on health-care quality.

Burton said providers are generally comfortable with the reports.

"When performance reporting first came about in the mid-1990s, there was healthy skepticism [from providers]," Burton said. "They wanted to know, 'What's going to be measured?' 'How is it going to be presented?' Some of the concerns were allayed when the first report was issued."