Nevada HMOs shy away from study

Art Nadler

Thursday, Oct. 9, 1997 | 10:10 a.m.

Of Nevada's 10 health maintenance organizations, only one chose to report performance data to a nationally recognized accrediting agency.

The National Committee for Quality Assurance conducted a comparative information study recently of 329 HMOs nationwide, ranking them in part on: member satisfaction, childhood immunizations, cancer screening, prenatal care, mammography and cardiovascular disease, diabetes, asthma and smoking cessation treatment.

The report, released Oct. 1 and featured in this month's issue of U.S. News and World Report, compares Health Plan Employer Data and Information Set (HEDIS) statistics -- information that HMOs collect, but are sometimes reluctant to make public.

Mutual of Omaha Exclusive Healthcare is the only Nevada HMO listed in the U.S. News report. It received a two-star rating out of a possible four.

"I'm surprised we were the only carrier to report," said Greta Vaught, regional vice president of network operations. "I think we did very well. It's very important that we participate in all of NCQA's studies. This was the first year that we required all of our sites (nationwide) to participate."

Sierra Health Services Inc., Nevada's largest HMO, chose not to supply data for the NCQA Quality Compass 1997 report. It is the only HMO in Nevada accredited by NCQA.

"There wasn't a level playing field," said Ria Marie Carlson, vice president of public relations. "It was not something that consumers were demanding. You only have limited time in your organizations, and our effort was focused on being accredited (by NCQA)."

Carlson said SHS was concerned that HMOs had the option to not answer certain questions on the survey. She said this would place HMOs that answered all questions at a disadvantage.

"Health plans do take a risk by being out there up front when other plans are not," said Barry Scholl, a spokesman for NCQA. "But employers across the country are recognizing this type of performance information. You can look at how one HMO compares to another. More and more employers will demand this in the future."

PacifiCare of Nevada, the state's second largest HMO, didn't participate because it said the HEDIS data should have been audited by a qualified third party, instead of being self-reported.

"PacifiCare's policy is to release our HEDIS data directly to employer groups, as part of the discussion regarding health benefits for their employees," said Kayla Callas, director of public affairs. "PacifiCare will be monitoring public interest and opinion of the Quality Compass report. Based on that, we may make a decision to participate in a program like the Quality Compass report in the future."

Callas added that PacifiCare is working with NCQA and other plans through its national trade association to help enhance Quality Compass.

John Drayna, a spokesman for Humana Health Care Plans, said his HMO did not participate because it was fearful that the data would be taken out of context and could be used by competitors. He said Humana representatives prefer to sit down with consumers and explain the data to them.

Barbara Buckley, D-Las Vegas, who sponsored legislation (Assembly Bill 156) this year that changed the way HMOs do business in Nevada, thinks the Quality Compass report is a good idea because it allows consumers to compare services in chart form.

The only recourse consumers have now, she said, is for them to ask the state insurance commissioner if there have been complaints filed against an HMO.