California Office of the Patient Advocate

Provides report cards on health insurance plans and medical groups, information on which insurance plans offer services in eight languages, tips on how to use your health plan, health care reform news, consumer alerts and more.

National Committee on Quality Assurance

Provides rankings of health insurance plans, health policy news and health publications.

After getting over the sticker shock, the next question is, which one?

For many people with job-based health insurance, fall is open enrollment season — when they may choose between several plans offered by their employer.

Insurers are raising rates by as much as 20 percent this year, prompting employers to switch plans to find better deals. That means workers may be picking among new and unfamiliar options.

And because of the increased rates, some companies are offering plans with higher deductibles or asking employees to pay a larger share of the premium.

Consumer advocates warn that employees should pick insurance plans based on more than just cost.

“We want consumers to do more comparison shopping based on quality and customer service,” said Anthony Wright, executive director of Health Access California, a statewide consumer advocacy organization. “The question is how to make that real.”

Two well-respected reports that grade managed health insurance plans according to national standards of care can be helpful tools.

The nonprofit National Committee for Quality Assurance recently issued its annual Health Insurance Plan Rankings, which will be published today in Consumer Reports. Formed in 1990, NCQA is the primary group that sets measurement standards for health insurance and accredits plans.

It has issued the rankings report annually since 2005.

California’s Office of the Patient Advocate issued its annual Health Care Quality Report Card in February. The Office of the Patient Advocate and the state Department of Managed Health Care were created in 2000 to regulate managed health care plans and protect consumer rights.

The NCQA report uses 49 measures, while the state ratings use 30 measures from the national standards. Both reports incorporate results from standardized surveys of consumer views about their insurance plans.

The measures are specific: Did asthma patients receive the correct medication? Did diabetics get eye exams? Did patients diagnosed with substance-abuse problems receive follow-up care within 30 days?

“Quality varies, health care is not equal,” said Andy Reynolds, spokesman for the National Committee for Quality Assurance, which ranked 227 health plans across the country. “Our job is to measure and report on the American health care system and its quality. This is important for consumers, especially this time of year, with people choosing health plans during open enrollment.”

A health plan must agree to provide data for the rankings. Some smaller plans, such as Sharp Health Plan, did not participate.

Both reports compared nine California health plans, including seven that are available in Southern California.

In both the state and NCQA ratings, Kaiser Foundation Health Plan of Southern California and Kaiser Foundation Health Plan of Northern California ranked highest for the state.

Kaiser Southern California ranked 31st among the 227 plans evaluated nationwide.

Wright said rankings by the national organization can be useful, but California consumers also should consider ratings from the state Office of the Patient Advocate.

“NCQA is where a lot of people start, but we don’t necessarily want them to end there,” he said.

While both ratings systems give solid information, the California study also rates health plans on how well they meet state access laws.

In addition to laws requiring access to care for disabled consumers, California has mandated since 2008 that health plans provide customers with providers who can meet their language or cultural needs.

For someone who uses a wheelchair or speaks a foreign language, Wright said, their top priority may be picking a plan with a doctor whose office is easy to get to or who speaks their language.

“California was first in the nation to require plans to provide culturally and linguistically appropriate access to care,” he said. “The idea is that if you are agreeing to a limited network, part of the terms of the contract is that the HMO will provide access to medical care that meets your needs.”

Sandra Perez, director of the California Office of the Patient Advocate, agreed.

“The report card helps people make a choice based on quality and value,” she said. “But quality depends on each consumer’s needs. If I’m diabetic, I should drill down immediately on those measures to help choose a plan.”

She recommended that consumers choose their health insurance plans by identifying their needs and their family’s specific health care priorities, then visiting the state Office of the Patient Advocate website to pick a plan by balancing cost with the quality and services it offers.

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