Published: November 30, 2008 10:25 pm      

PPO rating latest tool for consumers

PPO report from Maryland Health Care Commission.



CUMBERLAND — As the last of procrastinators fill out their employer-sponsored health care forms, Maryland consumers have a new tool designed to help them make the choice between providers and whether an HMO or PPO is right for them.

The Maryland Health Care Commission released for the 12th straight year a report on Health Maintenance Organizations and used information provided by four major health care carriers — certified by an audit vendor — to rate the carriers on elements from prevention and proper medical services to treating illness and patient satisfaction.

For the first time, four carriers — Aetna, Cigna, CareFirst BlueCross BlueShield and United Healthcare — provided information for the Preferred Provider Organization menu of options. The report is free and available online at www.mhcc.maryland.gov. It also can be viewed at www.times-news.com.

Maryland is the first state in the country to offer to the public an audited, comparative analysis of clinical and member satisfaction measures for PPOs, commission officials said. The data was collected by the insurance companies themselves and voluntarily submitted to the commission, said Joyce Burton, MHCC chief of health plan quality and performance.

“Up until this year, we always focused on HMOs because they are more tightly managed health care systems,” Burton said. “If you recall in the 1990s, there were concerns among the consumer base that care was being too tightly managed and it was so restrictive that folks thought they weren’t getting the care they needed.”

Now, Burton said, people are more frequently choosing a PPO. The report “allows comparisons to be made between plans,” she said.

“The state’s advancement of a first-in-the-nation PPO guide meets the market’s demand,” Dr. John P. Shematek, CareFirst senior vice president and chief medical officer, said in a news release. “Equally as important, the state’s guide will provide insurers a valuable tool each year for evaluating past performance and isolating areas for improvement.”

With an objective report in hand, Burton said consumers making their health care selections have better than water-cooler advice on what might be best for their families.

“It’s pretty common that folks talk” to others and seek their opinions, Burton said. That approach’s effectiveness is limited in that “we all factor in those personal filters as far as what our experience has been.”

Burton stressed the effort is a collaboration of all parties. The ultimate goal, she said, is “to work to improve the health care experience for all Marylanders.”

Contact Kevin Spradlin at kspradlin@times-news.com.