Insurers' report cards to allow comparisons

Health insurers have always known a lot about their customers, but the customers can't always say the same about their insurers.

That's about to change.

The California Department of Insurance today plans to announce a new "healthcare report card" program for six of the state's largest preferred provider organizations, or PPOs. The reports will include information on quality of care and patient satisfaction so that consumers can compare plans.

Insurance Department officials say the program, which is voluntary and will begin in early 2009, is the first of its kind in the country.

Similar data already are available for health maintenance organizations, a result of demands by California and other states in response to widespread complaints from consumers who said they were being denied care.

But those reporting guides haven't included the two-thirds of insured people who are covered by PPO health plans.

Unlike closed-network HMOs, PPO plans provide members who visit out-of-network doctors and hospitals a discount off the regular rates.

"This is the first time in the country that . . . people with PPO plans will be able to get data on how good their policy really is," California Insurance Commissioner Steve Poizner said.

While calling the announcement a step in the right direction, some advocates say insurers will need to do a lot more before they can be considered truly transparent.

"We welcome any involvement on the part of the state to monitor the insurance industry more aggressively, which is something it has long failed to do," said William Shernoff, a partner in Shernoff, Bidart & Darras of Claremont, which specializes in consumer insurance cases.

But, he said: "This is like a Band-Aid that won't do anything about problems like insurers denying care or pulling people's coverage for no reason."

Poizner acknowledged that the health insurance industry needed more oversight and said the new reporting program was the first in a series of measures he planned to take. He said the details of the new reporting program were still being finalized.

Broadly, he said, the report cards will assess how well doctors in each insurance network follow best-practices guidelines, such as providing childhood immunizations and giving at-risk patients regular cancer screenings, and how well they rate on patient satisfaction surveys.