. 
,., 
Department  of  Eklth  and  Human  Services 
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lNDIVl~UAL  ,
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 MEDi~A.~~RISK 
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)  APRIL  1995.. 
b.  OEI-06-91-00733    . 
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. 
,,  The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, as 
amended, is to protect the integrity of the Department of Health and Human Services' (HHS) 
programs as well as the health and welfare of beneficiaries served by those programs.  This 
statutory mission is carried out through a nationwide network of audits, investigations, and 
inspections conducted by three OIG operating components:  the Office of Audit Services, the 
Office of Investigations, and the Office of Evaluation and Inspections.  The OIG also informs the 
Secretary of HHS of program, and management problems, and recommends courses to correct 
them. 
OFFICE OF AUDIT SERVICES 
The OIG's Office of Audit Services (OAS) provides all auditing services for HHS, either by 
conducting audits with its own audit resources or by overseeing audit work done by others.  Audits 
examine the performance of HHS programs and/or its grantees and contractors in carrying out 
their respective responsibilities and are intended to provide independent assessments of HHS 
programs and operations in order to reduce waste, abuse, and mismanagement and to promote 
economy and efficiency throughout the Department. 
OFFICE OF INVESTIGATIONS 
The OIG's Office of Investigations (OI) conducts criminal, civil,. and administrative investigations 
of allegations of wrongdoing in HHS programs or to HHS beneficiaries and of unjust enrichment 
by providers.  The investigative efforts of OIlead to criminal convictions, administrative 
sanctions, or civil money penalties.  The OIalso oversees State Medicaid fraud control units which 
investigate and prosecute fraud and patient abuse in the Medicaid program. 
OFFICE OF EVALUATION AND INSPECTIONS 
The OIG's Office of Evaluation and Inspections (OEI) conducts short-term management and 
program evaluations (called inspections) that focus on issues of concern to the Department, the 
Congress, and the public.  The findings and recommendations contained in these inspection reports 
generate rapid, accurate, and up-todate information on the efficiency, vulnerability, and 
effectiveness of departmental programs.  This report was prepared in the Dallas regional office 
under the direction of Ralph Tunnell, Regional Inspector General and Chester B. Slaughter, 
Deputy Regional Inspector General.  Project staff: 
REGION  HEADQUARTERS 
Michelle Adams  Pamela Smith  Hugh Hetzer 
Leah Bostick  Sarah Taylor  Mark Krushat 
George DeLuna  Judith Tyler  Brian Ritchie 
Kevin Golladay  Nancy W atts Barbara Tedesco 
Carolyn Neuwirth 
For additional copies of this report, please contact the Dallas Regional Office at (800) 848-8960.   
Above average  @  Average  O  Below average  NS  Not sufficient  data 
HMo  ID #: 0545  Enrollees  Dkenrollees 
(N=37)  (N =36)
. 
lkeiicimy Responsesto Key  An  This  %Diff.  Comp.  An  Tbi$  %Diff.  Comp. 
Survey Qwations by Category  EIMos  HMo  HMos  HMO 
For scheduled appointments 
with specialists, usually  81%  96%  + 15%  g  75%  72%  -3%  e 
waited less than 13 days.  (970)  (26)  (477)  (13) 
IWIhen very sick, was able to 
get a doctors  appointment 93%  96%  +3%  e  89%  93%  +4%  e 
within 1 to 2 days.  (942)  (21)  (453)  (13) 
IuIsually  waited less than 1 
hour in the office  to see 95%  85%  -lo%  o  87%  76%  -11%  e 
primary HMO doctor.  (1,431)  (29)  (704)  (19) 
ICIonsistently busy telephone 
lines did n@ hinder benes 90%  86%  -4%  e  89%  90%  +1%  e 
making appointments.  (780)  (18)  (425)  (18) 
Primary
II HMO doctor never 
Pfailed rto piromvide needaed ry%%  100%  +4%    88%  82%  -6%  03 
Medicare services.  (1,475)  (34)  (744)  (22) 
II HMO doctor never 
failed to refer to a specialist  96%  97%  +1%  e  88%  71%  -17%  o 
when needed.  (1,439)  (30)  (732)  (20) 
Didnt feel the need to seek 
out-of-plan care, excluding 
dental, routine eye, and  93%  94%  +1%  @  86%  85%  -1%  e 
emergenthrgent  care.  (1,397)  (33)  (696)  (22) 
Medical care reeeived 
through the HMO caused 
beneficiaries  health to: 
b  improve	 53%  38%  -15%  o  41%  20%  -21%  o
(772) 
(13)  (296)  (5) 
P  stay about the same	 45%  59%  + 14%    49%  72%  +23%  
(649)  (20)  (383)  (18) 
b  worsen	 2%  3%  +1%  10%  8%  -2% 
(32)  (1)  @  (86)  (2)  e 
Primary HMO doctor never

failed to take beneficiarys  88%  79%  -9%  o  76%  88%  +12%  g

health conqhints  SeliOUSIJr.  (1349)  (22)  (650)  (29) 
29
  
Above average  @  Average  O  Below average  NS  Not sufllcient  data 
HMo  ID #: 0545  Enrollees  DKenrollees 
(N =37)  (N =36)
. 
W&icky  Reqxmsea to Ksy  Au  This  %Diff.  Comp.  Au  This  %DM.  Comp. 
Survey Questionsby Category  EMos  EMo  RMos  HMo 
Most important to primary 
HMO doctor was: 
b  giving the best 
medical care  86%  93%  +7%    72%  52%  -20%  o 
possible  (1,197)  (28)  (471)  (12) 
26%  48% 
F	 holding down the  9%  o%  -9%  o  +22%  g 
cost of care  (120)  (4)  (162)  (11) 
Most important to the HMO 
was: 
b  giving the best 
medical care  74%  72%  -2%  @  58%  43%  -15%  e 
possible  (1,036)  (23)  (387)  (9) 
b  holding down the  15%  6%  -9%  o  36%  48%  + 12%  e 
cost of care  (213)  (2)  (230)  (lo) 
30
 AETNA  HEALTH  PLANS  OF  NORTHERN  CALIFORNIA 
No. Enrokes:  14,580  Total No. f%unpkd: 94  Total No. Respondents:  60 
Model &pe: IPA  For-Profit  Competitive 
 
Above average  @  Average  O  Below  average  NS  Not suftlcient  data 
HMO ID #: H 0547  Enrollees  Disenrokes 
(N = 34)  (N =26) 
Benefkiary Reaponseato Ksy  All  This  %DM.  Comp.  Au  This  %Diff.  Comp. 
Survey Queaiionsby Category  HMos  EMo  Ervlos  HMo 
HkXJH7Z  fXREEh?ZVG 
Wss ~t  asked at application 
about health problems, 
excluding kidney failure and  63%  94%  +31%    58%  64%  +6%  03 
hospice care.  (717)  (15)  (430)  (9) 
Physical exam was n- 96%  100%  +4%  (B  98%  94%  -4%  o 
required before joining.  (1,295)  (20)  (824)  (16) 
tXWHIiST&V..ljW  UF EMUS 
Did know they could change 
their minds about enrolliig  88%  82%  -6%  e  82%  69%  -13%  e 
after they applied.  (1,078)  (14)  (611)  (11) 
Did know,  from the 
beginning, they must be 
referred to a specialist by  89%  91%  +2%  @  84%  83%  -1%  @ 
their primary HMO doctors.  (1,444)  (31)  (852)  (20) 
Did know,  from the 
beginning, they could only 
use HMO doctors and 
hospitals (except emergent 
care and urgent care outside  96%  100%  +4%    93%  96%  +3%  03 
the service area.)  (1,585)  (34)  (958)  (-23) 
Did know they had the right 
 
to appeal an HMOs  refusal  74%  86%  + 12%  67%  60%  -7%  e 
to providetpay for services.  (1,113)  (25)  (523)  (12) 
For scheduled appointments

with primary HMO  doctors,

usually waited less than 13  85%  94%  +9%  (B  82%  90%  +8%  e

days.  (1,276)  (29)  (681)  (17)

31 
  ,  Above average  @  Average  o  Below swrage  NS  Not suffkient  data 
HMO  ID #: H 0547  Enrollees  Dkenrollees 
(N = 34)  (N =26)
-..  ..--. 
Bendieimy Responsesto Key  Au  This  %Diff.  Comp.  All  This  %Diff.  Comp. 
Survsy Qm40ns  by Category  HMos  IWO  -ifIMOs  HMo 
.. 
For scheduled appointments 
with specialists, usually  81%  100%  + 19%  o  75%  94%  + 19%   
WSited  kis  than 13 (@W.  (970)  (27)  {477)  (16) 
. 
When very sick, was able to 
get a doctors  appointment  93%  96%  +3%  @  89%  100%  +11%  03 
within 1 to 2 days.  (942)  (24)  (4.53)  (14) 
. 
usually waited less than 1 
hour in the office  to see  95%  97%  +2%  @  87%  95%  +8%  @ 
primary HMO  doctor.  (1,431)  (31)  (704)  (18) 
.. 
Consistently busy telephone

lines did ~t  hinder benes  90%  100%  + 10%  e  89%  100%  +11%  e

making appointments.  (780)  (20)  (425)  (9)

Primary HMO doctor never 
failed to provide needed  96%  97%  +1%  e  88%  100%  + 12%  o 
Medicare services.  (1,475)  (31)  (744)  (19) 
Primary HMO doctor never 
failed to refer to a speciahst  96%  97%  +1%  @  88%  90%  +2%  @ 
when needed.  (1,439)  (30)  (732)  (18) 
Dkint feel the need to seek 
out-of-plan care, excluding 
dental, routine eye, and  93%  97%  +4%    ?36%  83%  -3%  @ 
emergentiurgent care.  (1,397)  (29)  (696)  (15) 
Medical care received 
through the HMO caused 
beneficiaries  health to: 
41%  41%  o%  e 
(296) 
49%  5:%  +10%  ~ 
(383)  (lo) 
10%  o% 
b  worsen  -lo% 
(86)  (o)  e 
Primary HMO  doctor never

failed to take beneficiarys  M%  84%  -4%  e  76%  95%  + 19%  

health COn@ainta  seriously.  (1349)  (26)  (650)  (18)

32
  
Above average  @  Average  O  Below average  NS  Not stilcient  data 
HMO  ID #  H 0547  Enrollees  Dwnrollees 
(N=  34)  (N =26)
. 
Beneficimy  Reaponseato Key  Au  This  % Diff.  Comp.  M  This  %Diff.  Comp. 
Survey Quedions by Category  EMos  HMO  HMos  HMO 
Most importaot to primary 
HMO doctor wax 
b  giving the best 
 
medkal  care  86%  88%  +2%  e  72%  95%  +23% 
possible  (1,197)  (28)  (471)  (18) 
b	 holding down the  9%  6%  -3%  26%  o%  -26%  O 
@ 
cost of care  (120)  (2)  (162)  (o) 
Most important to the HMO 
was: 
b  giving the best 
medical cam  74%  77%  +3%  03  58%  56%  -2%  (B 
possible  (1,036)  (23)  (387)  (9) 
b  holding down the  15%  20%  +5%  e  36%  31%  -5%  e 
cost of care  (213)  (6)  (230)  (5) 
33
 AM  ERIMED  (CA)
..  . 
 
No. Enrollees:  1,024  Total No. !hnpkd:  96  Total No. Respondents:  49 
 
Model ijpe  IPA  For-Profit  Competitive 
.  Above average  @  Average  O  Below average  NS  Not suftlcient  data 
HMo  ID #: 0557  Enrollees  DEenrollees 
(N=  28)  (N =  21)
 
Benetkii  Responsesto Key  Au  This  %Diff.  Comp.  Ao  This  % M.  Comp. 
Survsy Questionsby Category  EMos  HMO  KMos  HMo 
HWZH  $iCiU3EAWG 
Was ~t  asked at application 
about health problems, 
excluding kidney failure and  63%  63%  o%  @  58%  47%  -11%  e 
hospice care.  (717)  (12)  (430)  0) 
Did know they could change 
their minds about enrolling  88%  80%  -8%  e  82%  89%  +7%  03 
after they applied.  (1,078)  (20)  (611)  (16) 
Did know,  from the 
beginning, they must be 
referred to a specialist by  89%  85%  -4%  e  84%  77%  -7%  e 
their primary HMO doctors.  (1,444)  (22)  (852)  (13) 
Did know,  from the 
beginning, they could only 
use HMO doctors and 
hospitals (except emergent 
mm and urgent care outside  96%  %5%  -11%  o  93%  80%  -13%  o 
the service  area.)  (1,585)  (23)  (958)  (16) 
Did know they had the right 
b appeal au HMOs  refusal  74%  81%  +7%  e  67%  46%  -21%  o 
to providelpay  for services.  (1,113)  (17)  (523)  (5) 
For scheduled appointments

with primary HMO doctors,

usually waited less than 13  85%  91% +6%  e  82%  82%  O% @

iays.  (1,276)  (21)  (681)  (9)

34
  
Above average  @  Average  O  Below average  NS  Not sufficient  data 
HMo  ID #  0557  Enrollees  Dmenrollees 
(N=  28)  @  =  21) 
Baaeficii  Reapomca to Key  4a  This  %Diff.  Comp.  All  This  %Diff.  Comp< 
Survey Queatioasby Category  EMos  HMO  FKMos  HMo 
For scheduled appointments 
with specialist,  usually  81%  81%  O%  @  75%  55%  -20%  o 
waited less than 13 days.  (970)  (13)  (477)  (6) 
When very sick, was able to 
get a doctors  appointment  93%  100%  +7%  e  89%  80%  -9%  03 
within 1 to 2 days.  (942)  (9)  (453)  (8) 
Usually waited less than 1 
hour in the office  to see  95%  100%  +5%  @  87%  73%  -14%  o 
primary HMO doctor.  (1,431)  (24)  (704)  (8) 
Consistently busy telephone 
lines did ~t  hinder benes  90%  88%  -2%  e  89%  100%  +11%  e 
making appointments.  (780)  (T  (425)  (3) 
Primary HMO doctor never 
failed to provide needed  96%  91%  -5%  o  88%  82%  -6%  e 
Me&are  services.  (1,475)  (21)  (744)  (9) 
Primary HMO doctor never 
failed to refer to a specialist  96%  100%  +4%    88%  91%  +3%  %3 
when needed.  (1,439)  (20)  (732)  (lo) 
Didnt feel the need to seek 
out-of-plan care, excluding 
dental, routine eye, and  93%  95%  +2%  e  86%  82%  -4%  ~ 
emergentlurgent care.  (1,397)  (18)  (696)  (9) 
Me&al  care received 
through the HMO caused 
beneficiaries  health to: 
b  improve  53%  41%  -12%  o  41%  50%  +9%  (B 
(296) 
49%  5:%  +1% 
@ 
(383) 
10%  ;; 
-lo% 
(86)  (o)  e 
Primary HMO  doctor never

failed to take beneficiarys  88%  76%  -12%  o  76%  70%  -6%  e

health complaints seriously.  (1349)  (16)  (650)  m

35
 .  Above average  @  Average  O  Below average  NS  Not suffkient  data 
HMo  n)  #: 0557  EnrolIees  DwnrolIm 
(N = 28)  (-N = 21) 
. 
Beneficiary Responsesto Key  Au  This  %Diff.  Comp.  All  This  %Diff.  Comp. 
Survey QueatioIJbsy Category  EMos  HMo  HMos  HMo 
-. 
Most important to primary 
HMO doctor was: 
b  giving  the best 
medical care  86%  91%  +5%  e  72%  56%  -16%  @ 
possible  (1,197)  (19)  (471)  (5) 
b  holding down the  9%  10%  +1%  (B  26%  44%  +18%   
cost of care  (120)  (2)  (162)  (4) 
Most important to the HMO 
was: 
b  giving  the best 
o 
medical care  74%  71%  -3%  @  58%  25%  -33% 
possible  (1,036)  (12)  (387)  (-2) 
b  holding down the  15%  18%  +3%  e  36%  75%  +39%  g 
cost of care  (213)  (3)  (230)  (6) 
36
 HEALTH  NET  (CA) 
No. Enrollees: 6,131  Total No. !kunpkd:  99  Total No. Respondents:  72 
Model ~pe:  IPA  For-Profit  Competitive 
 
Above average  @  Average  O  Below average  NS  Not suftlcient  data 
HMO  ID #: H 0563  Enrollees  DkenroI1ees 
(N =36)  (N =36) 
Beneficiary Responsesto Key  An  This  %Diff.  Comp.  Au  This  % Diff.  Comp. 
Survey Questionsby Category  EMos  HMO  Elms  HMO 
MMLIH  SCREENING 
Was at  asked at application 
about health problems, 
 
excluding kidney failure and  63%  57%  -6%  @  58%  93%  +35% 
hospice care.  (717)  (4)  (430)  (13) 
Physical exam was nggt  96%  100%  +4%  @  98%  100%  +2%  e 
required before joining.  (1,295)  (8)  (824)  (14) 
Did know they could change 
their minds about enrolling  88%  83%  -5%  e  82%  91%  +9%  (B 
after they applied.  (1,078)  (5)  (611)  (lo) 
Dld know,  from the 
beginning, they must be 
referred to a specialist by  89%  84%  -5%  03  84%  92%  +8%  @ 
their primary HMO dootors.  (1,444)  (m  (852)  (3 
Did know,  from the 
beginning, they could only 
use HMO doctons and 
hospitals (except emergent 
care and urgent care outside  96%  94%  -2%  @  93%  100%  +7%  e 
the service area.)  (1,585)  (30)  (958)  @s) 
Did know they had the right 
to appeal an HMOs  refusal  74%  73%  -1%  @  67%  46%  -21%  o 
to providelpay  for services.  (1,113)  (22)  (523)  (6) 
For scheduled appointments

with primary HMO doctors,

usually waited less than 13  85%  90%  +5%  e  82%  85%  +3%  @

days.  (1,276)  (27)  (681)  (11)

37
 .  Above average  ~  Average  o  Below avengt?  NS  Not sufllcient  data 
.  ---
HMO ID #: H 0563  Enrollees  Dlsenrolkes 
(N=36)  (N =36)
.- . 
Bamfk&y  Respomwsto Key  Au  This  %Diff.  Comp.  All  This  %Diff.  Comp. 
Survey Questionsby Category  mm  HMO  5MOS  HMO 
.. -.- 
For scheduled appointments 
with specialists, usually  81%  88%  +7%  e  75%  73%  -2%  03 
waited less than 13 days.  (970)  (21)  (477)  (8) 
 
When very sick, was able to 
get a doctors  appointment  93%  86%  -7%  @  89%  100%  +11%  03 
within 1 to 2 days.  (942)  (19)  (453)  (9) 
usually waited less than 1 
 
hour in the office  to see  95%  100%  +5%  03  87%  100%  +13% 
primary HMO doctor.  (1,431)  (29)  (704)  (14) 
Consistently busy telephone

lines did @  hinder benes  90%  86%  -4%  @  89%  100%  + 11%  @

making appointments.  (780)  (19)  (425)  (6)

sERvmw 
Primary HMO doctor never 
failed to provide needed  96%  100%  +4%    88%  93%  +5%  (B 
Medicare services.  (1,47.5)  (30)  (744)  (13) 
Primary HMO doctor never 
failed to refer to a spczialkt  96%  97%  +1%  @  88%  93%  +5%  @ 
when needed.  (1,439)  (31)  (732)  (13) 
Didnt feel the need to seek 
out-of-plan care, excluding 
dental, routine eye, and  93%  90%  -3%  @  86%  93%  i-7%  (B 
emergenthugent care.  (1,397)  (28)  (696)  (13) 
Medkal  care  received 
through  the HMO  caused 
beneficiaries  health to: 
b  improve  53%  57%  +4%  @  41%  50%  +9%  @ 
(772)  (17)  (2%) 
b  stay about the same  45%  40%  -5%  @  49%  am%  -6%  @ 
(649)  (12)  (383)  (6) 
2%  3%  10%  7% 
b  worsen  +1%  -3%  @
(32)  (1)  @  (86)  (1) 
Primary HMO doctor never

o

failed to take beneficiarys  88%  90%  +2%  @  76%  69%  -7% 
health complaints seriously.  (1349)  (26)  (650)  (9)

38

  .  Above average  @  Average  O  Below average  NS  Not suftlcient  data 
HMO ID#H0563  Enrollees  Dwnrollees 
(N =36)  (N =36) 
BeneficiaryResponsesto Key  All  This  %Difr.  Comp.  Aa  This  %Diff.  Comp. 
&uvey QM?StiOM4by (kt=ory  EIWOS  HMO  EMos  HMO 
Most important to primary 
HMO doctor was: 
b  giving the best 
me&cal care  86%  93%  +7%  e  72%  73%  +1%  @ 
possible  (1,197)  (26)  (471)  (8) 
b	 holding down the  9%  o%  -9%  o  26%  27% +1%  e 
cost of care  (120)  (o)  (162)  (3) 
Most important to the HMO 
was: 
b  giving  the best 
 
medical care  74%  89%  +15%  58%  67%  +9%  @ 
possible  (1,036)  (23)  (387)  (8) 
b	 holding down the  15%  4%  -11%  o  36%  25%  -11%  e 
cost of care  (.213)  (1)  (230)  (3) 
39
 HMO  COLORADO,  INC.

b 
No. Enrollees: 894  Total No. fkunpkd:  57  Total No. Respondents:  52 
 
Model ijpe  IPA  Not For-Profit  Competitive
.- 
.  Above average  63  Average  O  Below  average  NS  Not sufilcient  data 
HMO ID #: H 0603  Enrollees  Dkenrollees 
(N=@  (N=@ 
Beneficiary Reaponseato Key  Au  This  %Diff.  Comp.  All  This  % Difr.  Comp. 
Survey Questionsby Category  EMos  HMo  EMos  HMO 
HJMLl!H  SIXEEWVG 
Was ~t  asked at application 
about health problems, 
excluding kidney failure and  63%  67%  +4%  e  58%  75%  + 17%  e 
hospice care.  (717)  (22)  (430)  (3) 
Physical exam was n- 96%  97%  +1%  @  98%  100%  +2%  e 
required before joining.  (1,295)  (35)  (824)  (5) 
UMUIH?STAAWN(?  iXHMOs 
Did know they could change 
their minds about enrolling  88%  90%  +2%  @  82%  50%  -32%  O 
after they applied.  (1,078)  (26)  (611)  (2) 
Did know,  from the 
beginning, they must be 
referred to a specialist by  89%  93%  +4%  e  84%  40%  -44%  o 
their primary HMO doctors.  (1,444)  (42)  (852)  (a 
Did know,  from the 
beginning, they could only 
use HMO doctors and 
hospitals (except emergent 
care and urgent care outside  96%  93%  -3%  e  93%  100%  +7%  @ 
the service area.)  (1,585)  (41)  (958)  (3 
Did know they had the right 
to appeal an HMOs  refusal  74%  74%  o%  e  67%  NS 
to providelpay for services.  (1,113)  (32)  (523) 
For scheduled appointments

with primary HMO doctors,

usually waited less than 13  85%  100%  +15%    82%  NS

days.  (1,276)  (43)  (681)

40
 .  Above average  @  Average  O  Below average  NS  Not stilcient  data 
HMO ID#:H0603  EnrolleH  DMenrollees 
(N=@  (N=@ 
Beneficiary ReapoKIMto Key  AU  This  % Diff.  Comp.  Au  II&  %Diff.  Comp. 
Survey @lf3tiOIIS by Ca@ory  EMos  HMo  IWos  HMO 
For scheduled appointments 
 
with specialists, usually  81%  92%  + 11%  e  75%  100%  +25% 
waited less than 13 days.  (970)  (34)  (477)  (1) 
When very sick, was able to 
get a doctors  appointment  93%  92%  -1%  e  89%  100%  +11%  (3 
within 1 to 2 days.  (942)  (24)  (453)  (1) 
usually waited less than 1 
hour in the office  to see  95%  98%  +3%  e  87%  100%  +13%   
primary  HMO doctor.  (1,431)  (42)  (704)  (1) 
Primary  HMO  doctor  never 
failed to provide needed  96%  96%  O%  @  88%  80%  -8%  @ 
Medicare services.  (1,475)  (42)  (744)  (4) 
Primary HMO doctor never 
failed to refer to a specialist  96%  96%  O%  e  88%  80%  -8%  e 
when needed.  (1,439)  (43)  (732)  (4) 
Didnt feel the need to seek 
out-of-plan care, excluding 
dental, routine eye, and  93%  91%  -2%  @  86%  100%  + 14%   
emergentlurgent care.  (1,397)  (40)  (696)  (5) 
Medical care received 
through the HMO caused 
beneficiaries  health to: 
b  improve	 53%  47%  -6%  (B  41%  40%  -1%  e 
(772)  (21)  (296) 
F  stay about the same	 45%  47%  +2%  e  49%  2;%  -29%  o
(649)  (21)  (383)  (1) 
F  2%  7%  10%  40% 
worsen  i-5%    +30%   
(32]  (3)  (86)  @ 
Primary HMO doctor never

failed to take beneficiarys  88%  87%  -1%  e  76%  80%  +4%  @

health complaints seriously.  (1349)  (34)  (650)  (4)

41  .  Above average  @  Average  O  Below average  NS  Not sufficient  data 
HMO ID #: H 0603  Enrollees  Dlsenrolkes 
 
(N=W  (N=O 
Bem&imyResponsesto Key  Au  This  %Diff.  Comp.  Au  This  % DW.  Comp. 
Survey (&StiOlls  by (htt!$jory  EMos  HMO  EMos  HMO 
Most important to primary 
HMO doctor was: 
b  giving the best 
medkal care  86%  89%  +3%  e  72%  60%  -12%  e 
possible  (1,197)  (32)  (471)  (3) 
b	 holding down the  9%  8%  -1%  e  26%  40%  + 14%  (B 
cost of care  (120)  (3)  (162)  (z 
Most important to the HMO 
wax 
b  giving the best 
me&al  care  74%  71%  -3%  %3  58%  60%  +2%  e 
possible  (1,036)  (27)  (387)  (3) 
b	 holding down the  15%  18%  +3%  e  36%  40%  +4%  e 
cost of care  (213)  (7)  (230)  (2) 
42
 CO  MPRECARE  HEALTH  CARE  SERVICES  (CO) 
No. Enrollees: 6,756  Total No. Sampled:  100  Total No. Respondents:  81 
Model ~pe:  IPA  For-Profit  Competitive 
 
Above average  63  Average  O  Below average  NS  Not sufficient  data 
HMO  ID #: H 0609	 Enrollees  DMnrolleea 
(N=  42)  (N =  39) 
BeneficiaryResponsesto Key  All  This  %Diff.  Comp.  Au  This  % Difr.  Comp. 
Survey Questionsby Categoq  HMos  HMO  EMos  EIWo 
MEJ4LTH  MXUWNWVG 
Was ~t  asked at application 
about health problems, 
excluding kidney failure and  63%  71%  +8%  e  58%  85%  +27%   
hospice care.  (717,)  (17)  (430)  (23) 
Physical exam was n- 96%  97%  +1%  e  98%  100%  +2%  e 
required before joining.  (1,295)  (29)  (824)  (34) 
Did know they could change 
their minds about enrolling  88%  74%  -14%  o  82%  69%  -13%  e 
after they applied.  (1,078)  (17)  (611)  (20) 
Did know,  from the 
beginning, they must be 
referred to a specialist by  89%  98%  +9%    84%  97%  +13%   
their primary HMO doctors.  (1,444)  (40)  (852)  (38) 
Did know,  from the 
beginning, they could only 
use HMO doctors and 
hospitals (except emergent 
care and urgent care outside  96%  100%  +4%    93%  100%  +7%  @ 
the service area.)  (1,585)  (40)  (958)  (38) 
Did know they had the right 
to appeal an HMOs  refusal  74%  68%  -6%  (B  67%  77%  + 10%  e 
to providelpay  for services.  (1,113)  (28)  (523)  (26) 
For scheduled appointments

with primary HMO doctors,

usually waited less than 13  85%  95%  + 10%  e  82%  97%  + 15%  e

days.  (1,276)  (38)  (681)  (31)

43
 .  Above average  @  Average  O  Beiow average  NS  Not sufficient  data 
HMO  ID #: H 0609  Enrollees  Disenrollees 
(N =  42)  (N=  39) 
Beneficiary Reaponseato Key  All  Thk  %Diff.  Comp.  Au  This  %Diff.  Comp. 
Survey Questionsby Category  EIblos  HMO  HMos  HMO 
For scheduled appointments 
 
with specialists, usually  81%  91%  + 10%  (B  75%  96%  +21% 
waited less than 13 davs.  (970)  (32)  (477)  (21) 
When very sick, was able to 
get a doctors  appointment  93%  100%  +7%  03  89%  96%  +7%  e 
within 1 to 2 days.  (942)  (28)  {453)  (21) 
usually waited less than 1 
hour in the office  to s=  95%  95%  o%  e  87%  94%  +7%  @ 
Pnmarv HMO doctor.  (1,431)  (35)  (704)  (-29) 
Consistently busy telephone 
lines did @  hinder benes  90%  100%  + 10%  e  89%  95%  +6%  e 
making appointments.  (780)  (18)  (425)  (18) 
SEWXXS 
Primary HMO doctor never 
failed to provide needed  96%  100%  +4%  c  88%  94%  +6%  @ 
Medicare services.  (1,475)  (41)  (744)  (32) 
Primary HMO  doctor never 
failed to refer to a specialist  96%  95%  -1%  e  88%  91%  +3%  (B 
when needed.  (1,439)  (39)  (732)  (32) 
Didnt feel the need to seek

out-of-plan care, excluding



dental, routine eye, and  93%  93%  o%  e  86%  97%  +11% 
emergenthrgent care.  (1,397)  (38)  (696)  (33)

Me&al  care received

through the HMO eauaed

beneficiaries  health to:

b  improve  53%  41%  -12%  o  41%  46%  +5%  e 
(772)  (16)  (296)  (12) 
b  stay about the same  45%  59%  + 14%    49%  54%  +5%  @
(649)  (383)  (14) 
b  worsen  2%  0%)  -2%  10%  o%  -lo%  @
(32)  (o)  @  (86)  (o) 
Primary HMO doctor never

failed to take beneficiarys  88%  93%  +5%  e  76%  76%  O%  0

health comphiints aerioudy.  (1349)  (37)  (650)  (25)
  
Above average  @  Average  0  Below average  NS  Not suftlcient  data 
HMO  ID #: H 0609  Enrollees  DNenrollees 
(N =  42)  (N =  39) 
.. 
Bene- Responsetso Key  Au  n&  % M.  ~Omp  Ml  This  %IMf.  Comp. 
key  @!StiOM  by Catqory  EMos  HMO  13TW0s  EMo 
Most important to primary 
HMO doctor was: 
b  giving the best 
medical care  86%  87%  +1%  03  72%  81%  +9%  03 
possible  (1,197)  (28)  (.471)  (21) 
F	 holding down the  9%  3%  -6%  (-- 26%  15%  -11%  e 
cost of care  (120)  (4)  (162)  (4) 
Most important to the HMO 
was: 
b  giving the best 
medical care  74%  81%  +7%  03  58%  52%  -6%  e 
possible  (1,036)  (30)  (387)  (12) 
b	 holding down the  15%  11%  ~%  e  36%  39%  +3%  e 
cost of care  (213)  (4)  (230)  (9) 
45
 QUA  L- MED,  INC.  (COLORADO  SPRINGS,  CO) 
No. Enroka:  82S  Total No. &unpkd:  63  Total No. Respondents:  50 
Model ~pe:  IPA  For-Profit  Competitive 
.  Above average  @  Average  O  Below average  NS  Not suftlcient  data 
HMO ID #  H 0616  Enrollees  D~enrollees 
(N =  39)  (N =  11) 
BenefkiaryReapoasesto Key  Au  This  %Diff.  Comp.  All  This  %Diff.  Comp. 
Survey Qaeatioosby Category  EMos  HMO  %MOs  HMO 
JIE..ll!l  SCUEENING 
Was ~t  asked at application 
about health problems, 
excluding kidney failure and  63%  84%  +21%    58%  50%  -8%  @ 
hospice care.  (717)  W)  (430)  (3) 
Physical exam was n- 96%  100%  +4%  @  98%  100%  +2%  e 
required before joining.  (1,295)  (36)  (824)  (lo) 
Z?NDERSZ4NDAYG 0FH&fi9# 
Did know they could change 
their minds about enrolling  88%  97%  +9%    82%  63%  -19%  o 
after they applied.  (1,078)  (33)  (611)  (5) 
Did know,  from the 
beginning, they must be 
referred to a spczialist by  89%  100%  +11%    84%  78%  -6%  e 
their primary HMO doctcms.  (1,444)  (36)  (852)  (7) 
Did know, from the 
beginning, they could only 
use HMO doctors and 
hospitals (exeept emergent 
care and urgent care outaide  96%  100%  +4%    93%  90%  -3%  e 
the service area.)  (1,585)  (36)  (958)  (9) 
Did know they had the right 
to appeal an HMOs  refhsal  74%  78%  +4%  e  67%  NS 
to providelpay  for servieea.  (1,113)  C@  (523) 
For scheduled appointments

with primary HMO doctors,

usually waited kxs than 13  85%  97%  + 12%  e  82%  NS

days.  (1,276)  (32)  (681)

46
  
Above average  @  Average  O  Below average  NS  Not sulllcient  data 
HMO ID #: H 0616	 Enrollees  DMenrollees 
(N = 39)  (N=  11) 
Beneficiary Responsesto Key  All  This  %Diff.  Comp.  Au  This  %DM.  Comp. 
&rvey  @lcstiOllS by Catqory  EMos  HMO  mos  HMO 
Most important to primary 
HMO doctor was: 
k  giving  the best 
medical care  86%  91%  +5%  e  72%  NS 
possible  (1,197)  (29)  (471) 
b  holding down the  9%  3%  -6%  o  26%  NS 
cost of care  (120)  (1)  (162) 
Most important to the HMO 
Ww: 
b  giving the best 
me&al  care  74%  60%  -14%  o  58%  NS 
possible  (1,036)  (18)  (387) 
b  holding down the  15%  20%  +5%  36%  NS 
@ 
cost of care  (213)  (6)  (230) 
48
 QUA  L-M  ED,  INC.  (P  UEBLOA  CO) 
No. Enrollees:  1,009  Total No. !hnpkd:  64 
Model ~pe  IPA  For-Profit  ~ 
 
Above average  @  Average  O  Below average  NS  Not stilcient  data 
HMO ID #: H 0617  Enrollees  Dkenrollees 
(N =35)  (N=7)
 
Benefkky  Reaponseato Key  All  This  %Diff.  Comp.  Au  Tbi.s  % M.  Comp. 
Survey Questionsby CategoIY  EMos  HMO  W4fos  EMo 
HZXLXW  SW!U?WING 
Was ~t  asked at application 
about health problems, 
excluding kidney failure and  63%  70%  +7%  @  58%  NS 
hospice care.  (717)  (14)  (430) 
Physical exam was n@  96%  96%  O%  @  98%  NS 
Did know they could change 
their minds about enrolling  88%  91%  +3%  e  82%  NS 
after they applied.  (1,078)  (21)  (611) 
Did know, from the 
beginning, they must be 
referred to a specialist by  89%  97%  +8%  @  84%  NS 
their primary HMO doctors.  (1,444)  (31)  (852) 
Did know,  from the 
beginning, they could only 
use HMO doctors and 
hospitals (except emergent 
care and urgent care outside  96%  94%  -2%  03  93%  NS 
the service area.)  (1,585)  (31)  (958) 
Did know they had the right 
to appeal an HMOs  refusal  74%  72%  -2%  @  67%  NS 
to provide/pay  for services.  (1,113)  (21)  (523) 
For  scheduled appointments

with primary HMO doctors,

usudy  WtLikd  kss  than 13  85%  84%  -1% e  82%  NS

days.  (1,276)  (26)  (681)

49
 .  Above average  @  Average  O  Below average  NS  Not suffkient  data 
HMO ID#H0617  Enrollees  DMenrollees 
(N =35)  (N=n 
Benelichry  Responsesto Key  An  lllis  %Diff.  Comp.  Au  This  %Diff.  Comp. 
key  @StiOIIS  by cat~ory  EMos  HMO  EMos  HMO 
For scheduled appointments 
with specialists, usually  81%  91%  + 10%  e  75%  NS 
Wtlitd  km  than 13  C@.  (970)  (20)  (477) 
When very sick, was able to 
get a doctors appointment  93%  96%  +3%  @  89%  NS 
within  1 to 2 days.  (942)  (26)  (453) 
usually  waited less than 1 
hour in the office  to see  95%  97%  +2%  @  87%  NS 
primary HMO doctor.  (1,431)  (29)  (704) 
Consistently busy telephone

lines did g@ hinder benes  90%  93%  +3%  e  89%  NS

making appointments.  (780)  (14)  (425)

Primary HMO doctor never 
failed to provide needed  96%  94%  -2%  (B  88%  NS 
Medicare services  (1,47$)  (29)  (744) 
Primary HMO doctor never 
failed to refer to a specialist  96%  97%  +1%  @  88%  NS 
when needed.  (1,439)  (29)  (732) 
Didnt feel the need to ~k 
out-of-plan care, excluding 
dental, routine eye, and  93%  91%  -2%  e  86%  NS 
emergentfurgent care.  (1,397)  (29)  (696) 
Me&al  care received 
through the HMO caused 
beneficiaries  health to: 
b  improve  53%  41%  -12%  o  41%  NS 
(772)  (12)  (296) 
b  stay about the same  45%  55%  + 10%    49%  NS 
(649)  (16)  (383) 
b  worsen  2%  3%  +1%  10%  NS 
(32)  (1)  e  (86) 
Primary HMO doctor never

failed to take beneficiarys  88%  84%  -4%  e  76%  NS

health conqkints  seriously.  (1349)  (26)  (650)

50
  
Above average  @  Average  O  Below average  NS  Not sufficient  data 
HMO ID #: H 0617  Enrollees  Disenrolkes 
(N =35)  (N=n
-
Benefi&ry  Reaponseato Key  All  This  %Diff.  Comp.  Au  This  % Diff.  Comp. 
Survey Questionsby Category  RMos  HMO  HMos  HMO 
 
Most  important  to primary 
HMO doctor was: 
b  giving the beat 
medical care  86%  85%  -1%  03  72%  NS 
possible  (1,197)  (-22)  (471) 
b  holding down the  9%  8%  -1%  26%  NS 
(B 
cost of care  (120)  Q)  (162) 
Most important to the HMO 
was: 
b  giving the best 
medical care  74%  62%  -12%  o  58%  NS 
possible  (1,036)  (18)  (387) 
k  holding down the  15%  28%  +13%    36%  NS 
cost of care  @13)  (8)  (230) 
51
 HEALTH  OPTIONS  - SOUTH  FLORIDA 
-1 
No. Enrollees:  19,310  Total No. Sampled:  100  Total No. Respondents:  62 
Model &w:  IPA  For-Profit  Competitive 
 
Above average  @  Average  O  Below average  NS  Not suftlcient  data 
HMO ID #: H 1026  Enrollees  DEenroUees 
(N = 34)  (N=  28) 
Benefkii  Reapoaseato Key  Au  This  %DitY.  Comp.  All  TbkJ  %Diff.  Comp. 
Survey QueatioILbsy Category  EMos  HMO  HMos  HMO 
HEALTH  SCREENING 
Was ~t  asked at application 
about health problerna, 
excluding kidney failure and  63%  56%  -7%  e  58%  33%  -25%  o 
hospice care.  (717)  (14)  (430)  (6) 
Physical exam was n@  96%  97%  +1%  @  98%  100%  +2%  @ 
required before joining.  (1,295)  (29)  (824)  @3) 
Did know they could change 
their minds about enrolling  88%  96%  +8%  @  82%  76%  -6%  @ 
after they applied.  (1,078)  (26)  (611)  (16) 
Did know,  from the 
beginning, they must be 
referred to a specialist by  89%  100%  +11%    84%  85%  +1%  e 
their primary HMO doctors.  (1,444)  (32)  (852)  (23) 
Did know,  from the 
beginning, they could only 
uae HMO doctors and 
hospitals (except emergent 
care and urgent care outside  96%  100%  +4%    93%  96%  +3%  e 
the service aria)  (1,585)  (32)  (958)  W) 
Did know they had the right 
to appeal an HMOs  refusal  74%  77%  +3%  @  67%  61%  -6%  @ 
to providelpay  for services.  (1,113)  (24)  (523)  (14) 
For scheduled appointment

with primary HMO doctors,

usually WSitedless than 13  85%  91%  +6%  e  82%  88%  +6%  @

days.  (1,276)  (28)  (681)  (21)

52
  
Above  average  @  Average  O  Below average  NS  Not sufllcient  data 
HMO ID #  H 1026  Enrollees  D~enrollees 
(N=  34)  (N =28)
. 
Beneficiary Reqxmses to Key  AU  This  %Diff.  Comp.  Au  This  % m.  Comp. 
Survey Questioas by Catego~  HMos  HMo  HMos  mio 
For scheduled appointments 
with specialists, usually  81%  89%  +8%  e  75%  95%  +20%   
waited less than 13 days.  (970)  (,23)  (477)  (18) 
. 
When very sick, was able to 
get a doctors  appointment  93%  87%  -6%  @  $9%  100%  +11%  e 
within 1 to 2 days.  (942)  (20)  (453)  (14) 
usually  waited less than 1 
hour in the office  to see  95%  94%  -1%  e  87%  77%  -lo%  e 
primary HMO doctor.  (1,431)  (29)  (704)  (17) 
Consistently busy telephone 
Primary HMO doctor never 
failed to provide needed  96%  90%  -6%  o  88%  88%  o%  e 
Medicare services.  (1,475)  (28)  (744)  (21) 
Primary HMO doctor never 
failed to refer to a specialist  96%  90%  -6%  O  88%  87%  -1%  e 
when needed.  (1,439)  (28)  (732)  (20) 
Didnt feel the need to seek 
out-of-plan care, excluding 
dental, routine eye, and  - 93%  97%  +4%    86%  91%  +5%  @ 
emergentiurgent care.  (1,397)  (29)  (696)  (20) 
Med&l  care received 
through  the HMO  caused 
beneficiaries  health  to: 
b  improve  53%  74%  +21%    41%  30%  -11%  @ 
(772)  (20)  (296)  m 
b  stay about the same  45%  26%  -19%  o  49%  57%  +8% 
e 
(649)  (383)  (13) 
b  worsen  2%  0%  -2%  10%  13%  +3% 
(32)  (o)  @  (86)  (3)  e 
Primary HMO doctor never

failed to take beneficiarys  88%  94%  +6%    76%  68%  -8%  e

health complaints seriously.  (1349)  (-29)  (650)  (17)

53
  
Above average  @  Average  O  Below average  NS  Not suftkient  data 
HMO ID #: H 1026  Enrollees  DMenrollees 
(N =  34)  (N =28) 
Beneficiary Responsesto Key  Au  This  %Diff.  Comp.  Au  This  %Diff.  Comp. 
Survey Questionsby Catego~  EMos  HMO  mos  HMO 
Most important to primary 
HMO doctor was: 
b  giving the best 
medical care  86%  96%  +10%  c  72%  75%  +3%  e 
possible  (1,197)  (24)  (471)  (12) 
w	 holding down the  9%  4%  -5%  o  26%  25%  -1%  e 
cost of care  (120)  (1)  (162)  (4) 
Most important to the HMO 
was: 
>  giving the best 
medkal  care  74%  71%  -3%  e  58%  61%  +3%  e 
possible  (1,036)  (20)  (387)  (11) 
b  holding down the  15%  21%  +6%  36%  2$%  -8%  ~ 
e 
cost of care  (213)  (6)  (230)  (a 
54
 HUM  ANA  MEDICAL  PLAN  (FL) 
No. EnrollePs: 209,393  Tot$d No. hnpkd:  96  Total No. Respondents:  59 
Model &w.:  Staff  For-Profit  Competitive 
 
Above average  @  Average  O  Below average  NS  Not sufilcient  data 
HMO ID #: H 1036  Enrollees  D~enrollees 
(N =36)  (N =23) 
Benelicii  Reapooseato Key  An  This  %Diff.  Comp.  All  This  %Diff.  Comp, 
Survey Queadonsby Category  EMos  HMO  EMos  HMO 
HIMJX?l  SCE?MVXVG 
Was @  asked at application

about health problems,

excluding kidney failure and  63%  46%  -17%  @  58%  39%  -19%
 03 
hospice care.  (717)  (13)  (430)  (7)

Did know they could change 
their minds about enrolling  88%  91%  +3%  e  82%  85%  +3%  @ 
after they applied.  (1,078)  (31)  (611)  (17) 
Did know,  from the 
beginning, they must be 
referred to a specialist by  89%  92%  +3%  e  84%  76%  -8%  @ 
their primary HMO doctors.  (1,444)  (33)  (852)  (16) 
Did know,  from the 
beginning, they could only 
w  HMO doctors and 
hospitals (except emergent 
care and urgent care outaide  %%  94%  -2%  e  93%  95%  +2%  e 
the service area.)  (1,585)  (34)  (958)  (20) 
Did know they had the right 
to appeal an HMOs  refusal  74%  74%  -o%  e3  67%  74%  +7%  e 
to providelpay  for services.  (1,113)  (W  (523)  (14) 
For scheduled appointments 
with primary HMO  doctors, 
usually waited less than 13  85%  86%  +1%  @  82%  86%  +4%  e 
days.  (1,276)  (24)  (681)  (18) 
55
  
Above average  @  Average  O  Below average  NS  Not sufilcient  data 
HMO ID #  H 1036  Enrollees  DMenrolkes 
(N=  36)  (N =23) 
Beneficiary Reapoasesto Key  Au  This  % m.  Comp.  Au  ll&  %Diff.  Comp. 
Survey Questioas by Category  EMos  HMO  EMos  HMO 
For scheduled appointments 
with specialists, wually  81%  71%  -lo%  @  75%  73%  -2%  @ 
waited less than 13 davs.  (970)  (17)  (477)  (11) 
When very sick, was able to 
get a doctors  appointment  93%  100%  +7%  @  89%  87%  -2%  @ 
within 1 to 2 days.  (942)  (19)  (453)  (13) 
usually  waited less than 1 
hour in the office  to see  95%  94%  -1%  e  87%  71%  -16%  o
Pliw 
HMO doctor.  (1,431)  (31)  (704)  (15) 
Consistently busy telephone 
lines did ~t  hinder benes  90%  90%  o%  03  89%  80%  -9%  e 
Primary HMO doctor never 
failed to provide needed  96%  97%  +1%  e  88%  65%  -23%  o 
Me&care  services.  (1,475)  (30)  (744)  (15) 
Primary HMO doctor never 
failed to refer to a specialist  96%  97%  +1%  e  88%  62%  -26%  o 
when needed.  (1,439)  (29)  (732)  (13) 
Didnt feel the need to seek 
out-of-plan care, excluding 
dental, routine eye, and  93%  93%  o%  @  86%  68%  -18%  o 
emergentlurgent care.  (1,393  W)  (696)  (15) 
Medical care received 
through the HMO  caused 
beneficiaries  health to: 
b  improve  53%  47%  -6%  03  41%  29%  -12%  @ 
(772)  (15)  (296)  (6) 
b  stay about the same  45%  53%  +8%  49%  33%  -16%  O 
e 
(649)  (17)  (383) 
b  worsen  2%  o%  -2%  10%  3?%  +28%   
(32)  (o)  e3  (86)  (8) 
Primary HMO doctor never

failed to take beneficiarys  88%  89%  -1%  @  76%  41%  -35%  o

health complaints seriouslv.  (1349)  (25)  (650)  (9)

56
 .  Above average  @  Average  O  Below average  NS  Not sufllcient  data 
HMO ID #: H 1036	 Enrollees  DMenroUees 
(N=  36)  (N=23) 
Beneficii  Reaponseato Key  An  This  %Diff.  Comp.  All  This  %Difr.  Comp. 
Survey Questionsby Category  RMos  HMO  EMos  HMO 
Most important to primary 
HMO doctor was: 
b  giving the best 
medical care  86%  69%  -17%  o  72%  39%  -33%  o 
possible  (1,197)  (18)  (471)  (7) 
b	 holding down the  9%  19%  + 10%    26%  56%  +30%   
cost of care  (120)  (5)  (162)  (lo) 
Most important to the HMO 
was: 
b  giving the best 
medical care  74%  71%  -3%  0)  58%  32%  -26%  O 
possible  (1,036)  (.20)  (387)  (6) 
b  holding down the  15%  11%  ~%  36%  58%  +22%   
e 
cost of care  (213)  (3)  (230)  (11) 
57
 No. Enrollees:  6,193  Total No. !hmpkd:  100  Total No. Respondents:  67 
 
Model ~pe:  IPA  For-Profit  Competitive 
 
Above average  @  Average  O  Below average  NS  Not sufilcient  data 
HMO ID #: H 1056  Enrollees  Dkenrdlees 
iN =40)  (N =27) 
Beneficimy  Reaponseato Key  AU  This  %Ixff.  Comp.  Au  This  %m.  Comp. 
Survey Quealionsby Catego~  HMos  HMO  EMos  HMO 
Wsa at  asked at application 
about health problems, 
 
excluding kidney failure and  63%  84%  +21%  58%  55%  -3%  e 
hospice care.  (717)  07)  (430)  (12) 
Physical exam was n~  96%  100%  +4%  @  98%  92%  -6%  0 
required before joining.  (1,295)  (34)  (824)  (,22) 
Did know they could change 
their minds about enrolling  88%  92%  +4%  e  82%  91%  +9%  e 
after they applied.  (1,078)  (34)  (611)  @l) 
Did know,  from the 
beginning, they must be 
referred to a specialist by  89%  95%  +6%  @  84%  83%  -1%  e 
their primary HMO doctors.  (1,444)  (38)  (852)  (19) 
Did know,  from the 
beginning, they could only 
use HMO doctors and 
hospitals (except emergent 
care and urgent care outside  96%  98%  +2%  e  93%  100%  +7%  e 
the service area.)  (1,585)  (39)  (958)  @) 
Did know they had the right 
to appeal an HMOs  refusal  74%  81%  +7%  e  67%  65%  -2%  @ 
to providelpay  for services.  (1,113)  (30)  (523)  (11) 
For scheduled appointments 
with primary HMO  doctors, 
usually waited km  than 13  85%  83%  -2%  e  82%  82%  O%  fl) 
days.  (1,276)  (30)  (681)  (14) 
58
  
Above average  @  Average  O  Below average  NS  Not suftlcient  data 
HMO ID #: H 1056  Enrollees  Disenrollees 
(N=  40)  (N =27) 
Bmeficiary  Respoasea to Key  Au  m  %Diff.  Comp.  All  This  %DitY.  Comp. 
Survey Queatioasby Category  EMos  HMO  HMos  IllWo 
For scheduled appointments 
with specialists, usually  81%  79%  -2%  @  75%  72%  -3%  @ 
waited less than 13 days.  (970)  (23)  (477)  (13) 
When very sick, was able to 
get a doctors  appointment  93%  84%  -9%  o  89%  80%  -9%  e 
within 1 to 2 days.  (942)  (21)  (453)  (8) 
Usually waited less than 1 
hour in the office  to see  95%  90%  -5%  (B  87%  75%  -12%  o 
primary HMO doctor.  (1,431)  (35)  (704)  (15) 
Consistently busy telephone 
lines dld g@ hinder benes  90%  94%  +4%  e  89%  100%  +11%  @ 
making appointments.  (780)  (29)  (425)  (13) 
S4?!?RV..C3?S 
Primary HMO doctor never 
failed to provide needed  96%  95%  -1%  e  88%  82%  -6%  e 
Me&are  services.  (1,475)  (36)  (744)  (14) 
Primary HMO doctor never 
failed to refer to a specifllst  96%  95%  -1%  (B  88%  68%  -20%  o 
when needed.  (1,439)  (36)  (732)  (13) 
Didnt feel the need to seek

out-of-plan care, excluding

dental, routine eye, and  93%  97%  +4%    86%  79%  -7%  e

emergentlurgent cam.  (1,397)  (37)  (696)  (15)

Me&cal  care received

through the HMO caused

beneficiaries  health to:

b  improve	 53%  49%  -4%  @  41%  12%  -29%  o
(772) 
(16)  (2%)  (2) 
b  stay about the same	 45%  52%  +7%  e  49%  71%  +22%  
(649)  (17)  (383)  (12) 
b  worsen	 2%  o%  -2%  10%  18%  +8%
(32)  (o)  e  (86)  (3)  e 
Primary HMO doctor never

failed to take beneficimys  88%  92%  +4%  @  76%  56%  -20%  o

health complaints seriously.  (1349)  (36)  (650)  (9)

59
  
Above average  @  Average  O  Below average  NS  Not sufllcient  data 
HMO ID #: H 1056  Enrollees  DKenrollees 
(N =40)  (N =27) 
Benefichry  Responsesto Key  All  This  %Diff.  Comp.  AU  This  % DitT.  Comp. 
Survey Questionsby Category  HMos  HMo  EWlos  HMO 
Most important to primary 
HMO doctor was: 
F  giving the best 
medical care  86%  79%  -7%  o  72%  62%  -lo%  e 
possible  (1,197)  (2?)  (471)  (8) 
b	 holding down the  9%  12%  +3%  e  26%  39%  +13%  e 
cost of care  (120)  (4)  (162)  (5) 
Most important to the HMO 
was: 
b  giving the best 
medical care  74%  62%  -12%  o  58%  31%  -27%  o 
possible  (1,036)  (21)  (387)  (4) 
b	 holding down the  15%  21%  +6%  36%  54%  + 18%   
@ 
cost of care  (.213)  (1)  (230)  m 
60
 HUM  ANA  HEALTH  PLAN  -(IL) 
No. Enrollees: 20,817  Total No. Sampled: 96  -~, 
Model ~:  Staff  For-Profit 
 
Above average  @  Average  O  Below average  NS  Not suffkient  data 
HMO ID #: H 1406  Enrollees  Dkenrollees 
(N=  35)  @  =  19)
,. 
Wm&iaryResponsesto Key  Aa  This  %Diff.  Comp.  An  This  %DM.  Comp. 
Survey Quesdonsby Catego~  EMos  HMo  mos  HMo 
HiX&l..  W?.EEVWG 
Was p@ asked at application 
about health problems, 
excluding kidney failure and  63%  44%  -19%  o  58%  NS 
hospice care,  (717)  (11)  (430) 
Physid  exam was n!mJ  96%  96%  O%  e  98%  NS 
Dld know they wuld  change 
their minds about enrolling  88%  92%  +4%  e  82%  NS 
after they applied.  (1,078)  (22)  (611) 
Did know, from the 
beginning, they must be 
referred to a specialist by  89%  82%  -7%  e  84%  NS 
their primary  HMO doctors.  (1,444)  (-27)  (852) 
Did know,  from the 
beginning, they could only 
use HMO doctors and 
hospitals (except emergent 
care and urgent care outaide  96%  97%  +1%  e  93%  NS 
the service area.)  (1,585)  (33)  (958) 
Dld know they had the right 
to appeal an HMOs  refusal  74%  76%  +2%  @  67%  NS 
to providelpay for services.  (1,113)  (22)  (523) 
For scheduled appointments

with primary HMO doctors,

usually waited less than 13  85%  73%  -12%  @  82%  NS

days.  (1,276)  (24)  (681)

61
  
Above average  @  Average  O  Below average  NS  Not suffkient  data 
HMO H) #: H 1406  Enrollees  Dkenrolkes 
(N =35)  (N =  19) 
BenefichuyRespoaseato Key  Au  This  %DM.  Comp.  All  This  %Diff.  Comp. 
Survey Queatioasby Category  EMos  HMO  EMos  HMO 
For scheduled appointments 
with specialists, usually  81%  73%  -8%  e  75%  NS 
waited less than 13 days.  (970)  (-22)  (477) 
When very sick, was able to 
get a doctors  appointment  93%  90%  -3%  @  89%  NS 
within 1 to 2 days.  (942)  (18)  (453) 
usually  waited less than 1 
hour in the office  to see  95%  94%  -1%  e  87%  NS 
primary HMO doctor.  (1,431)  (29)  (704) 
Consistently busy telephone 
lines did ~t  hinder benes  90%  69%  -21%  o  89%  NS 
making appointments.  (780)  (11)  (425) 
SJ??RVKXS 
Primary HMO doctor never

failed to provide needed  96%  90%  -6%  o  88%  NS

Medicare services.  (1,475)  (28)  (744)

Primary HMO doctor never 
failed to refer to a specialist  96%  97%  +1%  e  88%  NS 
when needed.  (1,439)  (31)  (732) 
Didnt feel the need to seek 
out-of-plan care, excluding 
dental, routine eye, and  93%  91%  -2%  e  86%  NS 
emergentlurgent care.  (1,397)  (29)  (696) 
Medhl  care received 
through the HMO caused 
beneficiaries  health to: 
b  improve  53%  62%  +9%  e  41%  NS 
(772)  (21)  (296) 
b  stay about the same  45%  38%  -7%  49%  NS 
e 
(649)  (13)  (383) 
10% 
NS
(86) 
Primary HMO doctor never

failed to tske beneficiarys  88%  79%  -9%  o  76%  NS

health complaints seriously.  (1349)  (23)  (650)

62
  
Above average  @  Average  O  Below average  NS  Not suffkient  data 
HMoxD#H  1406  Enrollees  DMenrollees 
(N =35)  (N =  19) 
Beneficiary  Reaponseato Key  All  This  %Diff.  Comp.  Au  W  %DifK  Comp. 
Survey Questiom by Category  HMos  HMo  EMos  HMO 
Most important to primary 
HMO doctor was: 
b  giving the best 
medical care  86%  93%  +7%    72%  NS 
possible  (1,197)  (28)  (471) 
b  holding down the  9%  o%  -9%  o  26%  NS 
cost of care  (120)  (o)  (162) 
Most important to the HMO 
was: 
b	 giving the best 
medical care  74%  88%  + 14%    58%  NS 
possible  (1,036)  (28)  (387) 
b  holding down the  15%  9%  -6%  36%  NS
e 
cost of care  (213)  (3)  (230) 
63
 HE  AL  THSOURCE  INDIANA  MANAGED  CARE  PLAN 
No. Enrollees: 399  Total No. Sampled: 55  Total No. Respondents:  52 
Model ~pe:  IPA  For-Profit  Non-Competitive 
 
Above average  @  Average  O  Below average  NS  Not stilcient  data 
HMO ID #: H 1551	 Enrollees  Dkenrollees 
(N =47)  (N .5) 
Beneficiary Responsexto Key  All  This  %Diff.  Comp.  Au  This  %Diff.  Comp. 
Smvey Queslionsby Category  HMos  HMO  IIrVlos  HMO 
JZJ!MLX?? XYU?EJWNG 
Was ~t  asked at application 
about health problems, 
excluding kidney failure and  63%  85%  +22%    58%  75%  + 17%  e 
hospice care.  (717)  (28)  (430)  (3) 
Physical exam was n- 96%  100%  +4%  @  98%  100%  +2%  @ 
required before joining.  (1,295)  (43)  (824)  (5) 
Did know they could change 
their minds about enrolling  88%  95%  +7%  e  82%  100%  + 18%   
after they applied.  (1,078)  (38)  (611)  (5) 
Did know,  from the 
beginning, they must be 
referred to a specialist by  89%  80%  -9%  o  84%  60%  -24%  o 
their primary HMO doctors.  (1,444)  (3?)  (852)  (3) 
Did know,  ffom the 
beginning, they could only 
Use HMO doctom and 
hospitals (except emergent 
care and urgent care outside  96%  91%  -5%  o  93%  60%  -33%  o 
the service area.)  (1,585)  (42)  (958)  (3) 
Did know they had the right 
to appeal an HMOs  refusal  74%  67%  -7%  @  67%  33%  -34%  o 
to providelpay  for services.  (1,113)  (28)  (523)  (1) 
For scheduled appointments

with primary HMO doctors,

usually waited less than 13  85%  91%  +6%  @  82%  100%  + 18%  

days.  (1,276)  (40)  (681)  (4)

64
 .  Above average  @  Average  O  Below average  NS  Not stilcient  data 
HMO ID #: H 1551  Enrollees  DKenrolleea 
  (N=47)  (N =5) 
Beneficiary Rqxmsea  to Key  Au  This  %BW.  Comp.  Au  This  % Biff.  Comp 
Sarvey Questioasby Category  HMos  HMO  EIIWos  HMo 
For scheduled appointments 
with specialists, usually  81%  74%  -7%  e  75%  NS 
waited less than 13 davs.  (970)  (20)  (477) 
When very sick, was able to 
get a doctors  appointment  93%  97%  +4%  @  89%  NS 
within 1 to 2 days.  (942)  (32)  (453) 
I-hmaUyWtited less than 1 
hour in the office to see  95%  86%  -9%  o  87%  NS 
primary HMO doctor.  (1,431)  (36)  (704) 
Consistently busy telephone 
lines did @  hinder benes  90%  100%  + 10%  e  89%  NS 
making appointments.  (780)  (23  (425) 
Primary HMO doctor never 
failed to provide needed  96%  93%  -3%  o  88%  75%  -13%  o 
Medkam  services.  (1,475)  (42)  (744)  (3) 
Primary HMO doctor never 
failed to refer to a specialist  96%  95%  -1%  e  88%  100%  + 12%   
when needed.  (1,439)  (39)  (732)  (4) 
Didnt feel the need to seek 
out-of-plan care, excluding 
dental, routine eye, and  93%  95%  +2%  e  86%  75%  -11%  o 
emergentlurgent care.  (1,397)  (38)  (696)  (3) 
Medical care received 
through the HMO caused 
beneficiaries health to: 
 
b  improve  53%  52%  -1%  e  41%  100%  +59% 
(772)  (296)  (2) 
b  stay about the same  45%  L&i  ()%  e  49%  NS 
(649)  (19)  (383) 
10% 
b  worsen  NS 
(86) 
Primary HMO doctor never

failed to take beneficiarys  88%  86%  -2%  03  76%  100%  +24%  

health COIUPhinta  .9twioudv.  (1349)  (38)  (650)  (4)

65
 .  Above average  @  Average  O  Below average  NS  Not sufllcient  data 
HMO ID #: H 1551  Enrollees  Disenrollees 
(N =47)  (N.~ 
Beneficiary Reapoasesto Key  An  This  %Diff.  Comp.  All  lllis  %Diff.  Comp. 
Survey Questionsby Cakgory  IInlos  HMO  mos  HMO 
Most important to primary 
HMO doctor was: 
b  giving the best 
mexlkal care  86%  85%  -1%  e  72%  100%  +28%   
possible  (1,197)  (34)  (471)  (4) 
b	 holding down the  9%  10%  +1%  (I)  26%  NS 
(120)  (4)  (162) 
cost of care 
Most important to the HMO 
was: 
b  giving the best 
medical care  74%  66%  -8%  @  58%  75%  + 17%  e 
possible  (1,036)  w)  (387)  (3) 
b  holding down the  15%  24%  +9%    36%  25%  -11%  e 
(.213)  (9)  (230)  (1) 
cost of care 
66
 No. Enrollees: 3,010  Total No. Sampled: 99  Total No. Respondents:  74 
Model &x  IPA  For-Profit  Non-Competitive 
 
Above average  @  Average  O  Below average  NS  Not sufficient  data 
HMO ID #: H 1890  Enrollees  Dfienrolkes 
(N =  41)  (N =  33) 
WmtkisryReaponseato Key  All  This  %Diff.  Comp.  All  Tb.is  %DM.  Comp. 
Survey Questionsby Category  HMos  HMo  EMos  HMO 
Was n@ asked at application 
about health problems, 
excluding kidney failure and  63%  38%  -25%  0  58%  55%  -3%  (II 
hospice care.  (717)  (9)  (430)  (11) 
physical exam was n?I  96%  94%  -2%  e  98%  92%  -6%  O 
required before joining.  (1,295)  (30)  (824)  (23) 
Did know they could change 
their minds about enrolling  88%  94%  +6%  e  82%  90%  +8%  (B 
after they applied.  (1,078)  (29)  (611)  (17) 
Did know,  from the 
beginning, they must be 
referred to a specialist by  89%  83%  -6%  03  84%  83%  -1%  e 
their primary HMO doetocs.  (1,444)  (33)  (852)  (25) 
Did know,  from the 
beginning, they could only 
use HMO doctors and 
hospitals (except emergent 
cam and urgent care outside  96%  100%  +4%    93%  94%  +1%  e 
the service area.)  (1,585)  (39)  (958)  (29) 
Did know they had the right 
to appeal an HMOs  refusal  74%  68%  -6%  @  67%  86%  + 19%   
to providelpay  for services.  (1,113)  (26)  (523)  (19) 
For scheduled appointments

with primary HMO doctors,

usually waited less than 13  85%  92%  +7%  e  82%  84%  +2%  e

days.  (1,276)  (35)  (681)  (21)

67
 .  Above average  @  Average  O  Below average  NS  Not stilcient  data 
HMO H) #: H 1890  Enrollees  Dwnrolkes 
(N=  41)  (N = 33) 
Beneficiary Responsesto Key  An  This  %DM  Comp.  Au  This  %Diff.  Comp. 
Survey Qaeatioas by Category  EMos  HMo  KMos  HMO 
For scheduled appointments 
with specialists, usually  81%  87%  +6%  e  75%  69%  -6%  @ 
waited less than 13 days.  (970)  (20)  (477)  (9) 
When very sick, was able to 
get a doctors  appointment  93%  100%  +7%  03  89%  86%  -3%  @ 
within 1 to 2 days.  (942)  (27)  (453)  (12) 
usually waited less than 1 
hour in the office  to see  95%  97%  +2%  @  87%  86%  -1%  %3 
primary HMO doctor.  (1,431)  (36)  (704)  (19) 
Consistently busy telephone

lines did ~t  hinder benes  90%  92%  +2%  e  89%  86%  -3%  e

Primary HMO doctor never 
failed to provide needed  96%  95%  -1%  e  88%  96%  +8%  @ 
Medicare aervicea.  (1,475)  (37)  (744)  (23) 
Primary HMO doctor never 
failed to refer to a specialist  96%  97%  +1%  e  8!3%  92%  +4%  @ 
when needed.  (1,439)  (35)  (732)  (3 
Didnt feel the need to seek 
out-of-plan care, excluding 
dental, routine eye, and  93%  90%  -3%  e  86%  95%  +9%   
emergent/urgent care.  (1,397)  (3s)  (696)  (18) 
Me&al  care received 
through the HMO caused 
beneficiaries  health to: 
	
b  improve  53%  63%  + 10%  41%  44%  +3%  03 
(2%)  (8) 
49%  50%  +1% 
e
(383)  (9) 
10%  6%  ~% 
(86)  (1)  @ 
Primary HMO  doctor never

failed to take beneficiarys  88%  82%  -6%  o  76%  76%  O% o

health complaints seriously.  (1349)  (32)  (650)  (19)

68
  
Above average  @  Average  O  Below average  NS  Not suftlcient  data 
HMO ID #: H 1890  EnrollePs  Disenrollees 
(N=  41)  (N = 33) 
Beneficiary Responsesto Key  Au  This  %Dim.  Comp.  Alt  Ilk  %Diff.  Comp. 
&rvey  @?stiOllS by Catqory  EMos  HMO  IllWos  HMO 
Most important to primary 
HMO doctor was: 
F  giving the best 
medical care  86%  78%  -8%  o  72%  84%  +12%  e 
possible  (1,197)  (28)  (471)  (16) 
b	 holding down the  9%  14%  +5%    26%  16%  -lo%  e 
(120)  (5)  (162)  (3) 
cost of care 
Most important to the HMO 
was; 
b  giving the best 
medkal care  74%  82%  +8%  @  58%  72%  +14%  e 
possible  (1,036)  (28)  (387)  (13) 
b	 holding down the  15%  15%  ()%  e  36%  28%  -8%  @ 
cost of care  (213)  (a  (230)  (1) 
69
 HE  AL  THCARE  CORP.  OF  THE  MID-ATLANTIC  (MD)
 
No. Enrollees:  697  Total No. Sampled: 53 
Model ~-~:  Group  For-Profit 
~ 
 
Above average  @  Average  O  Below average  NS  Not sufficient  data 
HMO ID #: H 2101  Enrollees  DMenrollees 
(N=  44)  (N.  q 
 
Beneficiary Respow  to Key  All  This  %Diff.  Comp.  AU  This  % Diff.  Comp. 
Survey Questionsby Category  EMos  HMO  mos  HMo 
HEALTH SCRi?lEAIING 
Wss ~  asked at application 
about health problems, 
excluding kidney failure and  63%  76%  +13%  e  58%  50%  -8%  0 
hospice care.  (713  (22)  (430)  (1) 
Physical exam was n- 96%  97%  +1%  @  98%  100%  +2%  @ 
required before joining.  (1,295)  (33)  (824)  (3) 
WVWMSTMDAW l?FHMOS 
Did know they could change 
their minds about enrolling  88%  82%  -6%  e  82%  100%  + 18%   
after they applied.  (1,078)  (22)  (611)  (2) 
Did know,  from the 
beginning, they must be 
 
referred to a specialist by  89%  86%  -3%  e  84%  100%  + 16% 
their primary HMO doctors.  (1,444)  (38)  (852)  (4) 
Did know,  from the 
beginning, they could only 
use HMO doctors and 
hospitals (except emergent 
me  and urgent care outside  96%  91%  -5%  o  93%  100%  +7%  e 
the service area.)    (1,585)  (40)  (958)  (4) 
Did know they had the right 
:0 appeal an HMOs  refusal  74%  76%  +2%  e  67%  50%  -17%  o 
LOprovidelpay  for services.  (1,113)  (32)  (523)  @ 
For scheduled appointments

withprimary HMO doctors,

Mually waited less than 13  85%  73%  -12%  @  82%  50%  -32%  o

iays.  (1,276)  (29)  (681)  (?)

70
 .  Above average  @  Average  O  Below average  NS  Not sufilcient  data 
HMO ID #: H 2101  Enrollees  Dkenrokes 
(N=  44)  (N =5) 
Beaefkimy Responsesto Key  Au  This  %DifK  Comp.  Au  This  %Diff.  Comp. 
Survey Questionsby Category  EMos  HMO  HMos  HMo 
For scheduled appointments 
with qmcialists, usually  81%  76%  -5%  e  75%  NS 
waited less than 13 days.  (970)  (29)  (477) 
When very sick, was able to 
get a doctors  appointment  93%  93%  o%  @  89%  NS 
within 1 to 2 days.  (942)  (,25)  (453) 
Usually waited less than 1 
hour in the office  to see  95%  95%  o%  e  87%  NS 
primary HMO doctor.  (1,431)  (38)  (704) 
Consistently busy telephone 
lines did ~t  hinder benes  90%  89%  -1%  @  89%  NS 
making appointments.  (780)  (23)  (425) 
Si!mlmxs 
Primary HMO doctor never 
failed to provide needed  %%  95%  -1%  e  88%  100%  + 12%   
Medicare services.  (1,475)  (39)  (744)  (4) 
Primary HMO doctor never 
failed to refer to a specialist  96%  100%  +4%    88%  100%  + 12%   
when needed.  (1,439)  (40)  (732)  (4) 
Didnt feel the need to seek

out-of-plan care, excluding

dental, routine eye, and  93%  97%  +4%    86%  100%  + 14%  

emergentfurgent care.  (1,397)  (38)  (696)  (4)

Medical care received

through the HMO caused

beneficiaries  health to:

   
b  improve	 53%  70%  + 17%  41%  75%  +34% 
(772)  (28)  (296) 
b  stay about the same	 45%  30%  -15%  o  49%  2?%  -24%  o
(649)  (12)  (383)  (1) 
ioti
b  worsen 
NS
(86) 
Primary HMO doctor never

failed to take beneficiarys  %a%  93%  +5%  e  76%  100%  + 24%  

health complaints SeliOUSly.  (1349)  (39)  (6S0)  (4)
 .  Above average  @  Average  O  Below average  NS  Not suffkient  data 
HMO H) #: H 2101  Enrollees  Dkenrolkes 
(N =44)  (N=~ 
Beneficiary Reapoaseato Key  All  This  % m.  Comp.  An  IIlk  % Diff.  Comp. 
Survey QIK40as by Categoq  HMos  mo  mlos  HMo 
Most important to primary 
HMO doctor was: 
b	 giving the best 
medical care  86%  87%  +1%  e  72%  100%  +28%  g 
possible  (1,197)  (32)  (471)  (3) 
b  holding down the  9%  11%  +2%  e  26%  NS
cost of care  (120)  (4)  (162) 
Most important to the HMO 
was: 
b  giving the best 
 
medkal  care  74%  80%  +6%  e  58%  100%  +42% 
possible  (1,036)  (31)  (387)  (3) 
b  holding down the  15%  13%  -2%  @  36%  NS 
cost of care  (213)  (5)  (230) 
72
 HARVARD  COMMUNITY  HEALTH  PLAN  - URBAN  (MA) 
No. Enrollees  8,432  Total No.  %trnpkd:  98  Total No. Respondents:  76 
Model ~pe:  SW  Not For-Profit  Competitive 
 
Above average  @  Average  O  Below average  NS  Not sti]cient  data 
HMO ID #: H 2206  Enrolkea  Dkenrolleea 
(N =  41)  (N =35) 
Beneficiary Responsesto Key  Au  II&  %DM.  Comp.  An  lllis  %IxfT.  Comp. 
kvey  @StiOllS  by Category  EMos  IWO  EMos  HMO 
HEALTH SCREMVWYG 
Was ~t  asked at application 
about health problems, 
excluding kidney failure and  63%  54%  -9%  @  58%  25%  -33%  o 
hospice care.  (717)  (7)  (430)  (3) 
Physical exam was n- 96%  100%  +4%  e  98%  92%  -6%  0 
required before joining.  (1,295)  (19)  (824)  (12) 
Did know they could change 
their minds about enrolling  88%  83%  -5%  e  82%  60%  -22%  o 
after they applied.  (1,078)  (lo)  (611)  (6) 
Did know,  from the 
beginning, they must be 
referred to a specialist by  89%  76%  -13%  o  84%  77%  -7%  03 
their primary HMO doctors.  (1,444)  (28)  (852)  (24) 
Did know,  from the 
beginning, they could only 
use HMO doctors and 
hospitals (except emergent 
care and urgent care outside  96%  93%  -3%  @  93%  94%  +1%  03 
the service area.)  (1,585)  (3-0  (958)  (31) 
Did know they had the right 
to appeal an HMOs  refusal  74%  54%  -20%  C)  67%  54%  -13%  @ 
to providelpay for services.  (1,113)  (20)  (523)  (14) 
For scheduled appointments

with primary HMO doctors,

usually  waited  km  than 13  85%  78%  -7%  @  82%  69%  -13%  @

days.  (1,276)  (28)  (681)  (18)

73
  
Ahove average  @  Average  O  Below average  NS  Not suffkient  data 
HMO ID #: H 2206  Enrolkes  DEenro11ee5 
(N =  41)  (N =35) 
Benefkky  Rqonses  to Key  Au  This  %Diff.  Comp.  All  This  %Diff.  Comp. 
!kwvey @StiOIIS  by Catqov  mos  HMO  EMos  HMO 
For scheduled appointments 
with specialists, usually  81%  85%  +4%  @  75%  68%  -7%  e 
Waited less than 13 dilJW.  (970)  (29)  (477)  (17) 
When very sick, was able to 
get a doctors  appointment  93%  100%  +7%  03  89%  %%  +7%  @ 
within 1 to 2 days.  (942)  (31)  (453)  (23) 
usually waited less than 1 
hour in the office  to see  95%  100%  +5%  e  87%  96%  +9%  @ 
P- HMO doctor.  (1,431)  (40)  (704)  W) 
Consistently busy telephone 
lines dld ~t  hinder benes  90%  88%  -2%  @  89%  71%  -18%  0 
making appointments.  (780)  (15)  (42s)  (lo) 
Primary HMO doctor never 
failed to provide needed  96%  95%  -1%  e  88%  93%  +5%  e 
Me&am  services.  (1,475)  (36)  (744)  (28) 
Primary HMO doctor never 
failed to refer to a specialist  96%  100%  +4%    88%  100%  + 12%   
when needed.  (1,439)  (38)  (732)  (V 
Didnt feel the need to seek 
out-of-plan care, excluding 
dental, routine eye, and  93%  97%  +4%    86%  96%  + 10%   
emergenthrgent  care.  (1,397)  (35)  (696)  (27) 
MedkA  care received 
through the HMO caused 
beneficiaries  health to: 
 
b  improve  53%  65%  + 12%  41%  47%  +6%  @ 
(772)  (24)  (296)  (14) 
b  stay about the same  45%  35%  -lo%  (-J  49%  53%  +4%  @ 
(649)  (13)  (383)  (16) 
10%  o% 
b  worsen  -lo%  ~ 
(86)  (o) 
Primary HMO doctor never

failed to take beneficiarys  88%  94%  +6%    76%  85%  +9%  e

health COm@inta  seriously.  (1349)  (33)  (650)  (23)

74
  
Above average  @  Average  O  Below average  NS  Not suftlcient  data 
HMO ID#:H2206  Enrollees  Dkenrollees 
(N =  41)  (N =35) 
Bene&ky  Responsesto Key  All  m  %Diff.  Comp.  All  This  %Diff.  Comp. 
&uvey @@iOllS  by Ca@ory  EMos  HMO  EMos  HMO 
Most important to primary 
HMO doctor was: 
b  giving the best 
medical care  86%  92%  +6%    72%  93%  +11%  @ 
possible  (1,197)  (33)  (471)  (26) 
b	 holding down the  9%  8%  -1%  26%  7%  -19%  o 
@ 
cost of care  (120)  (3)  (162)  (2) 
Most important to the HMO 
was: 
b  giving the best 
medical care  74%  74%  o%  03  S8%  83%  +25%   
possible  (1,036)  (26)  (387)  (19) 
b	 holding down the  15%  17%  +2%  36%  13%  -23%  o 
@ 
(213)  (6)  (230)  (3) 
cost of care 
75
 HEALTH  ALLIANCE  PLAN  OF  MICHIGAN 
No. Enrollees:  2,822  Total No. fkunpkd:  98  Total No. Respondents:  57 
Model ~-~.  Group  Not For-Profit  Competitive 
 
Above average  @  Average  O  Below average  NS  Not suffkient  data 
HMO ID #: H 2312	 Enrollees  Disenrolkes 
(N = 31)  (N =26) 
Benetkky  Reqmnsea to Key  All  This  %Diff.  Comp.  Au  I@  %Diff.  Comp. 
Snrvey Questionsby Category  EMos  HMO  EMos  HMo 
lJIML?%f  SIXEE~ZVG 
Was p@ asked at application 
about health problems, 
 
excluding kidney failure and  63%  88%  +25%  58%  39%  -19%  03 
hospice care.  (717)  (15)  (430)  (5) 
Physical exam was n- 96%  96%  O%  @  98%  95%  -3%  (B 
required before joining.  (1,295)  (25)  (824)  (19) 
tJiWJERSTANIMNGUFHAfOS 
Did know they could change 
their minds about enrolling  88%  88%  o%  (B  82%  64%  -18%  o 
after they applied.  (1,078)  (15)  (611)  (7) 
Did know,  from the 
beginning, they must be 
referred to a specialist by  89%  87%  -2%  e  84%  71%  -13%  o 
their primary HMO doctors.  (1,444)  (26)  (852)  (15) 
Did know,  from the 
beginning, they wuld  only 
use HMO doctors and 
hospitals (except emergent 
care and urgent care outside  96%  97%  +1%  @  93%  87%  -6%  @ 
the service area.)  (1,585)  (30)  (958)  w) 
Did know they had the right

to appeal an HMOs  refiwal  74%  76%  +2%  @  67%  53%  -14%  @

to providelpay  for services.  (1,113)  w)  (523)  (lo)

For scheduled appointments

with primary HMO doctors,

JSUdly  waited  kss  than 13  85%  52%  -33%  o  82%  59%  -23%  o

hys.  (1,276)  (13)  (681)  (13)

76
  
Above average  @  Average  O  13elow average  NS  Not suftlcient  data 
HMOlD#:H2312  Enrolka  Disenrolleea 
(N = 31)  (N=26) 
Beneficiary Rasponseato Key  Au  This  %Dirf.  Comp.  All  This  %Diff.  Comp. 
Survey Queslionsby Category  EMos  HMo  RMos  HMo 
For scheduled appointments 
with specialists, usually  81%  68%  -13%  o  75%  60%  -15%  e 
waited less than 13 days.  (970)  (13)  (477)  (9) 
When very sick, was able to 
get a doctors  appointment  93%  92%  -1%  e  89%  81%  -8%  e 
within 1 to 2 days.  (942)  (12)  (453)  (13) 
usually waited less than 1 
hour in the office  to see  95%  96%  +1%  e  87%  94%  +7%  03 
primary HMO doctor.  (1,431)  (27)  (704)  (17) 
Consistently busy telephone 
Primary HMO doctor never 
failed & provide needed  96%  93%  -3%  o  88%  100%  + 12%   
Medicare services.  (1,475)  @n  (744)  (19) 
Primary HMO doctor never 
failed & refer to a specialist  96%  93%  -3%  e  88%  100%  +12%  g 
when needed.  (1,439)  (28)  (732)  (20) 
Didnt feel the need to seek 
out-of-plan care, excluding 
dental, routine eye, and  - 93%  85%  -8%  o  86%  88%  +2%  @ 
emergentlurgent care.  (1,397)  @3)  (696)  (14) 
Me&al  care received 
through the HMO caused 
beneficiaries  health to: 
41%  63%  +22%   
(2%)  (lo) 
49%  38%  -11% 
@
(383)  (6) 
10%  o% 
b  wonsen  -lo%
(86)  (o)  e 
Primary HMO doctor never

failed to take beneficiarys  88%  86%  -2%  @  76%  74%  -2%  e

health comphints  SeliOUSly.  (1349)  (25)  (650)  (14)

77
 .  Above average  @  Average  O  Below average  NS  Not suffkient  data 
HMO ID #: H 2312  Enrollees  DMenrollees 
 
(N=  31)  (N =26) 
Benetkky  Reapoasesto Key  All  This  %Ditf.  Comp.  All  This  %Diff.  Comp. 
fkrvey Questionsby Category  HMos  HMO  EMos  HMO 
Most important to primary 
HMO doctor was: 
F  giving  the best 
medical care  86%  70%  -16%  o  72%  83%  +11%  03 
possible  (1,197)  (19)  (471)  (lo) 
b	 holding down the  9%  15%  +6%    26%  17%  -9%  @ 
cost of care  (120)  (4)  (162)  (2 
Most important to the HMO 
Wss: 
F  giving  the best 
 
medical care  74%  81%  +7%  @  58%  90%  + 32% 
possible  (1,036)  (21)  (387)  (9) 
b  holding down the  15%  12%  -3%  36%  10%  -26%  o 
e 
cost of care  (213)  (3)  (230)  (1) 
78(cid:1) PRIME  HEALTH  KANSAS  CITY  (MO) 
No. Enrollees: 6,320 
Total No. tkrnpled: 99 
Total No. Respondents:  62 
ModeI ~pe:  SW 
For-Profit 
Competitive 
 
Above average  o 
@  Average 
Below average  NS  Not sufficient  data 
HMO  ID #: H 2649 
Enrollees 
Disenrolkes 
(N = 42) 
(N = 20) 
Benefiby Reapo~  to Key 
Survey (hmationsby Category  HMAnos  HTMhisO   %Dify.  Comp.  Au  T&  %xMr.  Comp. 
EMos  HMO 
HIMLz!!  XXWENING 
Was ~t  asked at application 
about health problems, 
excluding kidney failure and 
hospice care.  6(731%7 )  32(8%)   -31%  o  58%  17%  -41%  o 
(430)  (1) 
Physical exam was n-
~uired  before joining.  (91,62%95 )  8(52%2)   -11%  o  9(882%4)   10(80)%    +2%  e 
VAUJEWT!iD~G  UF HMOS 
lid know they could change 
heir minds about enrolling 
,fter they applierl.  (818,0%7 8)  9(62%2)   +8%  e  82%  75%  -7%  @
(611)  (6) 
)id know,  from the 
qginning,  they  must be 
>ferred to a specialist by 
leir primary HMO doctors.  (819,4%4 4)  9(23%4)   +3%  @  84%  77%  -7%  @
(852)  (lo) 
~idknow,  from the 
e-g,  they could only 
w HMO doctors and 
wpitals (except emergent 
ue and urgent  care  outaide 
~eService area.)  (916,5%8 5)  10(401%)   +4%    93%  100%  +7%  e
(958)  (14) 
id know they had the right 
.o0  parpopveiadle l~p ayH MfoOr Ss er~vfi&ce s.  (714,1%1 3)  7(22%6)   -2%  @  67%  88%  +21%  g
(523)  (7) 
vith primary HMO doctors,

Lwlallywaited less than 13 
ays.  (81,52%7 6)  8(93%2)   +4%  e  82%  90%  +8%  @

(681)  (9) 
79
  
Above aveqe 
@  Average  o 
Below  average  NS  Not sufficient  data 
~0  ID #: H 2649 
Enrollees 
D:senrollees 
(N = 42) 
N  = 20)
Bene_  Reapoass to Key 
tkrvey Questioasby Category  IIMAlol s  ITIIhWiso   %~.  Comp.  Au  This  %DM  Comp.
EMos  HMO 
For Scheduld  appotitments 
with specialists, usually  81%  97%  + 16%  
Wtited 1.sssthan 13 diiyS.  (970)  (32)	 75%  67%  -8%  e
(477)  (4) 
When very sick, was able to 
get a doctors  appointment 
within 1 to 2 tiys.  9(934%2 )  10(304%)   +7%  @  89%  100%  +11%  03
(453)  (4) 
Usually Wtited less than 1 
hour in the office  to see 
primary HMO doctor.  (91,54%3 1)  9(73%8)   +2%  @  87%  91%  +4%  03
(704)  (lo) 
c onsistently busy telephone 
1mes did w  hinder benes 
making appointments.  9(708%0 )  10(209%)   +10%  @  89%  100%  +11%  @
(425)  (4) 
s ERV.CjRY 
m V  HMO doctor never 
falled to provide needd 
96%  100%  +4%   
M edicare service.q.  (1,475)  (41)  88%  90%  +2%  ~ 
(744)  (9) 
PrlmiuY HMO doctor never 
failed to refer to a specialist 
when need~.  (916,4%3 9)  9(83%9)   +2%  e  88%  100%  + 12%  
(732)  (lo) 
Di&t  f~l  the nd  to s~k

out-of-plan care, excludhg

denM,  routine eye, and 
emergentiurgent care.  (913,3%9 7)  9(53%5)   +2%  e  8(669%6 )  8(98%)
  +3%  @

Medical care received

through the HMO caused

beneficitim  health to:

b  improve 
5(737%2 )  5(11%8)   -2%  @  41%  56%  + 15%  @
b  stay about the same  45%  46%  (296)  (5)
(649)  (16)  +1%  @  4(398%3 )  4(44%)   -5% e 
b  Worsen  2%  3% 
+1%  10%  o%
(32)  (1)  e  -lo%  @ 
(86)  (o) 
PERS Ohuu  TWPENT 
Primary HMO doctor never

failed to take beneficiqs 
health compltik  seriously.  (8183%49 )  8(53%4)   -3%  @  76%  85%  +9%  ~

(650)  (11)

80
 .  Above average  @  Average  ()  Below average  NS  Not sufficient  data 
HMO  ID #: H 2649  Enrollees  DMenrollees 
(N=  42)  (N = 20)
 
Bm@iary ReapoIuesto Key  All  This  %DW.  Comp.  &l  This  %DM.  Comp. 
Survey Questionsby Category  EMos  II&lo  Ic&fos  HMo 
Most  important  to primary 
HMO doctor was: 
b  giving the best 
medical  care  86%  87%  +1%  03  72%  78%  +6%  @ 
possible  (1,197)  (34)  1471)  (7) 
b	 holding down the  9%  13%  +4%  26%  22%  ~%  * 
@ 
cost of care  (120)  (5)  (162)  (2 
Most important to the HMO 
was: 
b	 giving  the best 
me&al  care  74%  87%  +13%    58%  60%  +2%  @ 
possible  (1,036)  (32)  (387)  (6) 
b  holding down the  15%  14%  -1%  36%  40%  +4%  @
e 
cost of care  (213)  (5)  (230)  (4) 
81
 TOTAL  HEALTH  CARE  (MO) 
T 
No. Enrollees:  7,233  Total No. %znpkd:  99  Total No. Respondents:  71 
Model ~pe:  IPA  Not For-Profit  Competitive 
 
Above average  @  Average  O  Below average  NS  Not suftlcient  data 
HMO ID #: H 2652	 Enrollees  Dkmrollees 
(N=  43)  (N =28) 
BeneficiarRyeaponsesto Key  An  This  %I!MY.  Comp.  All  This  %DitT.  Comp. 
key  QIIWfiOIIS by Catqory  EUWOS  E&lo  HIWs  HMO 
IflWjl!if#  SCJU!?ZNW$TG 
Was p@ asked at application 
about health problems, 
excluding kidney failure and  63%  25%  -38%  o  58%  16%  -42%  o 
hospice care.  (717)  (8)  (430)  (3) 
Physical exam was n- 96%  95%  -1%  @  98%  100%  +2%  e 
required before joining.  (1,295)  (35)  (824)  (27) 
uNDE@iW14A!JXNG 0$ JJMUS 
Did know they could change 
their minds about enrolling  88%  78%  -lo%  o  82%  75%  -1%  C13 
after they applied.  (1,078)  (21)  (611)  (15) 
Did know,  from the 
beginning, they must be 
 
referred to a specialist by  89%  95%  I-6%  03  84%  100%  + 16% 
their primary HMO doctors.  (1,444)  (35)  (852)  (27) 
Did know,  from the 
beginning, they could only 
use HMO doctors and 
hospitals (except emergent 
care and urgent care outside  96%  100%  +4%  e  93%  100%  +7%  @ 
the service area.)  (1,585)  (41)  (958)  (28) 
Did know they had the right 
to appeal an HMOs  refbsal  74%  74%  -o%  e  67%  75%  +8%  e 
to providelpay  for services.  (1,113)  (29)  (523)  (0 
For scheduled appointments 
with primary HMO  doctors, 
usually Wtited 1sss than 13  85%  97%  + 12%  03  82%  100%  + 18%   
days.  (1,276)  (37)  (6S1)  @a 
82
 .  Above average  @  Average  O  Below average  NS  Not suffkient  data 
HMO ID #  H 2652	 Enrollees  DMenrolkes 
(N=  43)  (N=  28) 
BeneficiarRyesponsesto Key  Au  This  %Diff.  Conlp.  An  This  %DM.  Comp. 
Survey Quest.ioIIbsy Category  EMos  Enlo  EMos  HMO 
For  scheduled  appointments 
 
with  specialists,  usually  81%  81%  0%  @  75%  96%  +21% 
Wd(d  kSS  than 13 dllyS.  (970)  (6)  (477)  (-23) 
When very sick, was able to 
get a doctors  appointment  93%  100%  +7%  @  89%  100%  + 11%  @ 
within 1 to 2 days.  (942)  (32)  (453)  (17) 
usually Wilitd  kss than 1 
hour in the office  to see  95%  98%  +3%  e  87%  93%  +6%  e 
primmy HMO doctor.  (1,431)  (40)  (704)  (25) 
Consistently busy telephone 
lines dld @  hinder benes  90%  100%  + 10%  e  89%  94%  +5%  03 
making appointments.  (780)  w)  (425)  (16) 
Awm?M2Es 
Primary HMO doctor never 
failed to provide needed  96%  93%  -3%  o  88%  96%  +8%  @ 
Medkare  services.  (1,475)  (37,)  (744)  (26) 
Primary HMO doctor never 
failed to refer to a specialist  96%  87%  -9%  o  88%  92%  +4%  @ 
when needed.  (1,439)  (33)  (732)  (24) 
Didnt feel the need to seek

out-of-plan cam, excludiig

dental, routine eye, and  93%  95%  +2%  03  86%  96%  + 10%  

emergentJurgent care.  (1,397)  (37)  (696)  (26)

Medical care received

through the HMO caused

beneficiaries  health to:

b  improve  53%  56%  +3%  @	 41%  29%  -12%  gl 
(296) 
49%  6?%  + 18%  
(383)  (16) 
10%  4%  ~~ 
(86)  (1)  e 
Primary HMO doctor never

failed to take beneficiarys  88%  87%  -1%  e  76%  88%  + 12%  

health complaints seriously,  (1349)  (34)  (650)  (22)

83
 .  Above averqe  @  Average  o 
Mow  average  NS  Not sufflcient data 
~01D#H2652 
Enrollees 
  Disenrolkes
(N=  43) 
(N = 28)
Beneficiary Reapoms to Key 
key  (kx.ioas  by Category  HMAllo s  HThMisO    %Diff.  Comp.  Au  This  %mff.  Comp.
EMos  HMO 
Most impotit  to pri~ 
HMO doctor W=: 
b	 giving  the best 
medical care 
possible  (816,1%9 7,)  8(43%1)   -2%  e  72%  73%  +1%  e
(471)  (16) 
b	 holding down the  9%  11% 
+2%  26%  18% 
cost of care  (120)  (4)  @  -8%  ~
(162)  (4) 
Most impo~t  ~  the HMO 
was; 
b	 giving the best 
medical care 
74%  74%  ()% 
possible  (1,036)  (28)  03  58%  61%  +3%  ~
(387)  (14) 
b	 holding down the  15%  16%  +1%  36%  22% 
cost of w  (X3)  (6)  e3  -14%  ~
(230)  (3 
84
 SHARE  HEALTH  PLAN  OF  NEBRASKA 
No. Enrollecs: 3,256 
Total No. &unpkd:  100 
Total No. Respondent:  75 
Model &e:  IPA 
For-Profit 
Non-Competitive 
 
Above average 
@  Average 
O  IMOWaverage  NS  Not .sUfKcientdata 
~0  ID #: H 280z 
Enrollees 
Disenrollees 
(N=  38) 
(N  =37)
Benefjc&  Respoaws to Key  .. 
%ey  Que&.ioasby Category  EMAuo s  HTMhiso   %~.  Comp.  All  This  %Diff.  Comp.
EMos  HMO 
HWZW  Scl?J?jIINWG 
Was ~t  asked at application 
rnbouthealth problems, 
>xcluding kidney failure and 
63%  74%  +11%  ~ 
lospice care.  (717)  (17)  58%  73%  + 15%  @ 
(430)  (16) 
?hysical exam was not 
equired before job-g.  (916,2%9 5)  10(302%)   +4%  @  98%  100%  +2%  ~ 
(824)  (25) 
7NDlHw..B~G  UF.HiUOS 
)id know they could chrume 
leir minds about enrolling 
88%  85%  -3%  @ 
fter they applied.  (1,078)  82%  67%  -15%  o 
w)  (611)  (14) 
~idkUOW,from the 
egirming, they must be 
:fermd to a s&ialist  by 
89%  89%  o% 
[eir primary HMO doctors.  (1,444)  (31)  e  84%  82%  -2%  e3
(852)  (28) 
id know, from the 
:ginning, they could only 
se HMO doctirs  ~d

ospitals (except emergent

are and urgent care outside 
le service ~.)  (916,5%8 5)  9(43%4)   -2%  03  93%  89%  -4%  @

(958)  (31)

lid know they had the right

} appeal an HMOs  refbaal 
Iprovidelpay  for services.  (714,1%1 3)  8(52%9)   +11%    67%  66%  -1%  @

(523)  (19)

mMN?MEm 
x  scheduled appointments

ithprimary HMO doctors,

uysa.l ly waited less than 13  (81,52%76 )  1(0305%)	  + 15%  
 82%  100%  + 18%   
(681)  (29) 
85
  
Above average  @  Average  O  Below average  NS  Not suffkient  data 
HMOlD#H2802  Enrollees  Disenrdees 
(N = 38)  (N=37) 
Benefi&uyResponsetso Ksy  An  m  %DM.  Comp.  All  This  %Diff.  Comp. 
Survey Questioosby Categow  EMos  HMO  EMOS  HMO 
. 
For scheduled appointments 
with .qxXialkts, usually  81%  97%  + 16%    75%  92%  + 17%   
Wtited kss than 13 &yS.  (970)  (29)  (477)  (24) 
When very sick, was able to 
get a doctors  appointment  93%  100%  +7%  @  89%  91%  +2%  03 
within 1 to 2 days.  (942)  (23)  (453)  (19) 
usually waited leas than 1 
hour in the office  to see  95%  97%  i-2%  e  87%  97%  +10%  e 
primary HMO doctor.  (1,431)  (35)  (704)  (29) 
Consistently busy telephone 
lines dld ~t  hinder benes  90%  100%  + 10%  e  89%  94%  +5%  e 
making appointments.  (780)  (15)  (425)  (17) 
Primary HMO doctor never 
failed to provide needed  96%  94%  -2%  e  88%  91%  +3%  @ 
Medieare services.  (1,475)  (34)  (744)  (29) 
Primary HMO doctor never 
failed to refer to a specialist  96%  97%  +1%  @  88%  91%  +3%  @ 
when needed.  (1,439)  (35)  (732)  (29) 
Didnt feel the need to seek 
out-of-plan care, excluding 
&ntal,  routine eye, and  93%  100%  +7%    86%  82%  -4%  @ 
emergentiurgent care.  (1,397)  (34)  (696)  (V 
Medical care received 
through the HMO caused 
beneficiaries  health to: 
b  improve  53%  69%  + 16%    41%  39%  -2%  @ 
(772)  (296)  (12) 
b  stay about the same  45%  3?;  -14%  (-J  49%  58%  +9%  @ 
(649)  (lo)  (383)  (18) 
10%  3% 
b  women  -7%
(86)  (1)  e 
Primary HMO doctor never

failed to take beneficiarys  88%  89%  +1%  e  76%  70%  -6%  @

health coqdaints  seriously.  (1349)  (32)  (650)  @l)

86
 HEALTH  PLAN  OF  NEVADA 
No. Enrollees:  13,794  Total No. Sampled: 99 
Model ~~.  (kqI  Fw-IW% 

-E 
.  Above average  @  Average  0  Be&  avcmqge  NS  Not sufllcient  data 
HMO ID #: H 2931  Enrollees  Disenrollees 
(N=  42)  (N = 34)
..  ,  -
BenefkisrgResponsetso Key  An  m  %Wf.  Comp.  M  This  %Diff.  Comp. 
SurveyQuestionbsy Category  EMos  HMO  YfBlos  HMO 
 
HJA4LTH SCRZ?ZWEVG 
. 
Was g@  asked at application 
about health problems, 
excluding kidney faihne and  63%  68%  +5%  @  58%  63%  +5%  e 
hospice care.  (717)  (23)  t430)  (17) 
  ..s 
Did know they could change 
their minds about enrolling  88%  94%  +6%  e  82%  93%  +11%  @ 
after they applied.  (1,078)  (29)  (611)  (27) 
Did know,  from the 
beginning, they must be 
referred to a specialist by  89%  90%  +1%  @  84%  97%  +13%   
their primary HMO doctors.  (1,444)  (36)  (852)  (31) 
Did know,  from the 
beginning, they could only 
use HMO doctors and 
hospitals (except emergent 
care and urgent care outaide  96%  98%  +2%  e  93%  100%  +7%  e 
the service area.)  (1,585)  (39)  (958)  (32) 
Dld know they had the right 
to appeal an HMOs  refksal  74%  81%  +7%  e3  67%  65%  -2%  03 
to provide/pay  for services.  (1,113)  (30)  (523)  (17) 
For scheduled appointments 
with primary HMO doctors, 
o 
usually waited less than 13  85%  58%  -27%  O  82%  59%  -23% 
days.  (1,276)  (=)  (681)  (17) 
88
  
Above average  @  Average  O  Below average  NS  Not suflkient  data 
HMO ID #: H 2931  Enrollees  Duenrollees 
(N =  42)  (N = 34) 
Beneficiary Reaponseato Key  Au  This  %DifT.  Comp.  All  llIis  %DifT.  Comp. 
Survey Queatioasby Catego~  mos  IUWo  HMos  HMo 
For scheduled appointments 
with specialkts, usually  81%  67%  -14%  o  75%  55%  -20%  o 
waited less than 13 days.  (970)  (20)  (477)  (11) 
When very sick, was able to 
get a doctors  appointment  93%  71%  -22%  o  89%  72%  -17%  o 
within 1 to 2 days.  (942)  (17)  (453)  (13) 
usually  waited less than 1 
hour in the office  to see  95%  97%  +2%  @  87%  86%  -1%  %3 
primary HMO doctor.  (1,431)  (36)  (704)  (24) 
Primary HMO doctor never 
failed to provide needed  96%  97%  +1%  @  88%  85%  -3%  e 
Medicare services.  (1,475)  (36)  (744)  (22) 
Primary HMO doctor never 
failed to refer to a specialist  96%  95%  -1%  @  88%  89%  +1%  @ 
when needed.  (1,439)  (36)  (732)  (-,?5) 
Didnt feel the need to seek 
out-of-plan care, excluding 
dental, routine eye, and  93%  95%  +2%  e  86%  85%  -1%  @ 
emergentiurgent care.  (1,397)  (36)  (696)  (23) 
Medkal  care received 
through the HMO caused 
beneficiaries  health to: 
b  improve	 53%  47%  -6%  e  41%  56%  + 15%  @ 
(772)  (17)  (296)  (14) 
b  stay about the same	 45%  44%  -1%  49%  32%  -17%  o
e 
(649)  (16)  (383)  (8) 
2%  8%  io%  Ii% 
b  worsen	 +6%    +2% 
(32)  (3)  (86)  (3)  e 
Primary HMO doctor never

failed to take beneficiarys  88%  82%  -6%  o  76%  54%  -12%  o

health cmnolainta seriouslv.  (1349)  (31)  (650)  (13)

89
 .  Above average  @  Average  O  Below average  NS  Not sufficient  data 
HMO ID #: H 2931  Enrollees  DMenrollees 
 
(N = 42)  (N = 34)
. 
Benefk&ry Reapoasesto Key  Au  This  %DH.  Comp.  Au  This  %Diff.  Comp. 
!krvey  Qwstioas by Category  EMos  HMO  &UVIOs  HMO 
..  . 
Most important to primary 
HMO doctor WSS: 
b  giving the best 
medkal  care  86%  90%  -4%  @  72%  71%  -1%  e 
possible  (1,197)  (28)  (471)  (12) 
b	 holding down the  9%  o%  -9%  o  26%  24%  -2%  e 
cost of care  (120)  (o)  {162)  (4) 
Most important to the HMO 
was: 
b  giving  the best 
medical care  74%  79%  +5%  e  58%  61%  +3%  @ 
possible  (1,036)  (V  (387)  (11) 
b	 holding down the  15%  6%  -9%  o  36%  28%  -s%  ~ 
cost of care  (213)  e)  (230)  (5) 
90
 FHP,  INC.  (NV) 
 
No. Enrollees: 4,341  Total No. Sampled: 99 
Model &M: IPA  FoAhwflt 
-7  ~ 
.  Above average  @  Average  0  Below average  NS  Not stilcient  data 
HMO ID #  H 2949	 Enrollees  Disenrolkes 
(N = 32)  (N =26) 
  ! 
BenefkiaryResponsetso Key  Au  This  %Diff.  Uolq  Au  This  %Diff.  Comp. 
flurvey Questioas by Category  EMos  HMO  HMos  HMo 
.  . 
HEALTH  SCREENING 
. 
Was ~t  asked at application 
about health problems, 
excluding kidney failure and  63%  76%  +13%  @  58%  74%  + 16%  e 
hospice care.  (717)  w)  {430)  (14) 
.  ~  . 
Physical exam was @  96%  97%  +1%  @  98%  100%  +2%  03 
required before joining.  (1,295)  @s)  (824)  (23) 
Did know they could change 
their minds about enrolling  88%  93%  +5%  e  82%  83%  +1%  @ 
after they applied.  (1,078)  (28)  (611)  (19) 
Did know,  from the 
beginning, they must be 
referzed to a specialist by  89%  100%  +11%    84%  84%  O%  61 
their primary HMO doctors.  (1,444)  (30)  (852)  (21) 
Did know,  from the 
beginning, they could only 
use HMO doctors and 
hospitals (exeept emergent 
care and urgent care outside  96%  97%  +1%  @  93%  89%  -4%  @ 
the serviee area.)  (1,585)  (29)  (958)  (23) 
Did know they had the right 
to appeal an HMOs  refusal  74%  89%  + 15%    67%  73%  +6%  @ 
to providelpay for services.  (1,113)  W  (523)  (11) 
I?orscheduled appointments

with primary HMO doctors,

usually Wtited less than 13  85%  89%  +4%  @  82%  71%  -11%  @

hys.  (1,276)  m  (681)  (lo)

91
 .  Above average  @  Average  O  Below average  NS  Not suffkient  data 
HMO JD #: H 2949  Enrollees  DEenrollees 
(N = 32)  (N =26)
. 
Benefi&ry  Responsesto Key  AU  This  %Difx  Comp.  An  This  % Diff.  Comp
SluveyQuestionbsy Catqory  HMos  HMO  W$los  HMO 
For scheduled appointments 
with specialists, usually  81%  75%  -6%  @  75%  50%  -25%  0 
waited less than 13 days.  (970)  (12)  (477)  (5) 
When very sick, was able to 
get a doctors  appointment  93%  100%  +7%  e  $9%  56%  -33%  c) 
within 1 to 2 days.  (942)  (12)  (453)  (5) 
Uswdly WSited less than 1 
hour in the office  to see  95%  100%  +5%  e  87%  73%  -14%  o 
primary HMO doctor.  (1,431)  (26)  (704)  (11) 
Consistently busy telephone

lines did g@ hinder benes  90%  100%  + 10%  e  89%  80%  -9%  e

Primary HMO doctor never 
failed to provide needed  96%  100%  -t 4%    88%  88%  o%  e 
Medkare  services.  (1,475)  (28)  (144)  (15) 
Primary HMO doctor never 
failed to refer to a specialist  96%  100%  +4%    88%  88%  o%  @ 
when needed.  (1,439)  (28)  (732)  (15) 
Didnt feel the need to seek 
out-of-plan care, excludiig 
dentd,  routine eye, and  93%  100%  +7%    86%  87%  +1%  (B 
emergentlurgent care.  (1,397)  (V  (696)  (13) 
Medkal  care received 
through the HMO caused 
beneficiaries  health to: 
b  improve  53%  48%  -5%  @	 41%  29%  -12%  e 
(.2%)  (4) 
49%  64%  + 15% 
@
(383)  (9) 
10%  7% 
b  worsen  -3% @
(86)  (1) 
Primary HMO doctor never

failed to take beneficiarys  88%  96%  +8%    76%  71%  -5%  e

health complaints seriously.  (1349)  (27)  (650)  (12)

92
 .  Above average  @  Average  O  Below average  NS  Not suftlcient  data 
HMO ID #: H 2949  Enrollees  Dkenrollees 
(N=  32)  N=m
..-
Bene&ii  Responsetso Key  Au  This  %DifY.  Comp.  m  This  %rm.  Comp. 
&uveyQuestionbsy Category  EMos  EIMo  mos  HMO 
... 
Most  important  to primary 
HMO doctor was: 
b  giving the best 
medical care  86%  92%  +6%    72%  83%  +11%  @ 
possible  (1,197)  (23)  (471)  (5) 
b  holding down the  9%  8%  -1%  26%  17%  -9%  @ 
@ 
cost of care  (120)  (2)  (162)  (1) 
Most important to the HMO 
was: 
b	 giving  the best 
medkzd care  74%  82%  +8%  @  58%  33%  -25%  o 
possible  (1,036)  Q2)  (387)  (3) 
b	 holding down the  15%  4%  -11%  o  36%  44%  +8%  @ 
cost of care  (213)  (1)  (230)  (4) 
93
 FHP,  INC.  (NM)  . 
No. Enrollees:  16,234  Total No. fkmpkd:  97 
Model ~pe:  IPA  For-Profit 
:- = 
.  Above average  @  Average  O  Below average  NS  Not suffkient  data 
HMO  ID #: H 3204  Enrollea  DMenrollees 
(N=  31)  (N =28)
 
BeneficiarRyeapomwto Key  Au  This  %Xliff.  Coaqk  Au  This  %Diff.  Comp. 
Survey Questioasby Category  EMos  HMO  mm  HMO 
Was ~t  asked at application

about health problems,

excluding kidney failure and  63%  48%  -15%  @  58%  48%  -lo%  e

hospice care.  (717)  (11)  (430)  (11)

Dld know they could change 
their minds about enrolling  88%  89%  +1%  @  82%  71%  -11%  e 
after they applied.  (1,078)  (25)  (611)  (15) 
Did know,  from the 
beginning, they must be 
referred to a specialist by  89%  93%  +4%  e  84%  85%  +1%  @ 
their primary HMO doctors.  (1,444)  (26)  (S52)  m) 
Did know,  from the 
beginning, they could only 
use HMO doctors and 
hospitals (except emergent 
care and urgent care outside  96%  97%  +1%  e  93%  96%  +3%  @ 
the service area.)  (1,585)  (28)  (958)  (27) 
Dld know they had the right 
to appeal an HMOs  refusal  74%  56%  -18%  o  67%  76%  +9%  @ 
to providelpay for services.  (1,113)  (14)  (523)  (16) 
For scheduled appointments

with primary HMO doctors,

usually Wllitd  k  than 13  85%  78%  -7%  e  82%  83%  +1%  @

days.  (1,276)  (18)  (681)  (19)

94  .  Above average  @  Average  O  Below average  NS  Not suftlcient  data 
HMOlD#H3204  Enrollees  D~llees 
 
(N = 31)  (N = 28)
.. 
Btnefkimy Responsesto Key  Au  This  %Diff.  Comp.  Au  This  %DitY.  Comp. 
hey  Questionsby Category  EMos  HMo  IIMos  HMO 
For scheduled appointments 
with specialists, usually  81%  84%  +3%  e  75%  63%  -12%  e 
waited less than 13 days.  (970)  (16)  (477)  (12) 
When very sick, was able to 
get a doctors  appointment  93%  94%  +1%  e  89%  93%  +4%  e 
within 1 to 2 days.  (942)  (15)  (453)  (14) 
usually  Wtitd  kSS  than 1 
 
hour in the office to see  95%  96%  +1%  e  87%  100%  +13% 
primary HMO doctor.  (1,431)  (.23)  (704)  (3 
Consistently busy telephone 
lines did ~t  hinder benes  90%  92%  +2%  @  89%  92%  +3%  e 
making appointments.  (780)  (12)  (425)  (11) 
Primary HMO doctor never 
failed to provide needed  96%  89%  -7%  o  88%  91%  +3%  e 
Medicare services.  (1,475)  (24)  (744)  (21) 
_  HMO doctor never 
failed to refer to a specialist  96%  100%  +4%    88%  86%  -2%  e 
when needed.  (1,439)  (26)  (732)  (19) 
Didnt feel the need to seek 
out-of-plan care, excluding 
dental, routine eye, and  93%  88%  -5%  o  86%  64%  -22%  o 
emergenthrgent  care.  (1,397)  (21)  (696)  (14) 
Medical  care  received 
through  the HMO  caused 
beneficiaries  health  to: 
b  improve  53%  62%  +9%  e  41%  26%  -15%  e 
(772)  (16)  (296) 
b  stay about the same  45%  39%  -6%  49%  5:%  +9%  @ 
@ 
(649)  (lo)  (383)  (11) 
b  worsen  2%  o%  -2%  10%  16%  +6%  ~ 
(32)  (o)  e  (86)  (3) 
Primary HMO doctor never

failed to take beneficiarys  88%  96%  +8%    76%  85%  +9%  e

health complaints seriously.  (1349)  (25)  (6S0)  (17)

95   
Above average  @  Average  o  B&&wWvm-age  NS  Not suffkient  data 
HMO ID #: H 3204  Enrollees  Dkenrollees 
(N = 31)  (N = 28)
.   
Bene&iary Reaponseato Key  Au  This  %M.  Comp.  All  This  %Biff.  Comp. 
Survey Questionsby Catqory  HMos  HMO  Iw40s  HMO 
---.  - 
Most important to primary 
HMO doctor was: 
b  giving the best 
medkal care  86%  86%  0%  e  72%  67%  -5%  03 
possible  (1,197)  (19)  (471)  (lo) 
b  holding down the  9%  5%  ~%  @  26%  33%  +7%  ~ 
cost of care  (120)  (1)  (162)  (5) 
Most important to the HMO 
was: 
b  giving the best 
medical care  74%  73%  -1%  e  58%  59%  +1%  e 
possible  (1,036)  (19)  (387)  (lo) 
b  holding down the  15%  8%  -7%  e  36%  41%  +5%  e 
cost of care  (213)  (2  (230)  m 
96
 QUA  L-MED  INC.  (NM) 
No. Enrollees: 279  Total No. Sampled: 51  Total No. Respondents:  39 
Model &e:  IPA  For-Profit  Competitive 
.  Above average  @  Average  O  Below average  NS  Not sufilcient  data 
HMO  ID #: H 3249  Enrollees  DMenrollees 
(N = 39)  (N=O) 
BeneficiarRy eaponsetao Key  All  This  %DitY.  Comp.  .$  This  %Diff.  Comp. 
&mvey Quealionsby Category  EMos  HMo  EMos  HMo 
HEALTH  SCREENING 
Was @  asked at application 
about health problems, 
excluding kidney failure and  63%  91%  +28%  g  58%  NS 
hospice care.  (717)  (29)  (430) 
Physical exam was n- 96%  97%  +1%  @  98%  NS 
Did know they could change 
their minds about enrolling  88%  88%  o%  e  82%  NS 
after they applied.  (1,078)  (30)  (611) 
Did know,  from the 
beginning, they must be 
referred to a specialist by  89%  92%  +3%  @  84%  NS 
their primary HMO doctors.  (1,444)  (33)  (852) 
Dld know,  flom the 
beginning, they could only 
use HMO doctors and 
hospitals (except emergent 
care and urgent care outaide  96%  95%  -1%  @  93%  NS 
the service area.)  (1,585)  (35)  (958) 
Did know they had the right 
to appeal an HMOs  Aid  74%  80%  +6%  03  67%  NS 
to providelpay  for services.  (1,113)  (28)  (523) 
For scheduled appointment 
with primary HMO doctors, 
usually Wtiti  less than 13  85%  97%  + 12%  e  82%  NS 
days.  (1,276)  (31)  (681) 
97
  
Above average  @  Average  O  Below average  NS  Not suffkient  data 
HMOlD#H3249  Enrollees  DMenrollees 
 
(N = 39)  (N=O) 
.- 
Beneficii  Responsetso Key  An  This  %Diff.  Comp.  All  This  % Diff.  Comp. 
Survey Questionsby Catego~  HMO?  Imlo  KMos  HMo 
For scheduled appointments 
with specialists, usually  81%  87%  +6%  @  -75%  NS 
waited less than 13 days.  (970)  (20)  (477) 
When very sick, was able to 
get a doctors  appointment  93%  88%  -5%  e  89%  NS 
within 1 to 2 days.  (942)  (14)  (453) 
usually Wd3d  km  than 1 
hour in the office  to see  95%  97%  +2%  @  87%  NS 
primary HMO doctor.  (1,431)  (30)  (704) 
Consistently busy telephone 
lines dld ~t  hinder benes  90%  100%  + 10%  @  89%  NS 
Primary HMO  doctor  never 
ftiled  to provide  needed  96%  97%  +1%  @  88%  NS 
Me&xre  services.  (1,475)  (33)  (744) 
_  HMO doctor never 
failed to refer to a specialist  96%  100%  +4%    88%  NS 
when needed.  (1,439)  (34)  (732) 
Didnt feel the need to seek 
out-of-plan care, excluding 
dental, routine eye, and  93%  86%  -7%  o  86%  NS 
emergent.lurgentcare.  (1,397)  (30)  (696) 
Me&cal  care receiwxl 
through the HMO caused 
beneficiaries  health to: 
b  improve  53%  55%  +2%  e  41%  NS 
(772)  (18)  (2%) 
b  stay about the same  45%  46%  +1%  49%  NS 
e 
(649)  (15)  (383) 
b  worsen  2%  o%  -2%  10%  NS 
(32)  (o)  e  (86) 
Primary HMO doctor never

failed to take beneficiarys  88%  80%  -8%  o  76%  NS

health conqdainta  seriously.  (1349)  (28)  (6S0)

98
  
Above average  @  Average  O  Below average  NS  Not sufficient  data 
HMOlD#H3249  Enrollees  DNenrollees 
(N = 39)  (N=O)
.. 
BeneficiarRy eaponsetao Key  Au  This  %Diff.  Comp.  All  This  %DW.  Comp. 
!krvey  Questionsby Category  EMos  mwo  ifrfwos  HMO 
. 
Most important to primary 
HMO doctor was: 
b	 giving the best 
me&cal care  86%  85%  -1% e  72%  NS 
possible  (1,197)  Q8)  {471) 
b  holding down the  9%  9%  ()%  26%  NS
e 
cost of care  (120)  (3)  (162) 
Most importaut to the HMO 
was: 
b  giving the best 
medical care  74%  64%  -lo%  o  58%  NS 
possible  (1,036)  (21)  (387) 
b  holding down the  15%  15%  ()%  36%  NS 
03 
cost of care  (213)  (5)  (230) 
99
 No. Enrollees:  43,921  Total No. Sampie& 99 
Model ty-~: Group  Not For?rofit 
:~ 
 
Above average  @  Average  o  Below WWrage  NS  Not sufficient  data 
  . 
HMO ID #: H 3330  EnroUeea  Dkenrollees 
(N =40)  (N =  32)
.- ... 
BeneficiaryResponsetso Key  Au  This  %Diff.  Comp  All  This  % Biff.  Comp. 
&rvey  QllE@iODS by Catqory  HMos  HMO  WOS  HMO 
MWLT@  SCREENING 
- 
Wss =t  asked at application 
about health problems, 
excluding kidney failure and  63%  50%  -13%  @  58%  67%  +9%  03 
hospice care.  (717)  (5)  (430)  (lo) 
Physid  exam was n@  96%  100%  +4%  e  98%  87%  -11%  o
required
before joining.  (1,295)  m  (824)  (13) 
UA!BRRSXMAUMNG@FHMOs 
Did know they could change 
their minds about enrolling  88%  100%  + 12%    82%  86%  +4%  @ 
dler they applied.  (1,078)  (11)  (611)  (12) 
Did know,  from the 
beginning,they must be 
referred to a specialist by  89%  87%  -2%  @  84%  86%  +2%  @ 
heir primary HMO  doctors.  (1,444)  (32)  (852)  (25) 
Did know, from the 
wginning, they could only 
Me HMO doctors and 
lospitals (except emergent 
:are and urgent care outside  96%  97%  +1%  @  93%  90%  -3%  e 
he service area.)  (1,585)  (37)  (958)  @n 
Didknow they had the right 
o appeal an HMOs  retisal  74%  82%  +8%    67%  67%  O% e 
co providelpay  for services.  (1,113)  (27)  (523)  (16) 
For scheduled appointments

with primary HMO doctors,

usually waited less than 13  85%  68%  -17%  o  82%  46%  -36%  o

days.  (1,276)  (X)  (681)  (11)

100
 .  Above average  (B  Average  O  Below average  NS  Not stilcient  data 
HMO ID #: H 3330  Enrollees  DKenrollees 
 
(N =40)  (N = 32) 
BeneficiarRy eaponsetao Key  Au  This  %Diff.  Comp.  All  This  %Diff.  Comp.
SurveyQueatioabsy Category  HMos  HMO  EMos  HMo 
For scheduled appointments 
with specialists, usually 81%  58%  -23%  o  75%  54%  -21%  o
waited
kws than 13 &VS.  (970)  (19)  (473  (14) 
When very sick, was able to 
get a doctors  appointment  93%  94%  +1%  (1)  89%  75%  -14%  o 
within 1 to 2 davs.  (942)  (30)  (453)  (12) 
Usudy  Wi&d  km  than 1 
hour in the office  to see  95%  75%  -20%  o  87%  48%  -39%  o 
primary HMO doctor.  (1,431)  Q-o  (704)  (13) 
Consistently busy telephone 
lines did g@ hinder benes  90%  67%  -23%  o  89%  52%  -37%  o
making
appointments.  (780)  (18)  (425)  (13) 
Primary HMO doctor never 
failed to provide needed  96%  97%  +1%  03  88%  82%  -6%  e 
Medicare services.  (1,475)  (34)  (744)  (22) 
Primary HMO doctor never 
failed to refer to a specialist  96%  94%  -2%  e  88%  89%  +1  e 
when needed.  (1,439)  (32)  (732)  Q3) 
Didnt feel the need to seek 
out-of-plan care, excluding 
dental, routine eye, and  93%  83%  -lo  0  86%  79%  -7  Q3 
emergentlurgent care.  (1,397)  (29)  (696)  (19) 
Medkal  care received 
through  the HMO  caused 
beneficiaries  health  to: 
 
b  improve	 53%  65%  +12%  41%  25%  -16%  @ 
Cn)  (22)  (296) 
b  stay about the same	 45%  32%  -13%  o  49%  St%  +1% 
(B
(649)  (11)  (383)  (lo) 
b  worsen	 2%  3%  +1%  10%  25%  +15%  
(32)  (1)  e  (86)  (5) 
Primary HMO doctor never

failed to take beneficiarys  88%  91%  +3%  03  76%  83%  +7%  e

health complaints seriously.  (1349)  (32)  (650)  (19)

101
   Above average  @  Average  o  Belovrllverage  NS  Not sufficient  data 
HMO ID #: H 3330  Enrollees  D~enrollees 
(N=  40)  (N =  32)
-----
Beoeficiary Respo~  to Key  All  This  %Diff.  Comp.  An  This  %DitY.  Comp. 
&mvey @@iOOS  by Ca@ory  HMos  HMO  IIMos  HMo 
  . 
Most important to primary 
HMO doctor was: 
b  giving the best 
medical care  86%  87%  +1%  03  72%  77%  +5%  (B 
possible  (1,197)  (26)  (471)  (13) 
b	 holding down the  9%  10%  +1%  03  26%  24%  -2%  @ 
cost of care  (120)  (3)  (162)  (4) 
Most important to the HMO 
was: 
b  giving the best 
medical care  74%  82%  +8%  @  58%  47%  -11%  @ 
possible  (1,036)  @m  (387)  (13) 
b	 holding down the  15%  15%  ()%  e  36%  53%  + 17%  e 
cost of care  @3)  (3  (230)  (4) 
102
 SANUS  HEALTH  PLAN  OF  GREATER  NEW  YORK 
 
No. Enrollees: 5,794  Total No. !bIpkd:  100  Total No. Respondents:  70 
I 
Model ~pe:  IPA  For-Profit  Competitive 
.  Above average  @  Average  O  Below awrage  NS  Not sufilcient  data 
HMO ID #: H 3354  Enrollees  Disenrollees 
(N = 41)  (N = 29)
. 
Wm&iarYResponsetso Key  Aa  n&  %Diff.  Comp.  .All  This  %Diff.  Comp.
SurveyQuestionbsy Category  EM(3S  HMO  Wos  HMO 
 
HZXLTH  S4X?.EEIWJYG 
. 
Was ~t  asked at application 
about health problems, 
excluding kidney failure and  63%  71%  +8%  e  58%  63%  +5%  e 
hospice care.  (717)  (24)  (430)  (12) 
Physical exam was n~  96%  90%  -6%  o  98%  91%  -7%  o 
required  before  joining.  (1,295)  (34)  (824)  (21) 
UN~l!H?WWWl?$G  OFJ&&JS 
Did know they could change 
their minds about enrolling  88%  92%  +4%  @  82%  73%  -9%  al 
alter they applied.  (1,078)  (34)  (611)  (16) 
Did know,  from the 
beginning, they must be 
referred to a specialist by  89%  90%  +1%  e  84%  78%  -6%  (B 
their primary HMO doctors.  (1,444)  (35)  (S52)  (18) 
Did know,  from the 
beginning, they could only 
use HMO doctors and 
hospitals (except emergent 
care and urgent care outside  96%  97%  +1%  @  93%  83%  -lo%  o 
the service area.)  (1,585)  (37)  (958)  w) 
Did know they had the right 
to appeal so HMOs  refusal  74%  69%  -5%  @  67%  80%  +13%  e 
to providefpay  for services.  (1,113)  @a  (523)  (8) 
I?or scheduled appointments 
with primary HMO doctors, 
usually waited less than 13  85%  88%  +3%  e  82%  86%  +4%  03 
days.  (1,276)  (29)  (681)  (12) 
103
 .  Above average  @  Average  O  Beiow average  NS  Not sufllcient  data 
HMO ID #: H 3354  Enrolkea  Dmenrollees 
	 (N = 41)  (N = 29)
 
BeneficialResponsesto Kq  Au  This  %DitT.  tip.  AIi  This  % Diff.  Comp, 
SmVey QueatioIMby Category  EMos  HMO  HMos  HMO 
. -
For scheduled appointments 
with specialists, usually  81%  86%  +5%  @  75%  80%  +5%  e 
waited less than 13 days.  (970)  (12)  (477)  (8) 
When very sick, waa able to 
get a doctors  appointment  93%  75%  -18%  0  $9%  100%  + 11%  e 
within 1 to 2 days.  (942)  (9)  {453)  (5) 
, 
usually waited lem than 1 
o 
hour in the office  to see  95%  81%  -14%  Q  87%  75%  -12% 
primary HMO doctor.  (1,431)  (26)  (704)  (12) 
. 
Consistently busy telephone 
o
lines did ~t  hinder benes 90%  86%  -4%  @  89%  67%  -22% 
making
appointment.  (780)  (6)  (425)  G) 
Primary HMO doctor never 
failed to provide needed  96%  97%  +1%  e  88%  92%  +4%  e 
Medkxue services.  (1,475)  (36)  (744)  (12) 
Primary HMO doctor never 
failed to refer to a specialist  96%  94%  -2%  e  aa%  86%  -2%  e 
when needed.  (1,439)  (29)  (732)  (12) 
Didnt feel the need to seek 
out-of-plan care, excluding 
dental, routine eye, and  93%  94%  +1%  e  86%  92%  +6%  @ 
emergent.furgentcare.  (1,397)  (32)  (696)  (12) 
Medical care received 
through the HMO caused 
beneficiaries  health to: 
k  improve	 53%  47%  -6%  @  41%  8%  -33%  c)
(772)  (16)  (296)  (1) 
*	 stay about the same  45%  50%  +5%  49%  62%  +13%  @ 
e 
(649)  (17)  (383)  (8) 
io%  3ik 
+21%  g 
(86)  (4) 
Primary HMO doctor never

failed to take beneficiarys  /38%  91%  +3%  e  76%  71%  -5%  e

health complaints seriously.  (1349)  (32)  (650)  (lo)

104
  
Above average  @  Average  ~  %ek)w  smwswge  NS  Not  suffkient  data 
HMO ID #  H 3354  Enrollm  DMenrollees 
  (N = 41)  (N = 29)
.. . 
Beneficiary Reaponseato Key  Au  This  % ~mm  Comp.  All  This  %Diff.  Comp. 
Survey Questionsby Category  EMos  HMO  WWs HMO 
.. ..  .... 
Most important to primary 
HMO doctor was: 
b  giving the best 
~  o 
medical care  86%  77%  -9%  ?2%  50%  -22% 
possible  (1,197)  (24)  @71)  (4) 
b	 holding down the  9%  16%  +7%  26%  50%  +24%  g 
* 
cost  of care  (120)  (5)  {162)  (4) 
Most important to the HMO 
was: 
b  giving the best 
medical care  74%  67%  -7%  (B  58%  50%  -8%  @ 
possible  (1,036)  (20)  {387)  (4) 
b  holding down the  15%  17%  +2%  @  36%  50%  + 14%  ~ 
cost of care  (213)  (5)  (,230)  (4) 
105
 KAISER  FOUNDATION  HEALTH  PLAN  (OH) 
No. Enrollees:  13,842  Total No. %mpkd:  98  Total No. Respondents:  70 
Model t@x  Group  Not For-Profit  Non-Competitive 
 
Above  average  03  Average  O  Below average  NS  Not suftlcient  data 
HMO  ID #: H 3607  Enrollees  DKenrolleea 
(N =  38)  (N=  32) 
Beneficiq Respoases tn Key  Au  This  %Diff.  Comp.  Au  This  % Diff.  Comp( 
Survey Quealioasby Ca@gory  HMos  IllWo  EMos  HMo 
JWIILIX.?  S~lUJENllVG 
Was ~t  asked at application 
about health problems, 
excluding kidney failure and  63%  48%  -15%  e  58%  44%  -14%  e 
hospice care.  (717)  (lo)  (430)  m 
Did know they could change 
o 
their minds about enrolling  88%  84%  -4%  @  82%  50%  -32% 
after they applied.  (1,078)  (16)  (611)  (8) 
Did know, from the 
beginning, they must be 
o  84% 
referred to a specialist by  89%  80%  -9%  73%  -11%  @ 
their primary HMO doctors.  (1,444)  (28)  (852)  (22) 
Did know,  from the 
beginning, they could only 
use HMO doctors and 
hospitals (except emergent 
o 
care and urgent care outside  96%  94%  -2%  e  93%  80%  -13% 
the service area.)  (1,585)  (34)  (958)  (24) 
Did know they had the right 
o
bto appeal an HMOs  refusal 74%  76%  +2%  @  67%  40%  -27% 
providelpay  for services.  (1,113)  (25)  (523)  (lo) 
I 
For scheduled appointments

with primary HMO doctors,

o  o

usually waited less than 13  85%  30%  -55%  82%  32%  -50% 
days.  (1,276)  (lo)  (681)  (8)

106
  
Above average  @  Average  O  Below average  NS  Not suftlcient  data 
HMO ID #  H 3607  Enrollees  DNenrollees 
(N = 38)  (N = 32)
 
Beneficii  Responsetso Key  Au  This  %Diff.  Comp.  Au  This  %DifF.  Comp. 
Survey Questionsby Category  EMos  HMo  mlos  HMO 
For  scheduled appointment 
o 
with specialists, usually  81%  35%  -46%  o  75%  28%  -47% 
waited less than 13 days.  (970)  (9)  (477)  (5) 
When very sick, was able to 
get a doctors  appointment  93%  93%  o%  e  89%  84%  -5%  e 
within 1 to 2 days.  (942)  (26)  (453)  (16) 
Usually waited less than 1 
hour in the office  to see  95%  97%  +2%  @  87%  83%  -4%  @ 
primary HMO doctor.  (1,431)  (32)  (704)  (19) 
Consistently busy telephone  II 
o  o 
lines did ~t  hinder benes  90%  68%  -22%  89%  74%  -15% 
Primary HMO doctor never  II 
88%  o 
failed to provide needed  %%  100%  +4%    79%  -9% 
Medkare  services.  (1,475)  (35)  (744)  (-23) 
Primary HMO doctor never 
failed to refer to a specialist  96%  97%  +1%  e  88%  86%  -2%  e 
when needed.  (1,439)  (34)  (732)  (24) 
Didnt feel the need to seek 
out-of-plan care, excluding 
o 
dental, routine eye, and  93%  89%  -4%  86%  70%  -16%  0 
emereentiurgent care.  (1,397)  (32)  (696)  (19) 
Medkal  care received 
through the HMO caused 
beneficiaries  health to: 
b  improve  53%  58%  +5%  e  41%  32%  -9%  e  II 
(772)  (21)  (2%)  (8) 
b  stay  about  the same	 45%  36%  -9%  e  49%  40%  -9%  e
(649)  (13)  (383)  (lo) 
b  worsen  2%  6%  +4%    10%  23%  +18%  
(32)  (2)  (86)  0) 
Primary HMO doctor never

failed to take beneficiarys  88%  92%  +4%  @  76%  68%  -8%  63

health complaints seriously.  (1349)  (34)  (650)  (19)

107
  
Above average  @  Average  ~  BE40WWfW?$&  NS  Not sufilcient  data 
HMO ID #: H 3607  Enrollees  Disenrollees 
 
(N = 38)  (N = 32)
  .,- 
Beneficiary Responsesto Key  Au  This  %Dim.  Comp.  All  This  % Din.  Comp. 
Survey Questionsby Catfgory  HMos  mo  mos  HMO 
.  . . .  .  . 
Most important to primsry 
HMO doctor was: 
b  giving the best 
medcsl  care  86%  91%  +s%  63  72%  65%  -7%  e 
possible  (1,197)  (29)  (471)  (11) 
b	 holding down the  9%  6%  -3%  @  26%  35%  +9%  6!3 
cost of care  (120)  (2)  (162)  (6) 
Most important to the HMO 
Wss: 
b  giving the best 
medical care  74%  84%  +10%    58%  53%  -5%  e 
possible  (1,036)  (26)  (387)  (lo) 
b  holding down the  15%  10%  -5%  e  36%  47%  +11%  @ 
cost of care  (213)  (3)  (230)  (9) 
108
 PA  CIFICARE  OF  OKLAHOMA 
No. Enrollees:  5,077  Total No. Sampled:  100  Total No. Respondents:  80 
.-
Model t@x  Group  For-Profit  Non-Competitive 
 
Above average  @  Average  O  Below average  NS  Not sufficient  data 
HMO ID #: H 3749  Enrollees  D~enrollees 
(N =  41)  (N=  39)
. 
Beneficii  Responsesto Key  All  This  %M.  Comp.  Au  This  %Diff.  Comp. 
fkrvey (&l@iOliS  by Catqory  EMos  HMo  E&K%  HMO 
H&U!JW  SCIWMWNG 
Was ~t  asked at application

about health problems,



excluding kidney failure and  63%  63%  o%  e  58%  78%  +20% 
homice care.  (717)  (z  (430)  (25)

Did know they could change 
their minds about enrolling  88%  87%  -1%  e  82%  82%  O%  03 
after they applied.  (1,078)  (32)  (611)  (28) 
Dld know,  from the 
beginning, they must be 
referred to a specialist by  89%  98%  +9%    84%  78%  -6%  @ 
their primary HMO doctors.  (1,444)  (39)  (852)  @5) 
Did know, from the 
beginning, they could only 
use HMO doctors and 
hospitals (except emergent 
care and urgent care outside  96%  100%  +4%    93%  94%  +1%  e 
the service area.)  (1,585)  (40)  (958)  (31) 
Did know they had the right 
o 
to appeal an HMOs  refusal  74%  76%  +2%  e  67%  48%  -19% 
to providelpay for services.  (1,113)  (28)  (523)  (11) 
For scheduled appointments

with primary HMO doctors,

USllldlyWilitd  km  than 13  85%  92%  +7%  e  82%  81%  -1%  (B

days.  (1,276)  (33)  (681)  (2$

109
  
Above average  @  Average  O  Below average  NS  Not sfilcient  data 
HMO ID #: H 3749  Enrollees  DEenrolleeS 
(N=  41)  (N =  39) 
Bene&iary Responsesto Key  Au  This  %Diff.  Comp.  Au  This  % Diff.  Comp, 
LJurveyQuestionsby Category  EMos  EMo  EMos  HMO 
For scheduled appointments 
with specialists, usually  81%  83%  +2%  e  75%  71%  -4%  @ 
Wtited less than 13 dilYS.  (970)  (20)  (477)  (15) 
When  very  sick, was able to 
get a doctors  appointment  93%  100%  +7%  e  89%  81%  -8%  @ 
within 1 to 2 &Ys.  (942)  (19)  (453)  (13) 
Usually waited less than 1 
hour in the office  to see  95%  100%  +5%  e  87%  84%  -3%  03 
primary HMO doctor.  (1,431)  (34)  (704)  (26) 
Consistently busy telephone 
lines dld ~t  hinder benes  90%  94%  +4%  e  89%  85%  -4%  e 
Primary HMO doctor never 
o 
failed to provide needed  96%  97%  +1%  e  88%  68%  -20% 
Medicare services.  (1,475)  (34)  (744)  (21) 
Primary HMO doctor never 
o 
failed to refer to a specialkt  96%  97%  +1%  @  88%  66%  -22% 
when needed.  (1,439)  (35)  (732)  (19) 
Di&t  feel the need to seek 
out-of-plan care,  excluding 
dental, routine eye,  and  93%  92%  -1%  @  86%  89%  +3%  e 
emergenthrgent  care.  (1,397)  (33)  (696)  (23) 
Medkal  care nxeived 
through the HMO cased 
beneficiaries  health to: 
o 
b  improve  53%  37%  -16%  41%  28%  -13%  @ 
(772)  (13)  (296)  (8) 
b  stay about the same  45%  54%  +9%  49%  48%  -1% 
@  e 
(649)  (19)  (383)  (14) 
b  worsen  2%  9%  +7%    10%  24%  + 14%   
(32)  (3)  (86)  m 
Primary HMO  doctor never

failed to take beneficiarys  88%  91%  +3%  e  76%  69%  -7%  e

health cornP1aintsSeIiOUSIY.  (1349)  (32)  (650)  (20)

110
 .  Above average  @  Average  o  Below average  NS  Not stilcient  data 
HMO ID #: H 3749  Enrollees  DMnroUees 
(N=  41)  (N=  39)
  . . .  . 
Benefkiary Respons~ to Key  Au  This  % mm.  Comp.  J&U  This  %Biff.  Comp. 
Survey Quealionsby Category  EMos  3JM0  lIMOs  HMO 
..  . .. .. 
Most important to primary 
HMO doctor was: 
b  giving the best 
medical care  86%  79%  -7%  o  72%  58%  -14%  e 
possible  (1,197)  (23)  (471)  (14) 
26% 
b	 holding down the  9%  17%  -M%  e  38%  + 12%  e 
cost of care  (120)  (5)  (162)  (9) 
Most important to the HMO 
was: 
b  giving the best 
o  .58%  44% 
medical care  74%  64%  -lo%  -14%  @ 
possible  (1,036)  w)  P87)  (12) 
b	 holding down the  15%  28%  +13%    36%  48%  +12%  e 
cost of care  (213)  (10)  (230)  (13) 
111
 U.S.  HEALTH  CARE  SYSTEMS  OF  P!3NNSYLVANIA 
hio.Enrollees: 20,354  Total No. Sampkd:  99  Total No. Respondents:  71 
.,  . 
Model ~ptx  IPA  For-Profit  Competitive
 
 
Above average  @  Average  O  Below avemge  NS  Not suftlcient  data 
HMO ID #: H 3931  Enrollees  Dkenrollees 
(N=  39)  (N = 32)
. 
Benetkiary Responsesto Key  Au  This  %Ditr.  Comp.  All  This  %DM.  Comp. 
&uvey @16tiOIIS by Catqory  EMos  HMO  mos  HMo 
HEALTH  SCREENING 
Was @  asked at application 
about health problems, 
 
excluding kidney failure and  63%  69%  +6%  e  58%  86%  +28% 
hospice care.  (717)  (11)  (430)  (12) 
Physical exam was n@  96%  91%  -5%  e  98%  100%  +2%  03 
Dld know they could change 
their minds about enrolling  88%  85%  -3%  e  82%  92%  + 10%  e 
afler they applied.  (1,078)  (17)  (611)  (11) 
Did know,  from the 
beginning, they must be 
referred to a specialist by  89%  92%  +3%  @  84%  93%  +9%  e 
their primary HMO doctors.  (1,444)  (34)  (852)  (26) 
Did know,  from the 
beginning, they could only 
use HMO  doctors and 
hospitals (except emergent 
care and urgent care outside  96%  95%  -1%  e3  93%  96%  +3%  @ 
the service area.)  (1,585)  (36)  (958)  (27) 
Dld know they had the right 
 
to appeal an HMOs  refusal  74%  77%  +3%  e  67%  91%  +24% 
to provide/pay  for services.  (1,113)  (27)  (523)  (19) 
For scheduled appointments

with primary HMO doctors,

usually waited less than 13  85%  100%  + 15%    82%  92%  + 10%  03

days.  (1,276)  (34)  (681)  (23)

112
  
Above average  @  Average  O  Below average  NS  Not sufllcient  data 
HMO ID #: H 3931  Enrollees  Dwnrollees 
  (N = 39)  (N = 32) 
Benelicii  Responsetao Key  Au  This  %Diff.  Comp.  Au  This  %Diff.  Comp. 
SIUVeyQuestionsby Category  EMos  HMo  HMos  HMo 
For scheduled appointments 
with specialists, usually  81%  90%  +9%  e  75%  86%  +11%  e 
Wtited km  than 13 &yS.  (970)  (26)  (477)  (18) 
When very sick, was able to 
get a doctors appointment  93%  100%  +7%  e  89%  94%  +5%  03 
within 1 to 2 days.  (942)  w)  (453)  (17) 
usually  waited less than 1 
hour in the office to see  95%  100%  +5%  e  87%  S3%  -4%  @ 
Pti  HMO doctor.  (1,431)  (33)  (704)  (20) 
Consistently busy telephone 
lines dld @  hinder benes  90%  M%  -2%  e  89%  100%  +11%  03 
making appointments.  (780)  (14)  (425)  (12) 
Primary HMO doctor never 
failed to provide needed  96%  97%  +1%  e  88%  88%  o%  e 
Medicare services.  (1,475)  (33)  (744)  (22) 
Primary HMO doctor never 
failed to refer to a specialist  96%  94%  -2%  e  88%  88%  o%  e 
when needed.  (1,439)  (32)  (732)  (21) 
Didnt feel the need to seek 
out-of-plan care, excluding 
dental, routine eye, and  93%  94%  +1%  e  86%  91%  +5%  e 
emergenthrgent  care.  (1,397)  (34)  (696)  (21) 
Medical cam received 
through the HMO caused 
beneficiaries  health to: 
b  improve  53%  68%  + 15%    41%  64%  +23%   
(772)  (296)  (16) 
b  stay about the same  45%  2?;  -16%  O  49%  36%  -13%  e
(649)  (lo)  (383)  (9) 
10%  o% 
b  worsen  -lo% 
(86)  (o)  @ 
Primary HMO doctor never

failed to take beneficiarys  88%  94%  +6%    76%  84%  +8%  e

health comphinta seriously.  (1349)  (34)  (650)  (21)

113
  
Above average  @  Average  O  .Belowaverage  NS  Not sufficient  data 
HMO ID #: H 3931  Enrollees  Dlsenrolkes 
(N = 39)  (N = 32)
. 
Beneticky  Responses to Key  AU  This  %DM.  Comp.  Ml  This  %Diff.  Comp. 
Smvey Questionsby Ca&gory  HMos  HMo  HtWos  HMO 
.. 
Most important to primary 
HMO doctor was: 
b  giving the best 
medical care  86%  86%  o%  e  72%  86%  + 14%  (J) 
possible  (1,197)  (24)  (471)  (19) 
b  holding down the  9%  7%  -2%  @  26%  9%  -17%  o 
cost of care  (120)  (2)  (162)  (2) 
Most important to the HMO 
was: 
b	 giving the best 
medical care  74%  69%  -5%  (1)  58%  78%  +20%   
possible  (1,036)  (22)  (387)  (19) 
b	 holding down the  15%  13%  -2%  36%  13%  -23%  o 
@ 
cost of care  (213)  (4)  (230)  (3) 
114
 HUM  ANA  HEALTH  PLAN  OF  TEXAS  . (CORPUS  CHRISTI) 
. 
No.Enrollees: 5,486  Total No. !knpkd:  95  Total No. Respondents:  54 
..  -
Model ~pe:  IPA  For-Profit  Non-Competitive
 
 
Above average  @  Average  0  Below average  NS  Not suftlcient  data 
HMOlD#H4504	 Enrollees  Disenrollees 
(N=  30)  (N =  24)
  .   
BenefkkuyReapometso Key  Au  m&  %m.  ~om~  .J$ll  This  %nW.  Comp. 
Survey QuestioILsby Category  EMos  HMo  HMos  HMo 
HEALTH  SCREENING 
. 
Wss ~t  asked at application 
about health problems, 
excluding kidney failure and  63%  47%  -16%  03  58%  41%  -17%  @ 
hospice care.  (717)  (9)  (430)  (?) 
Physical exam was n@  %%  93%  -3%  @  98%  96%  -2%  e 
required before joining.  (1,295)  (26)  (824)  (21) 
UVDERST@lMVG  OF HMOS 
Did know they could change 
their minds about enrolling  88%  87%  -1%  e  82%  95%  +13%  e 
after they applied.  (1,078)  (20)  (611)  (18) 
Did know,  from the 
beginning, they must be 
referred to a specialist by  89%  82%  -7%  @  84%  91%  +7%  e 
their primary HMO doctors.  (1,444)  w)  (852)  (21) 
Did know,  from the 
beginning, they could only 
use HMO doctors and 
hospitals (except emergent 
care and urgent care outside  96%  93%  -3%  @  93%  96%  +3%  e 
the service area.)  (1,585)  @m  (958)  w) 
Dld know they had the right 
to appeal an HMOs  refusal  74%  71%  -3%  e  67%  75%  +8%  e 
to providelpay  for services.  (1,113)  @)  (523)  (12) 
For scheduled appointments

with primary HMO doctors,

usually Wtited less than 13  85%  100%  + 15%    82%  100%  +18%  

davs.  (1,276)  (28)  (681)  @)

115
  
Above average  @  Average  O  Below average  NS  Not sufllcient  data 
HMO ID #: H 4504  Enrollees  Dknrollees 
  (N=  30)  (N=  24) 
BeneficiarRyespoasetso Key  An  nlk  %lxfr.  Comp.  All  This  %Biff.  Comp. 
Survey Queatioasby Category  HMos  HMo  mios  HMO 
For  scheduled appointments 
with specialists, usually  81%  82%  +1%  (13  75%  73%  -2%  @ 
waited less than 13 days.  (970)  (18)  ,(477)  (11) 
When very sick, was able to 
get a doctors  appointment  93%  96%  +3%  @  89%  88%  -1%  e 
within 1 to 2 davs.  (942)  (21)  (453)  (7) 
Usually  Wilitd  k-as  than 1 
o 
hour in the office  to see  95%  87%  -8%  87%  79%  -8%  03 
primary HMO doctor.  (1,431)  (26)  (704)  (15) 
Consistently busy telephone

lines dld ~t  hinder benes  90%  100%  + 10%  03  89%  100%  +11%  e

making appointments.  (780)  (15)  (425)  (11)

Primary HMO doctor never 
failed to provide needed  96%  100%  +4%    88%  90%  +2%  e 
Medkare  services.  (1,475)  (29)  (744)  (18) 
Primary HMO doctor never 
o 
failed to refer to a specialist  96%  86%  -lo%  88%  90%  +2%  e 
when needed.  (1,439)  (25)  (732)  (17) 
Didnt feel the need to seek 
out-of-plan care,  excluding 
dental, routine eye, and  93%  93%  o%  e  86%  79%  -7%  @ 
emergentlurgent care.  (1,397)  W)  (696)  (15) 
Medical care received 
through the HMO caused 
beneficiaries  health to: 
b  impmve  53%  48%  -5%  e  41%  28%  -13%  03 
Q%) 
49%  6?%  + 12%  ~ 
(383)  (11) 
10%  11% 
+1% 
(86)  (2)  e 
Primary HMO doctor never

failed to take beneficiarys  88%  90%  +2%  @  76%  75%  -1%  @

health co~hinta  seriously.  (1349)  (26)  (650)  (15)

116
 .  Above average  @  Average  O  Below average  NS  Not stilcient  data 
HMO ID#:H4504  Enrollees  Dlsenrollees 
(N = 30)  (N =24) 
Beneficiary Reapoasesto Key  Au  Ink  %Diff.  Comp.  Au  This  %Diff.  Comp. 
Smvey Queatioasby Category  HMos  HMo  EIWos  IIIWo 
Most important to primary 
HMO doctor was: 
b  giving the best 
medical care  86%  85%  -1%  03  72%  77%  +5%  e 
possible  (1,197)  (23)  (471)  (lo) 
b  holding down the  9%  7%  -2%  @  26%  23%  -3%  @ 
cost of care  (120)  Q)  (162)  (3) 
Most important to the HMO 
was: 
b  giving the best 
medical care  74%  89%  + 15%    58%  69%  + 11%  e 
possible  (1,036)  (23)  (387)  (9) 
F	 holding down the  15%  8%  -7%  @  36%  31% -5% e 
cost of care  (213)  Q)  (230)  (4) 
117
 HUM  ANA  HEALTH  PLAN  OF  TEXAS  (SAN  ANTONIO) 
. 
No. Enrollees:  9,584  Total No. Sampled: 98 
Model ~pe:  IPA  For-Profit 
-= 
 
Above average  @  Average  O  Below average  NS  Not suftlcient  data 
HMO ID #: H 4510	 Enrollees  Dwnrollees 
(N =23)  (N =  19) 
BeneficiarRyesponsato Key  All  This  %Diff.  Comp.  Au  n&  %m.  Comp. 
%uvey Qoeationsby Category  HMos  HMo  HMos  HMO 
Was at  asked at application 
about health problems, 
o 
excluding kidney failure and  63%  40%  -23%  58%  NS 
hospice care.  (717)  (6)  (430) 
Physical exam was @  96%  100%  +4%  e  98%  NS 
Dld know they could change 
their minds about enrolling  88%  89%  +1%  @  82%  NS 
after they applied.  (1,078)  (16)  (611) 
Did know,  from the 
beginning, they must be  NS 
o 
referred to a specialist by  89%  73%  -16%  84% 
their mimarv HMO doctors.  (1,444)  (16)  (852) 
Did know,  from the 
beginning, they could only 
use HMO doctors and 
hospitals (except emergent 
o 
care and urgent care outside  96%  91%  -5%  93%  NS 
the service area.)  (1,585)  (20)  (958) 
Did know they had the right 
o 
to appeal an HMOs  refusal  74%  63%  -11%  67%  NS 
LOprovidelpay for services.  (1,113)  (12)  (523) 
For scheduled appointments 
with primary HMO doctors, 
o 
usually WSited less than 13  85%  70%  -15%  82%  NS 
days.  (1,276)  (14)  (681) 
118
  
Above average  @  Average  O  IMOWaverage  NS  Not suffkient  data 
HMO ID #: H 4510  Enrollees  Dwnrollees 
(N=  23)  (N =  19)
.. 
Beneficiary Responsesto Key  All  This  %DitY.  Comp.  An  This  %Diff.  Comp. 
&uvey Questionsby Category  lnW)s  HMO  WW3s  131Wo 
For  scheduled appointments 
with specialists, usually  81%  71%  -lo%  @  75%  NS 
waited less than 13 davs.  (970)  (12)  (477) 
When very sick, was able to 
get a doctors  appointment  93%  85%  -8%  e  89%  NS 
within 1 to 2 davs.  (942)  (11)  (453) 
Usually  Wtittd  kss  than 1 
o 
hour in the office to see  95%  85%  -lo%  87%  NS 
Dnrnarv  HMO doctor.  (1,431)  (17)  (704) 
Consistently busy telephone 
lines did Wt hinder bones  90%  56%  -34%  o  89%  NS 
Primary HMO doctor never 
failed to provide needed  96%  94%  -2%  (B  88%  NS 
Medicare services.  (1,475)  (17)  (744) 
Primary HMO doctor never 
failed to refer to a specidlst  96%  100%  +4%    88%  NS 
when needed.  (1,439)  (17)  (732) 
Didnt feel the need to seek 
out-of-plan care, excluding 
o 
dental, routine eye, and  93%  89%  -4%  86%  NS 
emergent/urgent care.  (1,397)  (16)  (696) 
Medical care received 
through the HMO caused 
beneficiaries  health to: 
b  impmve  53%  78%  +25%  o  41%  NS 
(772)  (14)  (296) 
b  stay about the same  45%  22%  -23%  o  49%  NS 
(649)  (4)  (383) 
b  worsen  2%  o%  -2%  10%  NS 
(32)  (0)  @  (86) 
Primary HMO doctor never

o 
failed to take beneficiarys  88%  81%  -7%  76%  NS

health COrn@3intS  seriously.  (1349)  (17)  (650)

119
  
Above average  @  Average  O  Below  average  NS  Not sulllcient  data 
HMO  ID #: H 451O  Enrollees  DKenrollees 
 
(N =23)  (N =  19)
 
BeneficiarRyespoasetso Key  Au  This  %Diff.  Comp.  Au  Illis  %Diff.  Comp. 
Survey Questionsby Catego~  QWOS  HMO  mvios  HMO 
. .. ..  -----
Most  important to primary 
HMO doctor was: 
b  giving  the best 
medical care  86%  88%  +2%  03  72%  NS 
possible  (1,197)  (15)  [471) 
b  holding down the  9%  12%  +3%  ~~%  NS
e 
cost of care  (120)  (2)  (162) 
Most important to the HMO 
was: 
b  giving the best 
o 
medkal care  74%  53%  -21%  58%  NS 
possible  (1,036)  (9)  (387) 
b  holding down the  15%  35%  +20%    36%  NS 
cost of care  (213)  (6)  (,230) 
120
 PA  CIFICARE  OF  TEXAS 
No. Enrollees:  16,833  Total No. fkwnpkd: 98  Total No. Respondents:  54 
Model ~pe:  IPA  For-Profit  Competitive 
 
Above average  @  Average  O  Below average  NS  Not sufllcient  data 
HMO ID #: H 4590	 Enrollees  Dkenrolkws 
(N = 34)  (N = 20) 
BeneficiarRyeaponseato Key  AU  This  %DM.  Comp.  Au  This  %LW.  Comp. 
tkrvey Questionsby Catqory  EMos  HMO  HIWos  HMO 
HEUTH  SCRIUW.NG 
Was p@ afdcedat application 
about health problems, 
excluding kidney failure and  63%  69%  +6%  @  58%  53%  -5%  e 
hospice care.  (717)  (20)  (430)  (8) 
Physical exam was n- 96%  100%  +4%  03  98%  100%  +2%  e 
required befo~  joining.  (1,295)  (31)  (824)  (19) 
Did know they could change 
their minds about enrolling  88%  97%  +9%    82%  82%  O%  @ 
after they applied.  (1,078)  (28)  (611)  (14) 
Did know,  from the 
beginning, they must be 
referred to a specialist by  89%  94%  +5%  @  M%  100%  + 16%   
their primary HMO doctors.  (1,444)  (31)  (852)  (17) 
Did know,  from the 
beginning, they could only 
use HMO doctors and 
hospitals (except emergent 
care and urgent care outside  %%  100%  +4%    93%  100%  +7%  @ 
the service area.)  (1,585)  (34)  (958)  (19) 
Did know they had the right 
to appeal an HMOs  &usal  74%  81%  +7%  e  67%  89%  +22%   
to providelpay  for services.  (1,113)  (25)  (523)  (8) 
For scheduled appointments

with primary HMO doctors,

usually WSiti  kss  than 13  85%  87%  +2%  @  82%  75%  -7%  e

days.  (1,276)  W)  (681)  (9)

121
  
Above average  @  Average  O  Below average  NS  Not suftlcient  data 
HMOlD#H4590  Enrollees  Dkenrolks 
  (N = 34)  (N = 20) 
Beneficiary Reaponseato Key  All  This  %Biff.  Comp.  Au  This  % Dim.  Comp. 
&wvey Qoestionsby Category  HMos  HMo  EMos  IIIWo 
For  scheduled appointments 
with specialists, usually  81%  87%  +6%  e  75%  71%  -4%  e 
waited less than 13 davs.  (970)  (20)  (477)  (5) 
When very sick, was able to 
o 
get a doctors  appointment  93%  100%  +7%  e  89%  71%  -18% 
within 1 to 2 davs.  (942)  (14)  (453)  (5) 
usually  waited less than 1 
hour in the office  to see  95%  97%  +2%  e  87%  82%  -5%  e 
primary HMO doctor.  (1,431)  (28)  (704)  (9) 
Consistently busy telephone 
lines did ~t  binder benes  90%  100%  + 10%  @  89%  83%  -6%  (B 
Primary HMO doctor never 
failed to provide needed  96%  97%  +1%  e  88%  82%  -6%  @ 
Medkare  services.  (1,475)  (28)  (744)  (9) 
primary HMO doctor never 
failed to refer to a specialht  96%  97%  +1%  @  88%  91%  +3%  e 
when needed.  (1,439)  (29)  (732)  (lo) 
Didnt feel the need to seek 
out-of-plan care, excluding 
dental, routine eye, and  93%  93%  o%  @  86%  83%  -3%  (I3 
emergentfurgent care.  (1,397)  (26)  (696)  (10) 
Medical care received 
through the HMO caused 
beneficiaries  health to: 
b  improve  53%  64%  +11%  	 41%  83%  +42%   
(2%)  (lo) 
49%  17%  -32%  o
(383)  (2) 
10%  o% 
b  worsen  -lo% 
(86)  (o)  @ 
Primary HMO doctor never

failed to take beneficiarys  88%  87%  -1%  @  76%  67%  -9%  @

health complaints seriously.  (1349)  W)  (650)  (8)

122
 .  Above average  03  Average  O  Below mwrage  NS  Not suffkient  data 
HMO ID#H4590  Enrollees  Dlsenrolk?s 
(N = 34)  (N=  20)
.. 
Beneficiary Reapoasesto Key  Au  Tbk  %Diff.  Comp.  All  This  %Diff.  Comp. 
Survey Questionsby Category  HMos  HMo  IitRlos  HMo 
,   
Most important to primary 
HMO doctor was: 
b  giving the best 
medical care  86%  72%  -14%  o  72%  91%  + 19%   
possible  (1,197)  (18)  (471)  (lo) 
b	 holding down the  9%  12%  +3%  e  26%  9%  -17%  o 
cost of care  (120)  (3)  (162)  (1) 
Most important to the HMO 
was: 
b  giving the best 
 
medkal  care  74%  65%  -9%  @  58%  90%  +32% 
possible  (1,036)  (17)  (387)  (9) 
b	 holding down the  15%  23%  +8%    36%  10%  -26%  o 
cost  of care  (213)  (6)  (230)  (1) 
123
 SE  NTARA  HEALTH  PLANS_  (VA) 
No. Enrollees: 259  Total No. &unpkd:  54 
Model @pe: Staff  For-Profit 
E-e 
.  Ahove average  @  Average  O  Below average  NS  Not suftlcient  data 
HMO ID #: H 4949  Enrollees  Dkenrollees 
(N=  44)  (N =3)
. 
BeneficiarRy eapoasetao Key  Au  This  %Diff.  Comp.  Au  This  % DW.  Comp. 
&uvey Queafioasby Category  EMos  HMO  IIMOS  HMo 
Was ~t  asked at application

about health problems,

o 
excluding kidney failure and  63%  17%  -46%  58%  67%  +9%  e

homice  care.  (717)  (6)  (430)  0

Did know they could change 
their minds about enrolling  88%  94%  +6%  e  82%  100%  + 18%   
after they applied.  (1,078)  (31)  (611)  (3) 
Did know, from the 
beginning, they must be 
referred to a specidlst  by  89%  98%  +9%    84%  100%  + 16%   
their urimarv HMO doctors.  (1,444)  (43)  (852)  (3) 
Did know,  from the 
beginning, they could only 
use HMO doctors and 
hospitals (except emergent 
care and urgent care outside  96%  100%  +4%    93%  100%  +7%  e 
the serviee area.)  (1,585)  (43)  (958)  (3) 
Did know they had the right 
to appeal an HMOs  ret%sal  74%  81%  +7%  e  67%  100%  +33%   
to providelpay  for services.  (1,113)  (33)  (523)  (3) 
For scheduled appointment

with primary HMO doctors,

usually waited less than 13  85%  83%  -2%  e  82%  100%  + 18%  

davs.  (1,276)  W)  (681)  @

124
 .  Above average  @  Average  O  Below average  NS  Not sufficient  data 
HMO ID #: H 4949  Enrollees  Dwnrolleea 
	 (N =44)  (N =3)
. 
JknefiiaryReapoawtso Key  Au  This  %mff.  Comp.  All  This  %DilY.  Comp. 
Wey  Queatioasby Category  EMos  HMO  laws  HMO 
 
For scheduled appointments 
with specialists, usually  81%  85%  +4%  e  75%  100%  +25%   
waited less than 13 days.  (970)  (29)  {477)  (3) 
When very sick, was able to 
get a doctors  appointment  93%  91%  -2%  e  89%  100%  + 11%  e 
within 1 to 2 days.  (942)  (21)  (453)  (1) 
usually  waited less than 1 
 
hour in the office  to see  95%  95%  o%  @  87%  100%  +13% 
primary HMO doctor.  (1,431)  (40)  (704)  (3) 
Primary HMO doctor never 
 
failed to provide needed  96%  93%  -3%  e  88%  100%  + 12% 
Medkare  services.  (1,475)  (40)  (744)  (3) 
Primary HMO doctor never 
 
failed to refer to a specialist  96%  95%  -1%  e  88%  100%  +12% 
when needed.  (1,439)  (38)  (732)  (3) 
Didnt feel the need to seek 
out-of-plan care, excludiig 
dental, routine eye, and  93%  88%  -5%  o  86%  100%  + 14%   
emergentiurgent care.  (1,397)  (38)  (696)  (3) 
Medical care wived 
through the HMO  caused 
beneficiaries  health  to: 
b  improve  53%  35%  -18%  0	 41%  33%  -8%  @ 
(2%)  (1) 
49%  67%  + 18%  
(383)  (2) 
10% 
NS 
(86) 
Primary HMO doctor never

failed to take beneficiarys  88%  95%  +7%    76%  67%  -9%  @

health complaints seriously.  (1349)  (39)  (650)  (2)

125
   o 
Above average  @  Average  Below average  NS  Not sufilcient  data 
HMO ID #: H 4949  Enrollees  DisenroUees 
(N=  44)  (N =3)
.. 
Beneficiary Reapoaseato Key  Au  This  %Diff.  Comp.  All  This  % Diff.  Comp. 
Survey Queatioasby Category  mos  HMO  Jlnlos  HMO 
.. 
Most important to primary 
HMO doctor was: 
b  giving the best 
o 
medical care  86%  90%  +4%  e  72%  33%  -39% 
possible  (1,197)  (34)  (471)  (1) 
	 holding down the  9%  3%  -6%  o  26%  67%  +41%   
cost of care  (120)  (1)  (162)  (2) 
Most important to the HMO 
was: 
b  giving the best 
o 
medical care  74%  76%  +2%  e  58%  33%  -25% 
possible  (1,036)  (28)  (387)  (1) 
b	 holding down the  15%  16%  +1%  36%  67%  +31%   
(B 
cost of care  (213)  (6)  (230)  @ 
126
 NETWORK  HEALTH  PLAN  (WA) 
No. Enrollees:  12,136  Total No. &Ullpkd: 99  Total No. Respondents:  S4 
Model ~pe:  IPA  For-Profit  Competitive 
 
Above average  @  Average  O  Below average  NS  Not suftlcient  data 
HMO ID#H5005  Enrollees  DMenrolkes 
(N=  43)  (N =  41) 
Ben&.iarYReaponsetao Key  Au  rllis  %mff.  Comp.  Au  Tllk  %Diff.  Comp. 
Sbrvey Questionsby Category  HMos  HMo  Jmlos  HMo 
H..TH  SC.UJW%WW 
Was at  asked at application 
about health problems, 
excluding kidney failure and  63%  80%  + 17%  @  58%  85%  +27%   
hospice care.  (717)  (-0  (430)  (28) 
Physical exam was n@  96%  100%  +4%  @  98%  100%  +2%  e 
required before joining.  (1,295)  (19)  (824)  (37) 
Did know they could chaoge 
their minds about enrolling  88%  97%  +9%  e  82%  88%  +6%  @ 
after they applied.  (1,078)  (lo)  (611)  (30) 
Dld know,  from the 
beginning, they must be 
referred to a specialist by  89%  86%  -3%  e  84%  95%  +11%   
their primary HMO doctors.  (1,444)  (28)  (852)  W) 
Did know,  from the 
beginning,they wuld  only 
use HMO doctors and 
hospitals (except emergent 
:are and urgent care outside  96%  95%  -1%  e  93%  97%  +4%  e 
the service area.)  (1,585)  (37)  (958)  (38) 
Did know they had the right 
to appeal an HMOs  refhsal  74%  82%  +8%    67%  81%  + 14%  @ 
to providelpay  for services.  (1,113)  @o)  (523)  (.26) 
For scheduled appointments 
with primary HMO doctors, 
.L9Uallywaited less than 13  85%  97%  + 12%  @  82%  97%  + 15%  (B 
tiys.  (1,276)  (28)  (681)  (34) 
127
  
Above average  @  Average  O  Below average  NS  Not suftlcient  data 
HMO ID #: H 5005  Enrollees  DEenrollees 
(N =43)  (N =  41) 
.. 
BeneficiarRy eaponsetao Key  All  This  %Wf.  Comp.  All  This  %m.  Comp. 
fkrvey Questionsby Category  EMos  HMO  mios  HMO 
For scheduled appointments 
with specialists, usually  81%  94%  +13%    75%  97%  +22%   
waited less than 13 &yS.  (970)  (28)  [.4-77)  (29) 
, 
When very sick, was able to 
get a doctors  appointment  93%  100%  +7%  @  89%  96%  +7%  e 
within 1 to 2 days.  (942)  (31)  (453)  (22) 
Usually waited less than 1 
hour in the office  to see  95%  100%  +5%  @  87%  91%  +4%  (13 
primary HMO doctor.  (1,431)  (40)  (704)  (31) 
Consistently busy telephone

lines did ~t  hinder benes  90%  94%  +4%  @  89%  94%  +5%  e

making appointments.  (780)  (15)  (425)  (16)

Primary HMO doctor never 
failed to provide needed  96%  95%  -1%  e  M%  95%  +7%  e 
Me&are  services.  (1,475)  (36)  (744)  (36) 
Primary HMO doctor never 
failed to refer to a specialist  96%  95%  -1%  e  88%  92%  +4%  e 
when needed.  (1,439)  (38)  (732)  (35) 
out-of-plan care, excluding 
dental, routine eye, and  93%  90%  -3%  @  86%  89%  +3%  @ 
emergent.lurgentcare.  (1,397)  (35)  (696)  (33) 
Medkal  care received 
through the HMO caused 
beneficiaries  health to: 
b  improve  53%  55%  +2%  @  41%  39%  -2%  03 
(772)  (-24)  (296)  (12) 
b  stay about the same  45%  45%  ()%  49%  55%  +6%  @ 
e 
(649)  (13)  (383)  (17) 
2%  0%  10%  7% 
b  worsen  -2%  -3% 
(32)  (o)  e  (86)  (3  @ 
Primary HMO doctor never

failed to take beneficiarys  88%  92%  +4%  e  76%  89%  +13%  

health conqdaints seriously.  (1349)  (35)  (650)  (32)

128
 .  Above average  @  Average  O  Below average  NS  Not suffkient  data 
HMO ID#H5005  Enrollees  Dlsenrollees 
(N =43)  (N =  41)
--- 
Beneficii  Respometso Key  All  This  %Diff.  Comp.  AN  This  %M.  Comp. 
Survsy Questionsby Category  HMos  HMO  mu% HMO 
-  .. 
Most important to primary 
HMO doctor was: 
b  giving the best 
medical care  86%  90%  +4%  e  72%  78%  +6%  03 
possible  (1,197)  (33)  (471)  (23 
b  holding down the  9%  5%  Af%  26%  16%  -lo%  @ 
03 
(120)  (3)  (162)  (5) 
cost of care 
. 
Most important to the HMO 
was: 
b  giving  the best 
o 
medical care  74%  64%  -lo%  58%  61%  +3%  @ 
possible  (1,036)  (26)  (387)  (19) 
b  holding down the  15%  22%  +7%  e  36%  23%  -13%  ~ 
cost of care  (213)  (6)  (230)  m 
129
 GROUP  HEALTH  CO-OP  OF  PtJGET  SOUND  (WA) 
No. Enrollees: 43,585  Total No. %unpkk  98 
Model &pe: Staff  Not For-Profit 
:  --:= 
 
Above average  @  Average  ~  Below average.  NS  Not sufficient  data 
HMO ID #: H 5050	 Enrollees  Dkenrollees 
(N=36)  (N =  32) 
BeneficiarRy esponsetso Key  Au  This  %Dilr.  Comp.  Au  This  %DitT.  Comp. 
&uvey  @leStiOIIS  by Catqory  EMos  HMO  HMOS  HMO 
Was @  asked at application 
about health problems, 
o 
excluding kidney failure and  63%  32%  -31%  58%  46%  -12%  (B 
hospice care.  (717)  (6)  (430)  (6) 
Physid  exam  was n!@  96%  81%  -15%  o  98%  100%  +2%  @ 
Did know they could change 
o   
their minds about enrolling  88%  79%  -9%  82%  100%  + 18% 
after they applied.  (1,078)  (11)  (611)  (12) 
Did know,  from the 
beginning, they must be 
o  84% 
referred to a specialist by  89%  81%  -8%  75%  -9%  @ 
their DrimarvHMO doctors.  (1,444)  (26)  (852)  (21) 
Did know,  fmm the 
beginning, they could only 
use HMO doctors and 
hospitals (except emergent 
care and urgent care outside  96%  97%  +1%  @  93%  93%  o%  @ 
the service area.)  (1,585)  (34)  (958)  (26) 
Did know they had the right 
to appeal an HMOs  refusal  74%  61%  -13%  o  67%  64%  -3%  e 
to providelpay  for servicxw.  (1,113)  (19)  (523)  (18) 
For scheduled appointments

with primary HMO doctors,

usually waited less than 13  85%  82%  -3%  e  82%  81%  -1%  e

days.  (1,276)  W)  (681)  (26)

130
  
Above average  @  Average  O  Below  average  NS  Not  suffkient  data 
HMO ID #: H 5050  Enrollees  Dkenrollees 
(N =36)  (N = 32) 
Beneficky Responsetso Key  All  This  %mfr.  Comp.  All  This  %DiH.  Comp. 
Survey QIKstionsby Categoq  EMos  HMO  lmos  HMo 
. 
For scheduled appointments 
with specialists, usually  81%  48%  -33%  o  75%  89%  + 14%  @ 
waited less than 13 days.  (970)  (14)  (477)  (23) 
When very sick, was able to 
get a doctors  appointment  93%  100%  +7%  e  89%  82%  -7%  @ 
within 1 to 2 days.  (942)  (26)  (453)  (22) 
Usually waited less than 1 
hour in the office  to see  95%  100%  +5%  e  87%  100%  +13%   
primary HMO doctor.  (1,431)  (31)  (704)  (29) 
Consistently busy telephone 
lines did ~t  hinder benes  90%  96%  +6%  Q1  89%  100%  +11%  e 
making appointment.  (780)  (22)  (425)  (21) 
LwwwxS 
Primary HMO doctor never 
failed to provide needed  96%  100%  +4%    88%  90%  +2%  e 
Medicare services.  (1,475)  (32)  (744)  (26) 
Primary HMO doctor never 
failed to refer to a specialist  96%  94%  -2%  @  88%  81%  -7%  e 
when needed.  (1,439)  (32)  (732)  (26) 
Didnt feel the need to seek 
out-of-plan care, excluding 
dental, routine eye, and  93%  97%  +4%    86%  83%  -3%  @ 
emergentlurgent care.  (1,397)  (31)  (696)  (24) 
Medkal  care received 
through the HMO caused 
beneficiaries  health to: 
b  improve	 53%  58%  +5%  @  41%  56%  +15%  e 
(772)  (18)  (296)  (15) 
b  stay about the same	 45%  39%  ~%  49%  ti%  -23%  o
e 
(649)  (12)  (383)
b 
2%  3%  10%  1P% 
women	 +1%  +9%
(32)  (1)  @  (86)  (5)  @ 
Primary HMO doctor never

o 
failed to take beneficiarys  88%  75%  -13%  76%  69%  -7%  @

health compkinta  seriously.  (1349)  (-24)  (650)  (22)

131
 .  Above average  @  Average  O  Below mwmgF  NS  Not sufllcient  data 
HMO ID #: H 5050  Enrollees  DMenrollees 
(N=  36)  (N = 32)
..-.  
BeneficiarRy eapoasetso Key  All  lllis  %JXfK  Comp.  AU  This  %Diff.  Comp. 
Survey QIWStioasby Category  HMos  HMO  HMOS  HMO 
.... 
Most important to primary 
HMO doctor was: 
b  giving  the best 
medical  care  86%  94%  +8%  e  72%  83%  +11%  e 
possible  (1,197)  p 1)  [47i)  (20) 
b  holding down the  9%  6%  -3%  26%  17%  -9%
e e 
cost of care  (120)  @  (162)  (4) 
Most important to the HMO 
was: 
b  giving  the best 
medical care  74%  87%  +13%    58%  76%  + 18%   
possible  (1,036)  (W  (387)  (22) 
b	 holding down the  15%  3%  -12%  o  36%  21%  -15%  e 
cost  of care  (213)  (1)  (230)  (6) 
132
 .  Above average  @  Average  O  Below average  NS  Not suftlcient  data 
HMO ID #: H 9016  Enrollees  DMenrollees 
(N = 29)  (N=  30)
 
Beneficii  Respoasetso Key  Au  This  %Diff.  Comp.  Au  Ill&  %DifF.  Comp. 
Survey Questionsby Category  EMos  HMO  lmios  Info 
For scheduled appointments 
o 
with specialists, usually  81%  73%  -8%  e  75%  47%  -28% 
waited less than 13 days.  (970)  (16)  (477)  (7) 
When very sick, was able to 
o 
get a doctors  appointment  93%  92%  -1%  e  89%  56%  -33% 
within 1 to 2 days.  (942)  (12)  (453)  ($ 
Usually Wtited less than 1 
o  o 
hour in the office  to see  95%  84%  -11%  87%  70%  -17% 
primary HMO doctor.  (1,431)  (21)  (704)  (16) 
Consistently busy telephone 
o
mlineas dkidi gn@g hinder benes  90%  85%  -5%  e  89%  53%  -36% 
appointments. (780)  (11)  (42S)  (8) 
Primary HMO doctor never 
o 
failed to provide needed  96%  100%  +4%  e  88%  70%  -18% 
Medicare services.  (1,47s)  (22)  (744)  (14) 
primary HMO doctor never 
o 
failed to refer to a specialist  96%  81%  -15%  88%  67%  -21%  o 
when needed.  (1,439)  (17)  (732)  (14) 
Didntfeel the need to seek 
out-of-plan care, excluding

dental, routine eye, and  93%  94%  +1%  03  86%  80%  -6%  @

emergentiurgent care.  (1,397)  (17)  (696)  (16)

Medical care received

through the HMO caused

beneficiaries  health to:

b  improve  53%  60%  +7%  03  41%  32%  -9%  e 
@96) 
49%  em%  -3% 
e 
(383)  (lo) 
10%  23% 
+13%   
(86)  (5) 
Primary HMO doctor never

failed to take beneficiarys  88%  7R%  .Ina  n  lkcz  Le w.  1107.  m

132
 .  Above average  @  Average  O  Below  average  NS  Not  sufficient  data 
HMO ID #: H 9016  Enrollees  DMenrolkes 
(N=  29)  (N = 30) 
BenefickuyResponsetso Key  Au  This  %Diff.  Comp.  Ml  This  % Diff.  Comp. 
&uvey  @KStiOIIS  by CatqoIY  HMos  HMO  Wos  HMO 
.-
Most important to primary 
HMO doctor was: 
b  giving the best 
medkal  care  86%  85%  -1%  @  72%  38%  -34%  o 
possible  (1,197)  (17)  (471)  (6) 
b	 holding down the  9%  10%  +1%  26%  63%  +37%   
e 
cost of care  (120)  Q)  (162)  (lo) 
Most important to the HMO 
Wm: 
b  giving the best 
o 
medkal  care  74%  60%  -14%  58%  42%  -16%  @ 
possible  (1,036)  (12)  (387)  (8) 
b	 holding down the  15%  25%  +10%  g  36%  58%  +22%   
cost of care  (213)  (5)  (230)  (11) 
135
 QUA  L-MED  CALIFORNIA  %  A  LLI!YPLAN 
---
No. Enrok!es:  7,143  Total No. Sampled  99 
:~1 
Model ~~.  Group  For-Profit 
o 
.  Above average  @  Average  Below average  NS  Not suftlcient  data 
HMO ID #  H 9037  Enrollees  DMenrollees 
(N = 41)  (N = 34)
.  ..  ... 
BeneficiarRy eapoasetso Key  Au  This  %DifK  camp.  All  This  %mff.  Comp. 
Survey Quealionsby Category  EMos  HMO  mms  HMO 
Was ~t  asked at application 
about health problems, 
excludiig  kidney failure and  63%  59%  -4%  e  58%  68%  + 10%  (B 
hospice care.  (717)  (19)  (430)  (15) 
Physical exam was n- 96%  92%  -4%  @  98%  100%  +2%  @ 
required before joining.  (1,295)  (33)  (824)  (29) 
UWJERSTX/WJl/?@ U#IiMOS 
Did know they could change 
o 
their minds about enrolling  88%  93%  +5%  e  82%  67%  -15% 
after they applied.  (1,078)  (28)  (611)  (16) 
Did know,  from the 
beginning, they must be 
referred to a specialist by  89%  92%  +3%  e  84%  86%  +2%  e 
their urimary HMO doctors.  (1,444)  (36)  (852)  (25) 
Did know,  from the 
beginning, they could only 
use HMO doctors and 
hospitals (except emergent 
care and urgent care outside  96%  97%  +1%  (B  93%  93%  o%  e 
the service  area.)  (1,585)  (38)  (958)  (26) 
Did know they had the right 
to appeal an HMOs  rei%aal  74%  74%  o%  e  67%  59%  -8%  @ 
to providelpay  for services.  (1,113)  (28)  (523)  (13) 
For scheduled appointments

with primary HMO doctors,

usually waited less than 13  85%  92%  +7%  (B  82%  89%  +7%  @

days.  (1,276)  (34)  (681)  @)

136
   o 
Above average  @  Average  Below average  NS  Not stilcient  data 
HMO  ID #: H 9037  Enrollees  Dnenrolkes 
(N=  41)  (N = 34)
... 
Beneticii  Reapooaetso Key  Au  This  %Diff.  Comp.  All  This  %Diff.  Comp. 
Survey Questionsby Catego~  HMos  Imo  mos  HMO 
For scheduled appointments 
with specialists, usually  81%  93%  + 12%  @  75%  88%  +13%  @ 
waited less than 13 days.  (970)  (28)  {477)  (15) 
When very sick, was able to 
get a doctors  appointment  93%  91%  -2%  63  $9%  94%  +5%  @ 
within 1 to 2 days.  (942)  (21)  (453)  (16) 
usually  waited leas than 1 
hour in the office  to see  95%  100%  +5%  @  87%  92%  +5%  e 
primary  HMO  doctor.  (1,431)  (36)  (704)  (-22) 
Consistently busy telephone 
limesdld ~t  hinder benes  90%  100%  + 10%  @  89%  100%  +11%  e 
Primary HMO doctor never 
failed to provide needed  96%  100%  +4%    88%  91%  +3%  (B 
Me&care  services.  (1,475)  (38)  (n4)  (20) 
Primary HMO doctor never 
failed to refer to a specialist  96%  100%  +4%    88%  91%  +3%  e 
when needed.  (1,439)  (38)  (732)  (21) 
Didnt feel the need to seek 
out-of-plan care, excluding 
dental, routine eye, and  93%  97%  +4%    86%  83%  -3%  e 
emergenthrgent  care.  (1,397,)  (36)  (696)  (19) 
Medical care received 
through the HMO caused 
beneficiaries  health to: 
b  improve  53%  50%  -3%  e  41%  47%  +6%  @ 
(772)  (1s)  (296)  (8) 
b  stay about the same  45%  50%  +5%  e  49%  47%  -2%  e 
(649)  (18)  (383)  (8) 
b  worsen  2%  o%  -2%  10%  6%  ~% 
(32)  (o)  @  (S6)  (1)  e 
Primwy HMO  doctor never

failed to take beneficiarys  88%  92%  +4%  e  76%  82%  +6%  e

health complaints seriously.  (1349)  (34)  (650)  (18)

137
 .  Above average  @  Average  O  Below average  NS  Not stilcient  data 
HMO ID#H9037  Enrollees  Dkenrollees 
  (N =  41)  (N=  34) 
BeneficiarRy eapoasetao Key  An  This  %Diff.  Comp.  AM  This  %Diff.  Comp. 
Survey Queatioasby Category  HMos  HMO  IWlos  HMo 
.... .. 
Most important to primary 
HMO doctor was: 
b  giving the best 
medical care  S6%  85%  -1%  e  -72%  63%  -9%  e 
possible  (1,197)  (28)  {471)  (lo) 
b	 holding down the  9%  6%  -3%  e  26%  19%  -7%  @ 
cost of care  (120)  (2)  (162)  (3) 
Most important to the HMO 
was: 
b  giving the best 
medical care  74%  77%  +3%  (B  58%  39%  -19%  o 
possible  (1,036)  (2?  (387)  (T 
b  holding down the  15%  9%  -6%  o  36%  50%  + 14%  (e 
cost of care  (-213)  (3)  (230)  (9) 
138
 SHARE  HEALTH  PLAN  OF  ILLINOIS 
No. Enrollees: 30,518  Total No. !knpkd:  100  Total No. Respondents:  78 
Model ~pe:  IPA  Fo@rofit  Competitive 
. 
 
Above average  @  Average  O  Below average  NS  Not sufficient  data 
HMo  ID #  9045	 Enrolleea  Disenrcdkes 
(N=44)  (N = 34) 
Bem&imyResponsetso Key  All  This  %Diff.  Comp.  An  This  %Ditr.  Comp. 
Survey Qll@iOIM  by Ca@ory  EMos  EMo  IJMos  EMo 
JW&#XIW  S@EEA?kVG 
Was p@ asked at application 
about health problems, 
excluding kidney failure and  63%  77%  + 14%  e  58%  55%  -3%  e 
hospice care.  (717)  (23)  (430)  (11) 
Physical exam was @  96%  95%  -1%  e  98%  100%  +2%  @ 
required before joining.  (1,295)  (39)  (S24)  (27) 
UNIZ?JRiSp!lXi??G  @FllM@ 
Did know they could change 
their minds about enrolling  88%  85%  -3%  e  82%  86%  +4%  e 
after they applied.  (1,078)  (-29)  (611)  (18) 
Did know,  from the 
beginning, they must be 
referred to a specialist by  89%  83%  -6%  03  84%  82%  -2%  @ 
their primary HMO doctors.  (1,444)  (34)  (S52)  (z) 
Did know,  from the 
beginning, they could only 
use HMO doctom and 
hospitals (except emergent 
o 
care and urgent care outside  96%  86%  -lo%  93%  93%  o%  @ 
the service area.)  (1,585)  (37)  (958)  (26) 
Did know they had the right 
to appeal an HMOs  refhaal  74%  71%  -3%  e  67%  59%  -8%  e 
to providelpay  for services.  (1,113)  (29)  (523)  (13) 
For scheduled appointments

with primary HMO doctors,

usually waited less than 13  85%  83%  -2%  @  82%  96%  + 14%  @

days.  (1,276)  (35)  (681)  (22)

139
 .  Above average  @  Average  O  Below average  NS  Not sufficient  data 
HMo 
ID#:  9045  Enrollees  DMenrollees 
  (N=  44)  (N =  34) 
Beneficii  Responsesto Key  Au  This  %DM.  Comp.  Au  This  %DitT.  Comp. 
Survey Queatioosby Category  EMos  HMO  HMos  HIWo 
For scheduled appointments 
with specialists, usually  81%  80%  -1%  @  75%  88%  +13%  e 
waited less than 13 &yS.  (970)  (24)  (477)  (14) 
When very sick, was able to 
get a doctors  appointment  93%  96%  +3%  e  89%  100%  +11%  @ 
within 1 to 2 days.  (942)  (26)  (453)  (to) 
usually waitedless than 1 
hour & the office to see  95%  95%  o%  (B  87%  86%  -1%  e 
primary HMO  doctor.  (1,431)  (38)  (704)  (19) 
Consistently busy telephone 
lines did @  hinder benes  90%  96%  +6%  e  89%  94%  +5%  e 
making appointment.  (780)  (22)  (425)  (15) 
Primary HMO doctor never 
failed to provide needed  96%  95%  -1%  @  88%  88%  o%  e 
Medicare services.  (1,475)  (37)  (744)  (21) 
Primary HMO doctor never 
failed to refer to a specialist  96%  95%  -1%  @  88%  79%  -9%  e 
when needed.  (1,439)  (37)  (732)  (38) 
Didnt feel the need to -k 
out-of-plan care, excluding 
dental, routine eye, and  93%  93%  o%  e  86%  83%  -3%  @ 
emergenthrgent  care.  (1,397)  (38)  (696)  (4) 
Medka.1 care received 
through the HMO caused 
beneficiaries  health to: 
F  improve	 53%  59%  +6%  e  41%  46%  +5%  @ 
(772)  (24)  (296)  (lo) 
  stay about the same  45%  39%  ~%  49%  46%  -3%  @
e
(649)  (16)  (383)  (lo) 
10%  9% 
b  worsen	 -1% 
(86) @  e 
Primary HMO doctor never

failed to take beneficimys  88%  83%  -5%  e  76%  78%  +2%  (B

health complaints seriously.  (1349)  (34)  (6S0)  (18)

140
  
Above average  @  Average  Cl  Mow  .Wemlge  NS  Not sufficient  data 
HMo  ID #: 9045  Enrollees  Dlsenrollet?s 
  (N =44)  (N = 34)
  .-. 
Bene&iary Reaponseato Key  Aa  This  %Diff,  Comp.  All  This  %Diff.  Comp. 
Survey Questionsby Catego~  HMos  HMo  ErMos  HMo
..-_. 
Most  important  to primary 
HMO doctor WSS: 
b	 giving the best 
medical care  86%  86%  0%  @  ~~%  71%  -1%  e 
possible  (1,197)  (30)  {471)  (12) 
b  holding down the  9%  11%  +2%  26%  18%  -8% 
@  @ 
cost of care  (120)  (4)  {162)  (3) 
. ..- . 
Most important to the HMO 
was: 
b  giving  the best 
medical care  74%  85%  +9%  @  58%  45%  -13%  e 
possible  (1,036)  (29)  (387)  (9) 
b	 holding down the  15%  9%  +5%  36%  45%  +9% 
@  e 
cost of care  (,213)  (3)  (230)  (9) 
141
 HEALTH  MAINTENANCE  OF  OREGON 
No. Enrollees:  11,400  Total No. !%mpkxk 99 
Model ~.  IPA  For-Profit 
..= 
.  Above average  @  Average  O  Below average  NS  Not suf13cient data 
 
HMO ID#H9049  Enrollees  Dlsenrollees 
(N = 39)  (N =37)
. 
BeneficiarRy esponsetso Key  Au  This  %Diff.  Comp.  m  This  %Difr.  Comp.
SurveyQuestionbsy Category  Eblos  mklo  EMos  HMo 
HEALTiY l!XXEENWG 
Was g@ asked at application 
about health problems, 
excluding kidney failure and  63%  76%  +13%  @  58%  a3%  +25%   
hospice care.  (717)  w)  (430)  w) 
Physical exam was n~  96%  100%  +4%  @  98%  97%  -1%  e 
required before joining.  (1,295)  (31)  (824)  (29) 
uNDIHLSTllNIMjYGOF  HMOS 
Did know they could change 
o 
their minds about enrolling  88%  79%  -9%  82%  93%  + 11%  @ 
after they applied.  (1,078)  @)  (611)  (W 
Did know,  from the 
beginning, they must be 
referred to a specialist by  89%  92%  +3%  @  84%  91%  +7%  (B 
their primary HMO doctors.  (1,444)  (35)  (852)  (30) 
Did know,  from the 
beginning,they could only 
use HMO doctors and 
hospitals (except emergent 
xire and urgent care outaide  %%  97%  +1%  e  93%  97%  +4%  @ 
the service area.)  (1,585)  (36)  (958)  (32) 
Did know they had the right 
LOappeal an HMOs  refiuud  74%  90%  + 16%  e  67%  82%  + 15%  e 
to providelpay  for services.  (1,113)  (28)  (523)  (23) 
Por scheduled appointments

with primary HMO doctors,

.m.udlyWtited  km  than 13  85%  97%  +12%  e  82%  80%  -2%  e

iays.  (1,276)  (33)  (681)  (24)

142
  
Above average  @  Average  O  Below average  NS  Not stilcient  data 
HMO  ID #: H 9049  Enrolk  DMenrollees 
(N=  39)  (N =37)
. 
BenefieisqResponsetso Key  Au  This  %Diff.  Compa  An  This  %DitK  Comp. 
Survey Queafionsby Category  EMos  HMO  .  HMos HMO
For scheduled appointments 
 
with specialists, usually  81%  95%  + 14%  7s%  90%  +15%  @ 
waited less than 13 days.  (970)  (20)  {477)  (17) 
When very sick, was able to 
get a doctors  appointment  93%  100%  +7%  e  89%  100%  + 11%  03 
within 1 to 2 days.  (942)  (19)  (453)  (17) 
usually waitedless than 1 
hour in the office  to see  95%  100%  +5%  e  87%  100%  +13%   
primary HMO doctor.  (1,431)  (31)  (704)  (30) 
Consistently busy telephone 
o
mlineas dkidi ~nt ghinder benes  90%  95%  +5%  @  89%  73%  -16% 
appointments.  (780)  (18)  (425)  (16) 
Primary HMO doctor never 
failed to provide needed  96%  94%  -2%  @  88%  93%  +5%  @ 
Medkare  services.  (1,475)  (31)  (744)  (26) 
Primary HMO doctor never 
failed to refer to a specialist  96%  97%  +1%  @  88%  96%  +8%  @ 
when needed.  (1,439)  (32)  (732)  07) 
Didnt feel the need to seek 
out-of-plan care, excluding 
dental, routine eye, and  93%  91%  -2%  e  86%  90%  +4%  e 
emergentlurgent care.  (1,397)  (30)  (696)  (28) 
Medical care received 
through  the HMO  caused 
beneficiaries  health to: 
b  improve  53%  42%  -11%  o  41%  31%  -lo%  @ 
(296)  (20) 
49%  62%  + 13% 
@ 
(383)  (18) 
10%  7% 
-3% 
(86)  (2)  e 
Primary HMO doctor never

failedto take beneficiarys  88%  94%  +6%    76%  74%  -2%  @

health complaints seriously.  (1349)  (30)  (6S0)  (23)

143
 .  Above average  @  Average  o  Below $.ww?age  NS  Not suffkient  data 
HMO ID#:H9049  Enrollees  Disenrollees 
(N = 39)  (N =37)
-..--
BmefkiaryResponsetso Key  All  This  %Diff.  Comp  All  This  %DM.  Comp. 
survey@?StiODS  by Catqory  mos  HMO  ...  .mm   HMo
Most important to primary 
HMO doctor was: 
k	 giving the best 
medical care  86%  87%  +1%  @  72%  67%  -5%  03 
possible  (1,197)  (26)  (471)  (18) 
b  holding down the  9%  7%  -2%  .2!%  33%  +7%
e e 
cost of oare  (120)  (2  (162)  (9) 
-. 
Most important to the HMO 
was: 
b  giving the best 
medical care  74%  79%  +5%  e  58%  73%  + 15%  e 
possible  (1,036)  (23)  (387)  (19) 
b  holding down the  15%  7%  -8%  o  36%  19%  -17%  @ 
cost of care  (X3)  @)  (-230)  (5) 
144
 ENDNOT.EM 
... ... .

1.	 Wg selected  a stratifkl  random  sample  from H(XAS  Group  Health  Plan  (GHP) 
data  base.  First,  we  sampled  45  HMOS  from  the  87  HMOS  under  a risk  contract 
with  HCFA  as  of  February  1993.  Beginning  with  the  GHP  data,  we  counted  the 
number  of  enrollments  occurring  within  calendar  years  J991  and 1992.  For  this 
cohort,  we  then  calculated  the  proportion  of  disenrolhnents  within  the  following  12 
months.  Based  on  this  disenrolhnent  rate,  we  divided  the  87 risk HMOS into three 
strata of 29 HMOS  each.  Within  each strata, we sekxted  15 HMOS  by simple 
random  sampling.  Second,  from  each  samplti  HMO,  we  mndomly  selected  50 
Medicare  beneficiaries  who  were  enrolled  as of  February  28,  1993  and  50  who  had 
disenrolled  between  November  1992  and  Februq  1993  inclusive.  When  the  total 
number  per  HMO  for  either  group  was  less  thari 50,  we  selected  them  all.  Using 
HCFAS  ~llrnent  Data  Base,  we  excluded,  from  the  ~pling  universe, 
beneficiaries  who  had  died  or  who  appeared  as ~tmrent  enrollees,  but  had  acttmlly 
disenrolled  since  the  last  update  to  the  GHP  f~e,,  This  process  resulted  in  2,217 
enrollees  and  1,915  disenrollees  for  a total  of  4,132  beneficiaries.  A  total  of  2882 
surveys  were  deemed  usable,  yielding  an unweighed  return  rate  of  70 %  overall, 
77%  for  enroll~s  (N=  1,705)  and  61 %  for  disenrollees  (N=  1,177). 
2.	 Complaints  against  Medicare  HMOS  show  large  variances  nationwide,   Modem 
HeaWzcare,  February  13, 1995, p.  17. 
3.	 Modem  Healihcare,  iJ&  The  absolute  number  of  reconsiderations  fded  with  an 
HMO  may  not  be  indicative  of  quality  issues related  to the provision  of medical 
care.  In some instances  it may indicate  a need for education  of beneficiaries  as to 
what Medicare  covers  or other operational  issues....Conversely,  a low rate of 
appeals  may indicate  that the (plan) is not providing  appeal rights to its members,  
145
 HMO  Means  and  Standard  Deviations  By  Survey  Question 
HMOSby Enrollees  HMOS by Dwnrollees 
Benel%iary  Responsesto Key  Mean of  S. D.  Lowest  Eigheat  Meao of  S. D.  Lowest  E@& 
Survey Questionsby Category  Ml nMos  HMo  HMO  All HMos  HMO  HMO 
m  W#lnmmmrr*Ym 
Was ~t  asked at application 
about health problems, 
excluding kidney failure and  63%  18%  17%  94%  58%  20%  16%  93% 
hospice care.  (45I-mlos)  (41Hhlos) 
Physical exam was n~  96%  6%  73%  100%  98%  4%  87%  100% 
required before joining.  (45HMos)  (41lmlos) 
Did know they could change

their minds about enrolling  88%  9%  46%  100%  82%  14%  50%  100%

after they applied.  (45HMos)  (41HMO,)

Dld know,  from the 
~ghming,  they must be 
referred to a specialist by  89%  8%  55%  100%  84%  11%  40%  100% 
their primary HMO doctors.  (45HMos)  (41HMO,) 
Did know,  ffom the 
beginning, they could only 
use HMO doctors and 
hospitals (emergent care and 
urgent care outaide the  96%  4%  85%  100%  93%  8%  60%  100% 
service area.)  (45Hb40s)  (41HMO,) 
Did know they had the right 
to appeal an HMOs  refusal  74%  8%  54%  90%  67%  16%  33%  100% 
to providelpay  for services.  (45HMO,)  (39HMos) 
For scheduled appointments 
with primary HMO doctors, 
usually waited less than 13  85%  14%  30%  100%  82%  16%  32%  100% 
days.  (45mos)  (39HMos) 
For scheduled appointments 
with specialists, usually  81%  13%  35%  100%  75%  17%  28%  100% 
waited leas than 13 days.  (45Hbios)  (39HMos) 
A  -1  HMOS by Enrollees  HMOS by Dkenrollees 
  ,. 
BenefkiaryResponsetso Key  MeaIsof  S. D.  Lowest  I@bt  M- of  S. D.  Lowest  f@best 
Survey @tiOSIS  by Category  Au EMos  HMO  HMO  All llwfos  HMo  HMO 
When  very  sick,  <ss  able  to 
get a doctors  appointment  93%  9%  67%  100%  89%  12%  56%  100% 
within 1 to 2 days.  (45HMO,)  (3$mos) 
-. 
Usually Wilited less than 1 
hour in the office  to see  95%  6%  75%  100%  87%  12%  48%  100% 
primary HMO doctor.  (45HMos)  (38Imfos) 
Consistently busy telephone 
lines dld g@ hinder benes  90%  11%  56%  100%  89%  13%  52%  100% 
making appointments.  (45HMos)  (36HMos) 
SERVICES 
Primary HMO doctor never 
failed to provide needed  96%  3%  89%  100%  88%  9%  65%  100% 
Medicare services.  (45Hblos)  (40HMos) 
Primary HMO doctor never 
failed to refer to a specialist  96%  4%  81%  100%  88%  10%  62%  100% 
when needed.  (45HMos)  (40HMos) 
Didnt feel the need to seek 
out-of-plan care, excluding 
dental, routine eye, and  93%  4%  83%  100%  86%  9%  64%  100% 
emergentfurgent care.  (45HMO,)  (40HMO,) 
Medical care received 
through the HMO caused 
beneficiaries  health to: 
b  improve  53%  10%  35%  78%  41%  18%  8%  100% 
(45HMos)  (41Hbfos) 
b  stay about the same  45%  10%  22%  63?4  49%  16%  O%  72% 
(45HMos)  (41Hhlos) 
10% 
b  worsen  11%  o%  40%
(40HMos) 
Primary HMO doctor never 
failed to take beneficiarys  88%  6%  75%  97%  76%  12%  41%  100% 
health complaints seriously.  (45HMos)  (41Hhlos) 
Most important to primary 
HMO doctor was: 
k  giving the best  86%  6%  69%  96%  72%  17%  33%  100% 
medical care possible  (45HMOE)  (40HMos) 
F  holding down the  9%  5%  0%  22%  26%  17%  o%  67% 
cost of care  (45HMos)  (40HMos) 
A -2  HMOS by Enrollees  HMOS by DKenrollees 
Renefkii  Reaponsetao Key  Meanof  S. D.  LOweat  Eigbeat  ~eao of  S. D.  Lowest  Highest 
SurveyQoeatioIIbsyCategory  AuHMos  HMO  HMo  Anmos  HMO  HMO 
.  .. 
Most important t; the HMO 
was: 
b  giving the best  74%  10%  52%  89%  58%  18%  25%  100% 
medical care possible  (45HMO,)  (40m.los) 
b  holding down the  15%  8%  3%  35%  36%  18%  O%  75% 
cost of care  (45HMo,)  {40 mlos) 
A -3
 APPENDIX  B 
BENEFICIARY COMMENTS 
Many beneficiaries  wrote comments  about  problems  they  perceival  with  their  HMOS. 
They  wrote  words  of  praise  less  Often.  We  make  no  inference  about  this  difference;  we 
merely  note  it.  We  have  tried  to  select  a representative  mixture  Of comments  that 
illustrate  what  beneficiaries  thought  and  felt  about  their  IIMO  txqmriences. 
Overall  Comments 
The whole time I was in the HMO,  I couldnt have asked for better  service than I got 
from the HMO.  But when the rates went  I just  didnt have the money to stay in or I 
up, 
would have still been in the HMO.  
Using only HMO doctors  and hospitals is very inconvenient  for me.  The closest doctor 
is 38 miles from my home.  
The doctor  I had and trusted  does not take HMO patients.  I am happy with the HMO 
primary  care doctor,  but my main worry  is what to do if we need emergency  care which 
might lead to long-term  care.  I am 86 years  old.  
Though I have no complaints  about care I have received  so far through  my HMO,  I 
prefer  the family doctor  medical  scene to todays highly specialized  Big Dollar 
machines.  However,  financially  this is no longer an option.  
I dont see how the government  can think HMOS are the answer to good medical  care. 
The doctor  could care less about the person  on these plans.  If you are well and do not 
need a doctor,  this would be okay.  
This program  is very  successful,  and if the government  would put every citizen in this 
program,  it would save millions  and millions because the doctors  and hospitals  would have 
to conform  or go into another profession.  
The problem  I have is paying  for all the p~scription  medicine  Im taking because  of the 
extremely  high prices.  Which  makes it impossible  for the elderly  to have any kind of 
health insurance.  Why pay for insurance  if one cant afford the cure? 
... you receive  more value for the money you spend for services.  I like their emphasis  on 
preventive  medicine.  The only negative  Ive seen.. .is that its a rather  complex/diverse 
organization  that tends to be impersonal  and requires  the patient  to show more initiative  in 
getting and keeping  track  of treatment,  
B-1  Understa  ndinz  of  HMOs 
The representative  I talked with said my HMO doctor could refer me to the doctor I had 
before  even if they were not a member,  but he didnt and wouldn't.  
My prescriptions  per  year  [were] over $1000.  My HMO promised  $5 per prescription, 
but did not explain the limitations  were a $100 per month,  two prescriptions,  then I paid if 
~ couldnt]  take generic  drugs.  
There were too many donts in coverage.  I did not know the restrictions  when I fwst 
signed up.  
MI health maintenance  plans are so complicated  for elderly people.  Dont cover us up 
with manuals,  rules and paperwork.  Just keep it simple.  
FHP had employees  who misrepresented  their plan.  When I discovered  this,  I was left 
with bills from  specialists  who were not on their list of providers.  I have turned  this 
matter  over to family members  because the entire  situation is overwhelming.  
I am enclosing  the statement  from Good Samaritan  Hospital.  The total bill was 
$6,521.55.  Kaiser  paid  $2,382.75.  They told me that is what Medicare  would pay.  I 
owe $4,138.80.  I am going to appeal.  
Your survey  should have addressed  the patient  education  clients receive  who belong to 
HMOS and how the services  decline as you get older and need more,  as well as what 
clients really know about the appeal process.  
Amxdntments 
D am] rushed  in and out too fast.  ~  spend a lot more time in the waiting room.  
Ive only had my physical  exam,  but theres  always a doctor at the offke  center  and I 
can walk in anytime  and see a doctor.  I can also call the offke  center  and they will 
provide  transportation  to and fmm  the ofilce  center.  
The average  time  [to wait for appointments]  was one appointment  approximately  every  3 
months,  and there  were times I needed it more in my estimation.  
You have to listen to about  15 minutes  [ofJ damn commercials  when calling for 
appointments.  
We left the HMO because  we had to make appointments  a month ahead of time at the 
beginning  of the month.  If we forgot to call at the beginning  of the month.  we were told 
to call back the fwst of the next month.  
B-2
 The medical  care was lousy.  I felt like a piece of meat being slmffled from one doctor 
to the next and not one of them ever na.lly  cad  about my health,  only how much money 
they could milk out of the Medic-am system.  
HMOS have no interest  in ones health.  I dont mean the doctors  or staff.  Its the ones 
making  the-rules,  such as medicine  formularies.  
.. .The HMO which I was formerly  covered  by and the present  one honestly try to give 
the best cam possible  and still try to keep the cost down.  I appreciate  this.  I do not 
believe  in  running  to  the  doctor unless I feel it is necessary.  
Their main objective  is to hold down costs....When a Parkinson patient  is refused  a 
specialist  and a heart patient  is refhsed  an electmca.rdiogmm,  the xeason is very clear.  
The  primary  HMO  doctor  tried  to  intimidate  me  by  yelling  at me.  He  was  ehher 
overworked  or felt  tlueatened  when  I asked  for  reasons  for  certain  medications.   
We have had little coqxxation  from the ~0]  offke  when we weded  it.  The offke 
staff was uninformed,  gave us incorrect  information  several times.  Gave us a run-around 
not to be believed  when we badly needed their  help.... 
.. male  HMO primary  physician  [delivers]  embarmssing  services  which should be 
available  for women by female HMO physician,  e.g.  Pap smears.  
 
- 
B-5