Study: Florida Not Getting Money’s Worth in Health Plans

By John Dorschner, The Miami Herald

Sep. 19–Florida’s health plans rank well below the best in the nation, a coalition of the state’s major employers announced Monday.

“If this was an FCAT scale, we wouldn’t be a B,” said Becky Cherney, head of the Florida Health Care Coalition. “We’re paying an enormous amount of money for health insurance, and we’re getting C’s, D’s or F’s.”

The in-depth report ranked the state’s six largest insurers. Vista, which is used by many Broward County and school employees, ranked at or near the bottom in six of eight major categories.

Cigna led in four areas — overall profile, consumer satisfaction, disease prevention and behavioral health. Aetna came in first for chronic disease management, Humana for information on providers, Blue Cross Blue Shield of Florida for information technology and UnitedHealthcare for pharmacy benefits.

“This study is very important,” said Brian Klepper, head of the Center for Practical Health Reform. “Purchasing health plans has been really confusing territory, trying to figure out what’s real and what’s not.”

Cherney said the coalition’s goal was to ‘pressure the plans to do better. If I were a benefits manager for a company, I’d say, ‘We’re looking at your quality now, and if you don’t improve your performance, we want a 10 percent discount.’ We have quality standards for other services. Why not for health plans?”

The Florida Health Care Coalition, founded in Central Florida in 1984, spread statewide last year. Its members include Florida Power & Light, Macy’s and the county governments and school boards of Broward, Miami-Dade and Palm Beach. Its goal is to increase healthcare quality while lowering insurance costs.

The study released Monday is based on a tool called eValue8, a measuring system developed by the National Business Coalition on Health and improved over the last several years by managers at General Motors and Marriott International. It’s also being supported by federal agencies like Medicare and the Centers for Disease Control as well as various universities.

This is the first time the Florida data has been made public. The state coalition did a survey last year but showed the results only to its members — and the insurers.

‘We didn’t want to do a ‘Gotcha!’ ” said Ron Weintraub, benefits director for Broward schools.

‘We said, ‘Here are the results. You have a year to improve.’ ” In fact, both Vista and Humana, the two plans for Broward school employees, “showed big increases” from their scores last year, said Weintraub.

Much of the information in the report is based on surveys that the plans themselves filled out.

One category, Plan Profile, is based 60 percent on accreditation by the National Committee for Quality Assurance, a nonprofit rating group that measures such aspects as good customer service, checking doctors’ qualifications and quality in taking care of patients.

The rest of the profile category measures patient convenience, such as timeliness in responding to phone inquiries, speed in paying claims and how well the insurer acts in trying to correct well-known racial and cultural disparities in care.

“One size doesn’t fit all,” said Cherney. “If I have diabetes, I’d probably focus on chronic disease management.” Aetna ranked highest in that category with 80, but far below the national benchmark of 97, based on a perfect score of 100.

Cigna followed at 77 and Humana with 66. At the bottom were Vista (57), BCBS (55) and UnitedHealthcare (52).

Another key category measured consumer engagement and support, which includes how easily patients get access to practitioners and services, how much they can learn about doctors’ and hospitals’ performances, whether there’s a 24/7 nurse advice line and how easily they can find out about co-pays and deductibles.

In that category, Cigna ranked first at 85, equal to the national high, with Vista far below at 37.

In promoting prevention measures and wellness programs such as weight management, Cigna was tops at 78, compared to a national high of 95. Vista was last at 40.

“It’s really good we have this independent look at insurers, particularly after the news that came out Monday,” said Klepper.

He was referring to an article in The Wall Street Journal that reported that some advisors on what health plans employers should select had secretly been receiving kickbacks from insurers.

UnitedHealthcare reportedly paid a $500,000 reward for a consultant recommending its plans to an Ohio school district.

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