Kaiser Permanente and M.D. IPA lead the field -- as they did last year -- in the annual consumer guide to HMOs published by the Maryland Health Care Commission, winning above-average scores in three of four measures of customer satisfaction. The guide covers seven commercial HMOs and their less restrictive cousins known as point of service, or POS, plans, but it does not rate the preferred-provider organizations, or PPOs, that many insurers offer.

At the bottom of the heap was CareFirst's BlueChoice, which earned below-average scores from its members in all four categories. For example, only 28 percent of BlueChoice members who were surveyed said they would definitely recommend the plan to others, compared with an average of 33 percent for all seven commercial plans in the guide.

Jack Nelson, a CareFirst vice president, said BlueChoice showed "modest improvement" in the consumer guide over the past two years. "However, the competition was improving at a faster rate." He said CareFirst has recently focused on better handling of customer service calls, "and we have seen some very significant improvements over the past six months. . . . We feel that will reflect itself in future annual surveys."

The guide, available at www.mhcc.state.md.us/hmo/consumerguide2004.pdf, also contains clinical measurements for the seven plans, which together offer health care to 2.3 million people in the Washington area and surrounding regions. By those yardsticks, Kaiser Permanente far surpassed even M.D. IPA.

Kaiser, for example, tested 76 percent of its young women members for chlamydia, twice as many as its closest competitor. Kaiser also checked 78 percent of adults with diabetes for kidney disease, compared with an average of 43 percent of patients in the other plans.

Kaiser scored above average on 17 of 32 tests; Aetna, by contrast, earned just one above-average rating.

"Obviously, we're not satisfied with the results," said Jay Feldstein, an Aetna spokesman. "In the areas where we have either scored average or below average, we're going to continue the initiatives . . . to improve our scores."

"There isn't a simple answer for why the gap is becoming larger" between Kaiser and its peers, said Joyce Burton, chief of HMO quality and performance at the commission. Kaiser and BlueChoice have more than 400,000 members each; the largest HMO/PPO operator, with about 525,000 members, is Optimum Choice.

"I think all the plans aim for star performer status," Burton said, but "Kaiser is very positive with outreach and quality improvement." Because most Kaiser doctors are employees of the plan rather than independent parties, "there are controls that Kaiser is able to implement that perhaps other plans aren't able to monitor."

-- Tom Graham

The System welcomes comments from patients, providers, insurers and others about the delivery of health care. While we cannot advocate on behalf of individuals, we are looking for examples of problems and solutions that may direct our reporting. Contact us by U.S. Mail at the address that appears below or by e-mail at thesystem@washpost.com. Do not send original documents.