Office of the Patient Advocate Releases 2014-2015 Health Care Quality Report Cards

Office of the Patient Advocate Releases 2014-2015 Health Care Quality Report Cards

The much anticipated 2014-2015 edition of the OPA’s Health Care Quality Report Cards comes months ahead of the usual release date so that the information can be of use to consumers in the coming open enrollment season. The OPA release actually includes three different report cards: one for the health plans (HMOs); one for Preferred Provider Organizations (PPOs); and one for the Medical Groups. All told, the findings will of interest to more than 16 million Californians, most enrolled in job-based coverage but also those enrolled in the individual marketplace through Covered California.

There’s good news and bad on these tools. Historically, the tools have not been all that well utilized by consumers or employers. While many Californians not in position to make their own plan selection—their employer typically picks it for them—the report card is useful for those who have choices in “open enrollment” period coming this fall, including potentially for those in Covered California. Purchasers and employers have been clamoring for better tools, and indeed the tools seem to be getting better (learn more here).

Health Access is honored to feature OPA Director Beth Abbott (former Director of Administrative Advocacy at Health Access) in a Q & A about the new report cards…\

Health Access: What’s new or different about the 2014-15 Report Card Release?

Beth Abbott of the OPA: This year’s release provides one point of entry to the most recent quality information on all commercial plans in the state: www.opa.ca.gov . The release features a few new measures, including the percentage of readmissions to hospitals that are preventable.  This is important because if the readmission to the hospital shouldn’t have been necessary, it both increases the cost of the care and can have an adverse impact on health outcomes. 

HA: Why release the report card now?

BA: We are releasing the Report Cards to coincide with open enrollment periods for both employer-sponsored health coverage [for people who get their insurance through their job) and for people who are making selections of plans through our state-based marketplace at www.CoveredCA.com.  This means that this easy to use tool is available at the precise time when many Californians will be making selections and they will be able to evaluate health plans, PPOs (Preferred Provider Organizations), and medical groups, not only based on costs, but also with the most up-to-date quality information at their disposal. 

HA: What is your long range vision for the report card and related transparency tools?

BA: We want to have consumers select health plans based on value, which is the intersection between cost and quality.  Getting the cheapest plan based on the monthly premium is not always the best choice, since there are also out-of-pocket expenses that should be considered when you use the plan (deductibles, co-payments and the like.)  Also, if a plan is low cost, but does not deliver good quality, it is not a good choice.  Using the OPA Report Cards to evaluate the plans enables the consumer to consider quality metrics in easy-to-understand terms.  In addition to having consumers use the Report Cards to evaluate health plans as a matter of routine, we would like to see employers and unions who contract with health plans factor those quality measures into their contracting decisions.  In other words, when they are deciding which plans to offer to their employees, they offer them a selection based not only on costs, but what kind of results they get for their patients based on accepted clinical standards and patient experience. 

HA: What can the report card do to help advance the goals of health reform?

BA: One of the chief goals of the Affordable Care Act is to promote the integration of health care for the patient and to help lower the costs of providing health care.  These cost and quality measures go hand in hand.  If health care achieves a high degree of integration, patients don’t have to undergo duplicate tests and procedures, and their clinical data can be easily shared among the team that is treating them so that all information is available.  A well-integrated approach to care means, for example, that simple things can be handled by email between the patient and the doctor or pharmacist. This gets answers to the patient more quickly without having to wait for a formal appointment to be scheduled.  All of these kinds of things mean that the cost of health care is going down and the quality of health care is much more coordinated and responsive to patients’ needs. 

HA: What can groups like Health Access go do to help promote use of the report card?

BA: Health Access and its allies, friends, and relations can help by publicizing the Reports Cards.  It continues to amaze me how few people actually are familiar with these important quality tools.  I have come to refer to the Office of the Patient Advocate that I now work for as the “best undiscovered gem in CA state government.”  People should share our website with their employer, their union, their PTA group, their church or synagogue organization, their neighborhood association, and all of their friends.  I want this to be second nature for everyone who is making a health plan choice to get the right plan for them. 

The OPA has provided the following tools for community partners to use in getting the word out about the Report Cards.

  • A web badge designed for other organizations to place on their websites that will link people directly to the Health Care Quality Report Cards. The html code needed for the web badge placement can be found on this webpage: www.opa.ca.gov/Pages/PartnersBadges.aspx.  There also are general OPA web badges available in additional languages and sizes that link to OPA’s home page instead of the Report Cards.
  •  OPA’s social media accounts and links:
    Facebook –  Office of the Patient Advocate
    Twitter – @CAPatientAdv
    YouTube – CAPatientAdvocate
  • Last but not least, OPA has a “California Health Care Report Card” Mobile App available for free download through iTunes and Google Play. An overview about the Mobile App and the links to the two online stores can be found here: www.opa.ca.gov/Pages/MobileApplications.aspx.

HA: Anything else we should know about the report card and the OPA?

BA: If you think you want to stay with the plan you have now, you might want to look at our Report Cards, and click on your plan name.  It will give you your “plan profile” with all the details.  You can also click on any other plan you have under active consideration for a comparison.  And if you have particular health concerns in your family, e.g. diabetes or a heart condition, you can compare plans clinical measures of that treatment to make sure you’ve selected a plan that excels in that kind of care. 

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