Consumer Protection in Private Health Insurance: The Role of Consumer Complaints. D. Comparing the Quality of Maryland HMOs 1999 Consumer Guide

06/01/2000

Features

The Maryland Health Care Commission (HCC), a public regulatory body established by the legislature, produces annual consumer report cards on HMO quality using HEDIS and CAPHS measures. The HCC produces three major types of reports:

  • An analytical Policy Report providing both an Executive Summary and Technical information;
  • A Comprehensive Performance Report directed at health plans and benefit managers providing complete, statistically detailed information; and
  • A Consumer Guide presenting the information in simple graphical format. In addition to a hard copy booklet, the HCC produces an electronic interactive guide which allows consumers to focus in on specific plans.

The Consumer Guide released in June 2000, comprising results from 1999, includes two complaints measures using the CAPHS 2.0H Survey (included in HEDIS 1999). The survey, sent to 1,240 members of each plan, includes:

  • In the last 12 months, have you called or written your health plan with a complaint or problem?; and
  • If you had a complaint, was it settled to your satisfaction?

While Maryland was the first state to produce an HMO quality report card, this is the first time that complaint measures have been included in the annual consumer guide.

Findings

In 1999 26% of commercial HMO members reported that they called or wrote to their health plan with a complaint over the past 12 months, ranging from a low of 15% to a high of 35% across individual HMOs. (Note: the Policy Report indicates that the average complaint rate was unchanged from 26% in 1998.) When asked whether the complaint was resolved to their satisfaction, 56% said yes (range of 45-71%), 21% said no (range of 16-27%), and 23% said the complaint had not yet been settled (range of 12-31%).

Assessment of the Report

Consumer friendliness: The Maryland HCC report is presented in a manner which is simple and easy for consumers to follow. It uses a graphical presentation which compares the performance of individual HMOs, ranking them as average, higher than average or lower than average using colored circles. In addition, for consumers who want more detailed information, the report contains numerical scores with bar charts for all the performance measures for individual HMOs.

Monitoring patient protection implementation: As the complaints data does not provide any breakdown of the types of complaints experienced by patients, it is of limited use in tracking the implementation of patient protection legislation.