Maryland to issue report cards on PPO plans

A state commission will provide consumers with comparative measures on PPOs.

By Pamela Lewis Dolan — Posted Jan. 21, 2008

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For more than a decade, Maryland residents have been able to compare data on the state's various HMO plans. Later this year, the same feedback will be available for PPOs.

The Maryland Health Care Commission announced late last year that it will partner with four of the state's largest PPOs to provide comparative analyses of their plans, which it said would make Maryland the first state to do so.

Beginning in 1996, the state has mandated that insurers publicly report the performance of their HMO plans using two widely used data sets -- Healthcare Effectiveness Data and Information Sets and Consumer Assessment of Healthcare Providers and Systems, a standardized customer satisfaction survey. Since then, the MHCC has offered a comparison tool for consumers to evaluate HMO plans against each other.

Joyce Burton, chief of the MHCC's Health Plan Quality and Performance Division, said a feasibility study determined that HEDIS and CAHPS data also could be collected from PPO providers, through a public-private partnership between the MHCC and the insurers. A comparison tool for PPOs is scheduled to launch later in 2008.

"It's good for consumers to have this information on cost and quality," said Susan Pisano, spokeswoman for America's Health Insurance Plans, a trade group for large insurers. "But they need it from all the sectors, including hospitals and providers."

CareFirst Blue Cross Blue Shield, one of the partners in the Maryland project, says the data collection also will be a good opportunity for the company to identify problems that may need to be addressed.

"The Maryland Health Care Commission's annual HMO report card serves a valuable purpose in focusing insurers on areas of care and service that can be improved. We expect that the PPO effort will do the same," said Daniel Winn, MD, vice president and senior medical director for medical and networks management at CareFirst.

Martin Wasserman, MD, executive director of MedChi, the Maryland State Medical Society, said that "if the health care commission wants to be looking at PPO satisfaction for patients, they ought to be looking in addition at whether this specific PPO is likely to retain its physician network in the future with its compensation fairness."

Dr. Wasserman is a member of Maryland Gov. Martin O'Malley's Task Force on Health Care Access and Reimbursement, which by June 30 is scheduled to deliver to the governor and state legislators a final list of recommendations for regulating health plans' business practices.

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