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Department of Eklth and Human Services -, ,. ,’ 

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‘IN’SPE~TC)lit ~E~fi~~~” 

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lNDIVl~UAL” p~o~]LEs’.’o~ ‘,

,, “ “MEDi~A.~~”RISK l+Mos “ . . ,. 

)’ APRIL’ 1995.. 

b’. OEI-06-91-00733 ‘ “. 

. . 

.“ 

,’, 
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 O Ilead to criminal convictions, administrative 

sanctions, or civil money penalties. The O I also 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 

Survey Qwations by Category 

An 

EIMos 

This %Diff. 

HMo 

Comp. An 

HMos 

Tbi$ %Diff. 

HMO 

Comp. 

For scheduled appointments 

with specialists, usually 81% 96% + 15% g 75% 72% -3% e 

waited less than 13 days. (970) (26) (477) (13) 

When very sick, was able to 

get a doctor’s appointment IIwithin 1 to 2 days. 

93% 

(942) 

96% +3% 

(21) 

e 89% 

(453) 

93% +4% 

(13) 

e 

usually waited less than 1 

hour in the office to see IIprimary HMO doctor. 

95% 

(1,431) 

85% -lo% 

(29) 

o 87% 

(704) 

76% -11% 

(19) 

e 

Consistently busy telephone 

lines did n@ hinder bene’s IImaking appointments. 

90% 

(780) 

86% -4% 

(18) 

e 89% 

(425) 

90% +1% 

(18) 

e 

HMO doctor never 

failed to provide needed IIPrimary%% 100% +4% � 88% 82% -6% 

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) 

Didn’t 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) 

Primary

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 beneficiary’s 88% 79% -9% o 76% 88% + 12% g


health conqhints SeliOUSIJr. (1349) (22) (650) (29) 

29


03 
� 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) 

F	 holding down the 9% o% -9% o 26% 48% +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 

cost of care 

15% 

(213) 

6% 

(2) 

-9% o 36% 

(230) 

48% 

(lo) 

+ 12% e 

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 HMO’s 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 doctor’s appointment 93% 96% +3% @ 89% 100% +11% 

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 bene’s 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) 

Dkin’t 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) 

b worsen 10% o% -lo% (86) (o) e 

Primary HMO doctor never


failed to take beneficiary’s M% 84% -4% e 76% 95% + 19% �


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


32


03 
� 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 

cost of care 

15% 

(213) 

20% 

(6) 

+5% e 

36% 

(230) 

31% 

(5) 

-5% e 

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% 

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 HMO’s 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


03 
� 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 doctor’s appointment 93% 100% +7% e 89% 80% -9% 

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 bene’s 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) 

Didn’t 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% 

(383) 

5:% +1% @ 

10% 

(86) 

;; 

(o) -lo% 

e 

Primary HMO doctor never


failed to take beneficiary’s 88% 76% -12% o 76% 70% -6% e


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


35


03 
. 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 QueatioIJsby 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 

cost of care 

9% 

(120) 

10% 

(2) 

+1% (B 26% 

(162) 

44% 

(4) 

+18% � 

Most important to the HMO 

was: 

b giving the best 

medical care 74% 71% -3% @ 58% 25% -33% o 

possible (1,036) (12) (387) (-2) 

b holding down the 

cost of care 

15% 

(213) 

18% 

(3) 

+3% e 36% 

(230) 

75% 

(6) 

+39% g 

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 HMO’s 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 doctor’s 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 bene’s 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) 

Didn’t 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% 5’7% +4% @ 41% 50% +9% @ 

(772) (17) (2%) 

b stay about the same 45% 

(649) 

40% 

(12) 

-5% @ 49% 

(383) 

am% 

(6) 

-6% @ 

b worsen 2% 

(32) 

3% 

(1) +1% @ 

10% 

(86) 

7% 

(1) -3% @

Primary HMO doctor never


failed to take beneficiary’s 88% 90% +2% @ 76% 69% -7% o


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 HMO’s 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 doctor’s 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) 

Didn’t 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 worsen 2% 7% i-5% 10% 40% +30% (32] (3) � (86) @ � 

Primary HMO doctor never


failed to take beneficiary’s 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) 

Beneficiary Responsesto 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 HMO’s 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 doctor’s 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 bene’s 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) 

Didn’t 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% 

(649) 

59% + 14% � 49% 

(383) 

54% 

(14) 

+5% @

b worsen 2% 0%) -2% 10% o% -lo% @

(32) (o) @ (86) (o) 

Primary HMO doctor never


failed to take beneficiary’s 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- Responsesto 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% 

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


03 
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 HMO’s 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 

cost of care 

9% 

(120) 

3% 

(1) 

-6% o 26% 

(162) 

NS 

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 

cost of care 

15% 

(213) 

20% 

(6) 

+5% @ 36% 

(230) 

NS 

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 HMO’s 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 doctor’s 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 bene’s 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) 

Didn’t 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% 

(649) 

55% 

(16) + 10% � 49% 

(383) 

NS 

b worsen 2% 

(32) 

3% 

(1) +1% 

e 

10% 

(86) NS 

Primary HMO doctor never


failed to take beneficiary’s 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 

cost of care 

9% 

(120) 

8% 

Q) 

-1% (B 26% 

(162) 

NS 

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 

cost of care 

15% 

@13) 

28% 

(8) 

+13% � 36% 

(230) 

NS 

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 QueatioILsby 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 HMO’s 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 doctor’s 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) 

Didn’t 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% 

(649) 

26% -19% o 49% 

(383) 

57% 

(13) 

+8% e 

b worsen 2% 

(32) 

0% 

(o) -2% @ 

10% 

(86) 

13% 

(3) +3% e 

Primary HMO doctor never


failed to take beneficiary’s 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%


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 HMO’s 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


03 
� 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 ‘l’l& %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 doctor’s 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 

Pliw HMO doctor. 

95% 

(1,431) 

94% -1% 

(31) 

e 87% 

(704) 

71% -16% 

(15) 

o

Consistently busy telephone 

lines did ~t hinder bene’s 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) 

Didn’t 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% 

(649) 

53% 

(17) 

+8% e 49% 

(383) 

33% -16% O 

b worsen 2% o% -2% 10% 3?% +28% 

(32) (o) e3 (86) (8) � 

Primary HMO doctor never


failed to take beneficiary’s 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 

cost of care 

15% 

(213) 

11% 

(3) 

~% e 36% 

(230) 

58% 

(11) 

+22% � 

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 

Survey Quealionsby Catego~ 

AU This %Ixff. 

HMos HMO 

Comp. Au 

EMos 

This %m. Comp. 

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% 

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 HMO’s 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


0 
� 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 doctor’s 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 bene’s 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) 

Didn’t 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 beneficimy’s 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 HMO’s 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 doctor’s 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 bene’s 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) 

Didn’t 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% 

(649) 

38% 

(13) 

-7% e 49% 

(383) 

NS 

10% NS (86) 

Primary HMO doctor never


failed to tske beneficiary’s 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 

Survey Questiom by Category 

All This %Diff. 

HMos HMo 

Comp. Au 

EMos 

W %DifK Comp. 

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 

cost of care 

9% 

(120) 

o% 

(o) 

-9% o 26% 

(162) 

NS 

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 HMO’s 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=4’7) (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 doctor’s 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 bene’s 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) 

Didn’t 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% 

(649) 

L&i 

(19) 

()% e 49% 

(383) 

NS 

b worsen 10% 

(86) NS 

Primary HMO doctor never


failed to take beneficiary’s 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 

cost of care (120) (4) (162) 

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 

cost of care 

15% 

(.213) 

24% 

(9) 

+9% � 36% 

(230) 

25% 

(1) 

-11% e 

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 HMO’s 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 doctor’s 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 bene’s 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 

Didn’t 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% 

(2%) (8) 

49% 50% +1% e (383) (9) 

10% 6% ~% 

(86) (1) @ 

Primary HMO doctor never


failed to take beneficiary’s 88% 82% -6% o 76% 76% O% o


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


68


03 
� 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 

cost of care (120) (5) (162) (3) 

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% 

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 HMO’s 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


0 
. 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 doctor’s 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 bene’s 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) 

Didn’t 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 (86) NS

Primary HMO doctor never


failed to take beneficiary’s %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% 26% e 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 

cost of care 

15% 

(213) 

13% 

(5) 

-2% @ 36% 

(230) 

NS 

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 HMO’s 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 doctor’s 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 bene’s 90% 88% -2% @ 89% 71% -18% 

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 

Didn’t 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) 

b worsen 10% 

(86) 

o% 

(o) -lo% ~ 

Primary HMO doctor never


failed to take beneficiary’s 88% 94% +6% � 76% 85% +9% e


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


74


0 
� 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 

cost of care (213) (6) (230) (3) 

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% 

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) 

tJiWJERST’ANIMNGUFHAfOS 

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 HMO’s 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


03 
� 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 doctor’s 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% 

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) 

Didn’t 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) 

b wonsen 10% o% -lo% (86) (o) e 

Primary HMO doctor never


failed to take beneficiary’s 88% 86% -2% @ 76% 74% -2% e


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


77


03 
. 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 %Dit’f. 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% 

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 

cost of care 

15% 

(213) 

12% 

(3) 

-3% e 36% 

(230) 

10% 

(1) 

-26% o 

78

03 
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 @ Average o Below average NS Not sufficient data 

HMO ID #: H 2649 Enrollees Disenrolkes 

Benefiby Reapo~ to Key An

Survey (hmationsby Category HMos 

This 

HMO 

%Dify. Comp. Au 

EMos 

T& 

HMO 

%xMr. Comp. 

HIMLz!! XXWENING 

Was ~t asked at application 

about health problems, 

excluding kidney failure and 63% 

hospice care. (717) 

32% 

(8) 

-31% o 58% 

(430) 

17% 

(1) 

-41% o 

Physical exam was n- 96% 

~uired before joining. (1,295) 

85% 

(22) 

-11% o 98% 

(824) 

100% 

(8) 

+2% e 

VAUJEWT!iD~G UF HMOS 

lid know they could change 

heir minds about enrolling 88% 

,fter they applierl. (1,078) 

96% 

(22) 

+8% e 82% 

(611) 

75% 

(6) 

-7% @

)id know, from the 

qginning, they must be 

>ferred to a specialist by 89% 

leir primary HMO doctors. (1,444) 

92% 

(34) 

+3% @ 84% 

(852) 

77% 

(lo) 

-7% @

(N = 42) (N = 20) 

~idknow, from the 

e-g, they could only 

w HMO doctors and 

wpitals (except emergent 

ue and urgent care outaide 96% 100% +4% � 93% 100% +7% ~eService area.) (1,585) e (41) (958) (14) 

id know they had the right 

.0 appeal ~ HMO’S ~f& 

o providelpay for services. 

74% 72% -2% @ 67% 88% +21% g (1,113) (26) (523) (7) 

vith primary HMO doctors,


Lwlallywaited less than 13 85% 89% +4% 

ays. e 82% 90% +8% @
 (1,276) (32) (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 All This %~. Comp. Au This %DM Comp. tkrvey Questioasby Category IIMos IIIWo 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 doctor’s appointment 93% 100% +7% @ 89% 100% +11% within 1 to 2 tiys. (942) (34) 03 (453) (4) 

Usually Wtited less than 1 

hour in the office to see 

primary HMO doctor. (1

95% 

,431) 

97% 

(38) 

+2% @ 87% 91% +4% 03 (704) (lo) 

c onsistently busy telephone 

1“mes did w hinder bene’s 90% 100% +10% @ making appointments. (780) 89% 100% +11% @ (29) (425) (4) 

s ERV.CjRY 

m “V HMO doctor never 

fal“led to provide needd 

M edicare service.q. 

96% 

(1,475) 

100% 

(41) 

+4% � 88% 

(744) 

90% 

(9) 

+2% ~ 

Prl“miuY HMO doctor never 

failed to refer to a specialist 

when need~. 

96% 

(1,439) 

98% 

(39) 

+2% e 88% 

(732) 

100% 

(lo) 

+ 12% �

Di&’t f~l the nd to s~k


out-of-plan care, excludhg


denM, routine eye, and 93% 95% +2% emergentiurgent care. e 86% 89% +3% @
 (1,397) (35) (696) (8)


Medical care received


through the HMO caused


beneficitim’ health to:


b improve 53% 

(772) 

51% -2% @ 41% 56% + 15% @ (18) b (296) (5) stay about the same 45% 46% +1% @ 49% 44% (649) (16) -5% (383) (4) e b Worsen 2% 3% 10% o% (32) (1) +1% e (86) (o) -lo% @ 

PERS Ohuu TWP’ENT 

Primary HMO doctor never


failed to take beneficiq’s 88% 85% health compltik seriously. -3% @ 76% 85% +9% ~
 (1349) (34) (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) 

BeneficiaryReaponsesto 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 HMO’s 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) 

Responsesto Key Au This %Diff. Conlp. An This %DM. Comp. 

Survey Quest.ioIIsby Category EMos En’lo 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 doctor’s 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 bene’s 90% 100% + 10% e 89% 94% +5% 

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) 

Beneficiary

Didn’t 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 beneficiary’s 88% 87% -1% e 76% 88% + 12% �


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


83


03 
. Above averqe @ Average o Mow average NS Not suf’flcient data 

~01D#H2652 Enrollees — Disenrolkes

(N= 43) (N = 28) Beneficiary Reapoms to Key All This %Diff. Comp. Au This %mff. Comp. key (kx.ioas by Category HMos HMO EMos HMO 

Most impotit to pri~ 

HMO doctor W=: 

b	 giving the best 

medical care 86% 84% -2% e 72% 73% +1% possible (1,197,) e (31) (471) (16) 

b	 holding down the 9% 11% +2% @ 26% 18% cost of care (120) -8% ~ (4) (162) (4) 

Most impo~t ~ the HMO 

was; 

b	 giving the best 

medical care 74% 74% ()% possible 03 58% 61% +3% ~ (1,036) (28) (387) (14) 

b	 holding down the 15% 16% +1% e3 36% 22% 

cost of w (X3) -14% ~ (6) (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 

EMos HMO 

HWZW Scl?J?jIINWG 

Was ~t asked at application 

rnbouthealth problems, 

>xcluding kidney failure and 63% 

lospice care. (717) 

74% 

(17) 

+11% ~ 58% 

(430) 

73% 

(16) 

+ 15% @ 

?hysical exam was not 96% 

equired before job-g. (1,295) 

100% 

(32) 

+4% @ 98% 

(824) 

100% 

(25) 

+2% ~ 

7NDlHw’.’.B~G UF.HiUOS 

)id know they could chrume 

leir minds about enrolling 88% 

fter they applied. (1,078) 

85% 

w) 

-3% @ 82% 

(611) 

67% 

(14) 

-15% o 

~idkUOW,from the 

egirming, they must be 

:fermd to a s&ialist by 89% 

[eir primary HMO doctors. (1,444) 

89% 

(31) 

o% e 84% 

(852) 

82% 

(28) 

-2% e3

id know, from the 

:ginning, they could only 

%ey Que&.ioasby Category EMos HMo 

Au This %~. Comp. All This %Diff. Comp.

se HMO doctirs ~d


ospitals (except emergent


are and urgent care outside 96% 94% -2% le service ~.) 03 93% 89% -4% @
 (1,585) (34) (958) (31)


lid know they had the right


} appeal an HMO’s refbaal 74% 85% +11% � Iprovidelpay for services. 67% 66% -1% @
 (1,113) (29) (523) (19)


mMN?’MEm 

x scheduled appointments


ithprimary HMO doctors,


ually waited less than 13 85% 100% + 15% �
 ys. (1,276) (35)	 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&uyResponsesto 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 doctor’s appointment 93% 100% +7% @ 89% 91% +2% 

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 bene’s 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) 

Didn’t 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% 

(649) 

3?; 

(lo) 

-14% (-J 49% 

(383) 

58% 

(18) 

+9% @ 

b women 10% 3% -7% (86) (1) e 

Primary HMO doctor never


failed to take beneficiary’s 88% 89% +1% e 76% 70% -6% @


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


86


03 
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) ..—— ,— -

BenefkisrgResponsesto Key An m %Wf. Comp. M This %Diff. Comp. 

SurveyQuestionsby 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 HMO’s refksal 74% 81% +7% e3 67% 65% -2% 

to provide/pay for services. (1,113) (30) (523) (17) 

For scheduled appointments 

with primary HMO doctors, 

usually waited less than 13 85% 58% -27% O 82% 59% -23% o 

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

88


03 
� 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 doctor’s 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) 

Didn’t 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% e 49% 32% -17% o (649) (16) (383) (8) 

b worsen	 2% 8% +6% io% Ii% +2% (32) (3) � (86) (3) e 

Primary HMO doctor never


failed to take beneficiary’s 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) 

to 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) 

BenefkiaryResponses

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 HMO’s 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 

SluveyQuestionsby Catqory 

AU 

HMos 

This %Difx 

HMO 

Comp. An 

W$los 

This % Diff. 

HMO 

Comp

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 doctor’s 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 bene’s 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) (1’44) (15) 

Primary HMO doctor never 

failed to refer to a specialist 96% 100% +4% � 88% 88% o% @ 

when needed. (1,439) (28) (732) (15) 

Didn’t 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) 

b worsen 10% 7% -3% @ (86) (1) 

Primary HMO doctor never


failed to take beneficiary’s 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 Responsesto Key Au This %DifY. Comp. m This %rm. Comp. 

&uveyQuestionsby 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 

cost of care 

9% 

(120) 

8% 

(2) 

-1% @ 26% 

(162) 

17% 

(1) 

-9% @ 

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

94 

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) —— 

BeneficiaryReapomwto 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 HMO’s 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)

95 

. Above average @ Average O Below average NS Not suftlcient data 

HMOlD#H3204 Enrollees D~llees — (N = 31) (N = 28) .——. 

Btnefkimy Responsesto Key 

hey Questionsby Category 

Au 

EMos 

This 

HMo 

%Diff. Comp. Au 

IIMos 

This 

HMO 

%DitY. Comp. 

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 doctor’s 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 bene’s 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) 

Didn’t 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% 

(649) 

39% 

(lo) 

-6% @ 49% 

(383) 

5:% 

(11) 

+9% @ 

b worsen 2% 

(32) 

o% 

(o) -2% e 

10% 

(86) 

16% 

(3) 

+6% ~ 

Primary HMO doctor never


failed to take beneficiary’s 88% 96% +8% � 76% 85% +9% e


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

� 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 7’2% 67% -5% 

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 

cost of care 

15% 

(213) 

8% 

(2 

-7% e 36% 

(230) 

41% 

m 

+5% e 

96


03 
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) 

Beneficiary Reaponseato 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 HMO’s 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 Responsesto Key An This %Diff. Comp. All This % Diff. Comp. 

Survey Questionsby Catego~ HMO? Imlo KMos HMo 

For scheduled appointments 

with specialists, usually 

waited less than 13 days. 

81% 

(970) 

87% 

(20) 

+6% @ -75% 

(477) 

NS 

When very sick, was able to 

get a doctor’s 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 bene’s 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) 

Didn’t 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% 

(649) 

46% 

(15) 

+1% e 49% 

(383) 

NS 

b worsen 2% 

(32) 

o% 

(o) -2% 

e 

10% 

(86) NS 

Primary HMO doctor never


failed to take beneficiary’s 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) .—. 

Beneficiary Reaponseato 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 

cost of care 

15% 

(213) 

15% 

(5) 

()% 03 36% 

(230) 

NS 

99

No. Enrollees: 43,921 Total No. Sampie& 99 

Model ty’-~: Group Not For?rofit 

:~ 

� Above average @ Average o Below WWr’age NS Not sufficient data 

—— —. 

HMO ID #: H 3330 EnroUeea Dkenrollees 

(N =40) ————.- .——.. (N = 32)

BeneficiaryResponsesto Key 

&rvey QllE@iODS by Catqory 

Au This %Diff. Comp” All 

HMos HMO WOS 

This % Biff. Comp. 

HMO 

MWLT@ SCREENING -— 

Wss =t asked at application 

about health problems, 

excluding kidney failure and 63% 50% -13% @ 58% 67% +9% 

hospice care. (717) (5) (430) (lo) 

Physid exam was n@ 96% 

required

100% +4% e 98% 87% -11% o

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 

before joining. (1,295) m (824) (13) 

Didknow they had the right 

o appeal an HMO’s 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


03 
. Above average (B Average O Below average NS Not stilcient data 

HMO ID #: H 3330 Enrollees DKenrollees — (N =40) (N = 32) 

Reaponsea

by Category HMos HMO EMos HMo 

For scheduled appointments 

with specialists, usually

waitedkws than 13 &VS. 

81% 

(970) 

58% 

(19) 

-23% o 75% 

(473 

54% 

(14) 

-21% o

When very sick, was able to 

get a doctor’s appointment 

within 1 to 2 davs. 

93% 

(942) 

94% 

(30) 

+1% (1) 89% 

(453) 

75% 

(12) 

-14% o 

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 bene’s 

makingappointments. 

90% 

(780) 

67% 

(18) 

-23% o 89% 

(425) 

52% 

(13) 

-37% o

Beneficiary to Key Au This %Diff. Comp. All This %Diff. Comp.

SurveyQueatioas

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) 

Didn’t 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 beneficiary’s 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 I Total No. Respondents: 70 

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&iarYResponsesto Key Aa ‘n& %Diff. Comp. .All This %Diff. Comp. SurveyQuestionsby 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 OF’J&&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 HMO’s 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 doctor’s appointment 93% 75% -18% 0 $9% 100% + 11% e 

within 1 to 2 days. (942) (9) {453) (5) ,— 

usually waited lem than 1 

hour in the office to see 95% 81% -14% Q 87% 75% -12% o 

primary HMO doctor. (1,431) (26) (704) (12) ——. 

Consistently busy telephone 

lines did ~t hinder bene’s making 90% 86% -4% @ 89% 67% -22% o

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) 

Didn’t 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% e 

49% 62% +13% @ 

(649) (17) (383) (8) 

io% 3ik 

(86) (4) +21% g 

Primary HMO doctor never


failed to take beneficiary’s /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 ~ medical care 86% 77% -9% ‘?2% 50% -22% o 

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 

their minds about enrolling 88% 84% -4% @ 82% 50% -32% o 

after they applied. (1,078) (16) (611) (8) 

Did know, from the 

beginning, they must be 

referred to a specialist by 89% 80% -9% o 84% 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 

care and urgent care outside 96% 94% -2% e 93% 80% -13% o 

the service area.) (1,585) (34) (958) (24) 

Did know they had the right 

to appeal an HMO’s refusal bprovidelpay for services. 

74% 

(1,113) 

76% 

(25) 

+2% @ 67% 

(523) 

40% 

(lo) 

-27% o

I 

For scheduled appointments


with primary HMO doctors,


usually waited less than 13 85% 30% -55% o 82% 32% -50% o


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 to Key 

Survey Questionsby Category 

Au 

EMos 

This 

HMo 

%Diff. Comp. Au 

m’los 

This 

HMO 

%DifF. Comp. 

For scheduled appointment 

with specialists, usually 81% 35% -46% o 75% 28% -47% o 

waited less than 13 days. (970) (9) (477) (5) 

When very sick, was able to 

get a doctor’s 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 

lines did ~t hinder bene’s 90% 68% -22% o 89% 74% -15% o II 

Responses

Primary HMO doctor never 

failed to provide needed 

Medkare services. 

%% 

(1,475) 

100% 

(35) 

+4% � 88% 

(744) 

79% 

(-23) 

-9% o II 

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) 

Didn’t feel the need to seek 

out-of-plan care, excluding 

dental, routine eye, and 93% 89% -4% o 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 

(772) (21) (2%) (8) II 

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 beneficiary’s 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 

cost of care 

15% 

(213) 

10% 

(3) 

-5% e 36% 

(230) 

47% 

(9) 

+11% @ 

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% 

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 

to appeal an HMO’s refusal 74% 76% +2% e 67% 48% -19% o 

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


03 
� 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 doctor’s 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% 

primary HMO doctor. (1,431) (34) (704) (26) 

Consistently busy telephone 

lines dld ~t hinder bene’s 90% 94% +4% e 89% 85% -4% e 

Primary HMO doctor never 

failed to provide needed 96% 97% +1% e 88% 68% -20% o 

Medicare services. (1,475) (34) (744) (21) 

Primary HMO doctor never 

failed to refer to a specialkt 96% 97% +1% @ 88% 66% -22% o 

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: 

b improve 53% 37% -16% o 41% 28% -13% @ 

(772) (13) (296) (8) 

b stay about the same 45% 

(649) 

54% 

(19) 

+9% @ 49% 

(383) 

48% 

(14) 

-1% e 

b worsen 2% 

(32) 

9% 

(3) +7% � 

10% 

(86) 

24% 

m + 14% � 

Primary HMO doctor never


failed to take beneficiary’s 88% 91% +3% e 76% 69% -7% e


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


110


03 
. 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) 

b	 holding down the 9% 17% -M% e 26% 38% + 12% e 

cost of care (120) (5) (162) (9) 

Most important to the HMO 

was: 

b giving the best 

medical care 74% 64% -lo% o .58% 44% -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 HMO’s 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) 

to 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 doctor’s 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 bene’s 90% M% -2% e 89% 100% +11% 03 

making appointments. (780) (14) (425) (12) 

Benelicii Responsea

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) 

Didn’t 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% 

(649) 

2?; 

(lo) 

-16% O 49% 

(383) 

36% 

(9) 

-13% e

b worsen 10% 

(86) 

o% 

(o) -lo% @ 

Primary HMO doctor never


failed to take beneficiary’s 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 

cost of care 

9% 

(120) 

7% 

(2) 

-2% @ 26% 

(162) 

9% 

(2) 

-17% o 

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) — .— —— 

BenefkkuyReapomesto 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% 4’7% -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 HMO’s 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) 

BeneficiaryRespoasesto Key An ‘nlk %lxfr. Comp. All This %Biff. Comp. 

Survey Queatioasby Category HMos HMo mios HMO 

For scheduled appointments 

with specialists, usually 

waited less than 13 days. 

81% 

(970) 

82% +1% 

(18) 

(13 75% 

,(477) 

73% -2% 

(11) 

@ 

When very sick, was able to 

get a doctor’s appointment 93% 96% +3% @ 89% 88% -1% e 

within 1 to 2 davs. (942) (21) (453) (7) 

Usually Wilitd k-as than 1 

hour in the office to see 95% 87% -8% o 87% 79% -8% 03 

primary HMO doctor. (1,431) (26) (704) (15) 

Consistently busy telephone


lines dld ~t hinder bene’s 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 

failed to refer to a specialist 96% 86% -lo% o 88% 90% +2% e 

when needed. (1,439) (25) (732) (17) 

Didn’t 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 beneficiary’s 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 

cost of care 

9% 

(120) 

7% 

Q) 

-2% @ 26% 

(162) 

23% 

(3) 

-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) 

BeneficiaryResponsato Key All This %Diff. Comp. Au ‘n& %m. Comp. 

%uvey Qoeationsby Category HMos HMo HMos HMO 

Was at asked at application 

about health problems, 

excluding kidney failure and 63% 40% -23% o 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 

referred to a specialist by 89% 73% -16% o 84% 

their mimarv HMO doctors. (1,444) (16) (852) 

Did know, from the 

beginning, they could only 

use HMO doctors and 

hospitals (except emergent 

care and urgent care outside 96% 91% -5% o 93% NS 

the service area.) (1,585) (20) (958) 

Did know they had the right 

to appeal an HMO’s refusal 74% 63% -11% o 67% NS 

LOprovidelpay for services. (1,113) (12) (523) 

For scheduled appointments 

with primary HMO doctors, 

usually WSited less than 13 85% 70% -15% o 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 doctor’s appointment 93% 85% -8% e 89% NS 

within 1 to 2 davs. (942) (11) (453) 

Usually Wtittd kss than 1 

hour in the office to see 95% 85% -lo% o 87% NS 

Dnrnarv HMO doctor. (1,431) (17) (704) 

Consistently busy telephone 

lines did Wt hinder bone’s 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) 

Didn’t feel the need to seek 

out-of-plan care, excluding 

dental, routine eye, and 93% 89% -4% o 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% 

(32) 

o% 

(0) -2% @ 

10% 

(86) NS 

Primary HMO doctor never


failed to take beneficiary’s 88% 81% -7% o 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)

BeneficiaryRespoasesto 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 

medkal care 74% 53% -21% o 58% NS 

possible (1,036) (9) (387) 

b holding down the 

cost of care 

15% 

(213) 

35% 

(6) 

+20% � 36% 

(,230) 

NS 

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) 

BeneficiaryReaponseato 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 HMO’s &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 

get a doctor’s appointment 93% 100% +7% e 89% 71% -18% o 

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 bene’s 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) 

Didn’t 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) 

b worsen 10% o% -lo% 

(86) (o) @ 

Primary HMO doctor never


failed to take beneficiary’s 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) ——. 

Beneficiary Reapoaseato Key Au This %Diff. Comp. Au This % DW. Comp. 

&uvey Queafioasby Category EMos HMO IIMOS HMo 

Was ~t asked at application


about health problems,


excluding kidney failure and 63% 17% -46% o 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 HMO’s 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) —. 

JknefiiaryReapoawsto 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 doctor’s 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) 

Didn’t 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% 

(86) NS 

Primary HMO doctor never


failed to take beneficiary’s 88% 95% +7% � 76% 67% -9% @


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


125

� Above average @ Average o Below average NS Not sufilcient data 

HMO ID #: H 4949 Enrollees DisenroUees 

(N= 44) —..— (N =3)

Beneficiary Reapoaseato Key 

Survey Queatioasby Category 

Au 

mos 

This %Diff. 

HMO 

Comp. All 

Jlnlos 

This % Diff. 

HMO 

Comp. 

—.. 

Most important to primary 

HMO doctor was: 

b giving the best 

medical care 86% 90% +4% e 72% 33% -39% o 

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 

medical care 74% 76% +2% e 58% 33% -25% o 

possible (1,036) (28) (387) (1) 

b	 holding down the 15% 16% +1% (B 36% 67% +31% � 

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&.iarYReaponseato Key 

Sbrvey Questionsby Category 

Au 

HMos 

‘rllis %mff. 

HMo 

Comp. Au 

Jmlos 

Tllk %Diff. 

HMo 

Comp. 

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 HMO’s 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) 

Beneficiary Reaponseato 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% 9’7% +22% � 

waited less than 13 &yS. (970) (28) [.4-77) (29) —, 

When very sick, was able to 

get a doctor’s 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 bene’s 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% 

(772) (-24) (296) (12) 

b stay about the same 45% 

(649) 

45% 

(13) 

()% e 49% 

(383) 

55% 

(17) 

+6% @ 

b worsen 2% 

(32) 

0% 

(o) -2% e 

10% 

(86) 

7% 

(3 

-3% @ 

Primary HMO doctor never


failed to take beneficiary’s 88% 92% +4% e 76% 89% +13% �


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


128


03 
. Above average @ Average O Below average NS Not suffkient data 

HMO ID#H5005 Enrollees Dlsenrollees 

(N =43) (N = 41) —---— 

Beneficii Respomesto 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% 

possible (1,197) (33) (471) (23 

b holding down the 9% 5% Af% 03 ’26% 16% -lo% @ 

cost of care (120) (3) (162) (5) 

—. 

Most important to the HMO 

was: 

b giving the best 

medical care 74% 64% -lo% o 58% 61% +3% @ 

possible (1,036) (26) (387) (19) 

b holding down the 15% 22% +7% 36% 23% -13% ~ e cost of care (213) (6) (230) m 

129


03 
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) 

Beneficiary Responsesto Key Au This %Dilr. Comp. Au This %DitT. Comp. 

&uvey @leStiOIIS by Catqory EMos HMO HMOS HMO 

Was @ asked at application 

about health problems, 

excluding kidney failure and 63% 32% -31% o 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 

their minds about enrolling 88% 79% -9% o 82% 100% + 18% � 

after they applied. (1,078) (11) (611) (12) 

Did know, from the 

beginning, they must be 

referred to a specialist by 89% 81% -8% o 84% 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 HMO’s 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 Responsesto 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 doctor’s 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 bene’s 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) 

Didn’t 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% ~% e 49% ti% -23% o (649) (12) (383)

b women	 2% 3% +1% 10% 1P% +9% (32) (1) @ (86) (5) @ 

Primary HMO doctor never


failed to take beneficiary’s 88% 75% -13% o 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)

Beneficiary Reapoasesto 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% e -9% 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 Respoasesto Key Au This %Diff. Comp. Au ‘Ill& %DifF. Comp. 

Survey Questionsby Category EMos HMO lmios Info 

For scheduled appointments 

with specialists, usually 81% 73% -8% e 75% 4’7% -28% o 

waited less than 13 days. (970) (16) (477) (7) 

When very sick, was able to 

get a doctor’s appointment 93% 92% -1% e 89% 56% -33% o 

within 1 to 2 days. (942) (12) (453) ($ 

Usually Wtited less than 1 

hour in the office to see 95% 84% -11% o 87% 70% -17% o 

primary HMO doctor. (1,431) (21) (704) (16) 

Consistently busy telephone 

lines did g@ hinder bene’s making appointments.

90% 

(780) 

85% 

(11) 

-5% e 89% 

(42S) 

53% 

(8) 

-36% o

Primary HMO doctor never 

failed to provide needed 96% 100% +4% e 88% 70% -18% o 

Medicare services. (1,47s) (22) (744) (14) 

primary HMO doctor never 

failed to refer to a specialist 96% 81% -15% o 88% 67% -21% o 

when needed. (1,439) (17) (732) (14) 

Didn’tfeel 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% 

(383) 

em% 

(lo) 

-3% e 

10% 

(86) 

23% 

(5) +13% � 

Primary HMO doctor never


failed to take beneficiary’s 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) 

BenefickuyResponsesto 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% e 26% 63% +37% � 

cost of care (120) Q) (162) (lo) 

Most important to the HMO 

Wm: 

b giving the best 

medkal care 74% 60% -14% o 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 

. Above average @ Average o Below average NS Not suftlcient data 

HMO ID # H 9037 Enrollees DMenrollees 

(N = 41) (N = 34) —. .. . .. 

Beneficiary Reapoasesto 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 

their minds about enrolling 88% 93% +5% e 82% 67% -15% o 

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 HMO’s 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

� Above average @ Average o Below average NS Not stilcient data 

HMO ID #: H 9037 Enrollees Dnenrolkes 

(N= 41) ..—. (N = 34)

Beneticii Reapooaesto 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 doctor’s 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 bene’s 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) 

Didn’t 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% 

(649) 

50% 

(18) 

+5% e 49% 

(383) 

47% 

(8) 

-2% e 

b worsen 2% 

(32) 

o% 

(o) -2% @ 

10% 

(S6) 

6% 

(1) 

~% 

e 

Primwy HMO doctor never


failed to take beneficiary’s 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) 

Beneficiary Reapoaseato 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 

cost of care 

15% 

(-213) 

9% 

(3) 

-6% o 36% 

(230) 

50% 

(9) + 14% (e 

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&imyResponsesto 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 

care and urgent care outside 96% 86% -lo% o 93% 93% o% @ 

the service area.) (1,585) (37) (958) (26) 

Did know they had the right 

to appeal an HMO’s 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 

Survey Queatioosby Category 

Au 

EMos 

This 

HMO 

%DM. Comp. Au 

HMos 

This 

HIWo 

%DitT. Comp. 

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 doctor’s 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 

primary HMO doctor. 

95% 

(1,431) 

95% 

(38) 

o% (B 87% 

(704) 

86% 

(19) 

-1% e 

Consistently busy telephone 

lines did @ hinder bene’s 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) 

Didn’t 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) 

b worsen	 10% 9% -1% 

(86) @ e 

Primary HMO doctor never


failed to take beneficimy’s 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) —. 

Beneficiary to Key Au 

SurveyQuestionsby Category Eblos 

This 

mklo 

%Diff. Comp. m 

EMos 

This 

HMo 

%Difr. Comp.

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 

their minds about enrolling 88% 79% -9% o 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 HMO’s refiuud 74% 90% + 16% e 67% 82% + 15% e 

to providelpay for services. (1,113) (28) (523) (23) 

Responses

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 

making

HMO ID #: H 9049 Enrolk DMenrollees 

(N= 39) .— (N =37)

BenefieisqResponsesto Key 

Survey Queafionsby Category 

Au 

EMos 

This %Diff. 

HMO 

Compa An 

—. HMos

This %DitK 

HMO

Comp. 

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 doctor’s 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 

lines did ~t hinder bene’s 90% 95% +5% @ 89% 73% -16% o

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) 

Didn’t 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% 

(383) 

62% 

(18) 

+ 13% @ 

10% 

(86) 

7% 

(2) 

-3% e 

Primary HMO doctor never


failedto take beneficiary’s 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) -.. —--

BmefkiaryResponsesto 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% 

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 

cost of care 

15% 

(X3) 

7% 

@) 

-8% o 36% 

(-230) 

19% 

(5) 

-17% @ 

144


03 
ENDNOT.EM —. ... .


1.	 Wg selected a stratifkl random sample from H(XA’S 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 

HCFA’S ~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) (41Hh’los) 

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 HMO’s 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. (45Hb’ios) (39HMos) 

A -1 
HMOS by Enrollees HMOS by Dkenrollees —— ,. 

BenefkiaryResponsesto 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 doctor’s 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 bene’s 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. (45Hb’los) (40HMos) 

Primary HMO doctor never 

failed to refer to a specialist 96% 4% 81% 100% 88% 10% 62% 100% 

when needed. (45HMos) (40HMos) 

Didn’t 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) (41Hh’los) 

b worsen 10% 11% o% 40% (40HMos) 

Primary HMO doctor never 

failed to take beneficiary’s 88% 6% 75% 97% 76% 12% 41% 100% 

health complaints seriously. (45HMos) (41Hh’los) 

Most important to primary 

HMO doctor was: 

k giving the best 86% 6% 69% 96% 72% 17% 33% 100% 

medical care possible (45 HMOE) (40 HMos) 

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 Reaponseato Key Meanof S. D. LOweat Eigbeat ~eao of S. D. Lowest Highest 

SurveyQoeatioIIsbyCategory 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 m’los) 

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 couldn’t have asked for better service than I got 

from the HMO. But when the rates went up, I just didn’t have the money to stay in or I 

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 today’s highly specialized ‘Big Dollar’ 

machines. However, financially this is no longer an option. ” 

“I don’t 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 I’m 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 can’t afford the cure?” 

“... you receive more value for the money you spend for services. I like their emphasis on 

preventive medicine. The only negative I’ve seen.. .is that it’s 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 didn’t 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 

~ couldn’t] take generic drugs. ” 

“There were too many don’ts in coverage. I did not know the restrictions when I fwst 

signed up. ” 

“MI health maintenance plans are so complicated for elderly people. Don’t 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. ” 

“I’ve only had my physical exam, but there’s 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 one’s health. I don’t mean the doctors or staff. It’s 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. ” 

— 

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B-5