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HMO's Score Healthy Marks

By Eileen Buckley

Buffalo, NY – Three Buffalo area Health Maintenance Organizations surpassed the national average for overall ratings in the fourth annual report card on New York's HMO's.

Community Blue, Independent Health and Univera scored average to above average in member satisfaction.

The New York State Health Accountability Foundation, a public-private partnership of state government and major New York employers, issued the ratings.

71 percent of Independent Health subscribers gave their plan an eight, nine or ten on a ten point scale - with ten being the highest.

Community Blue received 68 percent and Univera 67 percent, all beating the national average of 59-percent.

Dr. Michael Cropp is Chief Medical Officer for Independent Health.

"The three plans in Western New York really do a great job of living up to members expectations," said Cropp.

"The HMO's perform at a level above the national average and generally above the New York State average as well."

The report examines the quality of 24 commercial HM0's and compares the numbers to state and national averages.

Performance is based on a range of areas, from access and service, to health screening for various diseases.

Dr. Mary Hibberd, with the foundation, says overall, state HMO's rated well in 17 of the 19 performance areas.

Hibberd said four new measures were added this year - cholesterol control, eye and blood sugar exams for diabetics and high blood pressure testing.

"We're not just looking anymore at whether a test was ordered, but we are now starting to look at what was done with the results of that test," said Hibberd.

"So, what you are really look in this report is the interaction between the doctor, health care provider, the patient and the health plan."

The foundation reports that the state's HMO's serve patients slightly better than the national average, but need to improve screening for high cholesterol, high blood pressure and diabetes.

Hibberd said much work is needed in preventing blindness and keeping blood sugar levels in check for diabetics.

"If you look at the percent, both the national average, which is at 43 percent, and the New York's average, which is 39 percent, there is a long, long way to go in helping to manage blood sugar levels for folks with diabetes," said Hibberd. But for diabetic eye exams it varied.

Univera was issued an above average rating, while Community Blue received an average grade, and Independent Health rated lower than the average.

However, Dr.Cropp said that some of the data the foundation used in the report is from 1999 and does not include recent improvements, such as last week's announcement of universal guidelines for diabetes screenings.

"We don't get much value out of this report ourselves because the data is so old," said Cropp.

"The elements used to build this report are the same elements we monitor internally. But we have much more recent indications of level of member satisfaction, level of performance in respect to diabetes care, as well as screening for cancers."

Cropp added, "And we do use those measures to help improve our performance. But it is important that we have current measures that can help us understand the most recent interventions and what those interventions have been able to bring about in performance improvement."

Community Blue, Independent Health and Univera all scored below average in the number of primary care physicians who are board certified.

That was not a change from last year's rating.

There has been speculation by some area health care leaders that the local economy led to the loss of board-certified doctors. He said they do not measure quality based solely on board certification.

"Our experience with board certification is a less valuable indicator," said Cropp.

"We can demonstrate levels of performance preventative care and services that we are able to achieve here in Western New York working with our physician network."

Dr. Hibberd with the foundation agrees with Cropp.

She said that despite the below average rating for board certification in Buffalo it is "not the end all" in quality care.

"In all honesty, I tend to look more at a plan drilled down to individual physicians care practices," said Hibberd.

"You can look at these indicators and many others. I would personally focus on the quality care they are giving to patients rather than they are board certified or not." The foundation reports stats that all scores issued "reflect the responsibility" of not only the HMO's and physicians, but also the subscribers in maintaining a healthy lifestyle.