HMOs on target in some areas, not others

Utahns enrolled in or considering a health maintenance organization can look online to see how several commercial and Medicaid plans compare to national averages and to each other.

The Utah Department of Health has released its annual HMO report, designed to tell consumers not only how selected HMOs compare in measures that might be important to individuals but also to help the plan providers see where improvement could be made, said Keely Cofrin, the department's HMO Health Program manager.

The measures, covering basics such as asthma treatment, diabetes management and cancer screening, also give consumers a checklist of sorts to help them see that they're getting the appropriate care, she added.

It is not intended as a report card, she said, but rather a tool to help consumers make choices that will work for them in the increasingly costly and complex arena of health care services.

Prepared by the UDOH's Health Data Committee and the Division of Health Care Financing, the report measures both performance quality and member satisfaction, based on data the health plans themselves provided and a customer satisfaction surrvey.

Participating commercial HMOs were Altius Health Plans, CIGNA Health Care, IHC Health Plans, Regence HealthWise and UnitedHealthcare of Utah. The four Medicaid plans were Healthy U, IHC Preferred Provider Network, Molina Healthcare and the Fee for Service Plan. Two Children's Health Insurance Program (CHIP) plans were also included: Public Employees Health Program and Molina HealthCare of Utah. Together, the report says, those plans cover about 42 percent of Utah's insured population.

The report is not all rosy. On average, Utah commercial HMOs fell short on screening rates for breast, cervical and colon cancer, compared to national averages. They also fell "well below national averages" in seeing that adolescents get well-care doctor visits and immunizations. The report identified a number of areas where Utah commercial plans falter, including controlling high blood pressure and children's access to primary care and some aspects of diabetes care, including routine eye exams and cholesterol testing.

Not all of the plans provided information in all of the areas measured. And there was wide variation in results for the different HMOs. IHC plans, for instance, bested national averages in most measures, although overall the state fell behind.

Utah HMO averages are on target in some areas, including prenatal and post-partum care, tracking blood sugar levels in those with diabetes and asthma treatment.