High marks for North Coast health plans

Local physician groups and health plans once again scored high marks on a state health care quality report card intended to help consumers better choose the right doctor and health plan.

The report card, generated by the state Office of the Patient Advocate, gave Sonoma County’s three major medical groups ratings of “good” or “excellent.”

The three are Sutter Medical Group of the Redwoods; Meritage Medical Network, which partners with Annadel Medical Group; and the Permanente Medical Group, which is affiliated with Kaiser Permanente.

The Kaiser-affiliated medical group pulled a four-star excellent rating this year on a ranking assessing whether it is providing the recommended level of care. That’s an increase of one star from last year’s three-star grade in provided recommended care, which is based on medical and patient claims records.

The Sutter-affiliated medical group received a four-star rating in another key category, where surveyed patients rate their medical group. Meritage received three-star ratings for both categories.

The OPA report card, released last week and available at www.opa.ca.gov/pages/reportcard.aspx, also contains statewide rankings for health insurance plans. Kaiser Permanente’s Southern and Northern California HMO offerings were the only plans that scored a four-star excellent rating.

Kaiser’s Northern California HMO, which covers 24 counties including Sonoma, Napa and Marin, achieved four-star ratings in every category but behavioral and mental health care. The HMO has recently drawn criticism from some patients and mental health advocates over the level of service it provides to members. But the HMO still rated a three-star “good” in the behavioral and mental health care category.

Dr. Lynn Mortensen, assistant physician in chief for health promotion at Kaiser Permanente Medical Center in Santa Rosa, said Kaiser’s enviable health care rankings are the result of an intricate internal system of tracking every patient medical service and health outcome. Mortensen, a family physician, said the system involves the participation of a number of Kaiser employee, including health educators, medical assistants and physicians.

“I know that’s why we’re able to achieve the excellent ratings,” Mortensen said. “You can’t achieve excellence without having both a culture and a system to support that success.”

Mortensen said the report card is a useful tool for assessing a medical group’s performance.

“I like the fact that we can really measure what we’re doing based on quality standards, “she said. “We can know for that whole group.”

The Office of the Patient Advocate uses a variety of sources to derive its medical group and HMO rankings. Patient survey data comes from the California Healthcare Performance Information System and the nationally recognized Consumer Assessment of Healthcare Providers and Systems.

Clinical performance data for both medical groups and HMOs comes from the Healthcare Effectiveness Data and Information Set, or HEDIS, which is derived from medical records, claims records and other health care administrative files.

The state ratings are aimed at giving consumers useful information when choosing the right health plan and medical provider. In the report card, medical groups and HMOs are given a ranking of one to four stars, with one star designating a poor grade. Two stars are fair, three stars are good and four represent an excellent score.

The OPA released this year’s report card just one month before the Nov. 15 open enrollment date for individuals and families looking to buy health insurance on the statewide health care exchange.

But the report card also is an effort to remind local medical groups and insurance plans where specific improvements can be made, said Barbara Marquez, the office’s deputy director.

“We always say you can’t improve what you don’t measure,” Marquez said.

Marquez said that with ratings of 3 to 4 stars, Sonoma County medical groups performed extremely well, overall. She said there are some counties where the OPA is handing down one- and two-star grades.

Gary McLeod, president and medical director of quality for Sutter Medical Group of the Redwoods said its four-star grade for how patients rate their medical group reflects an ongoing effort to ensure patient satisfaction.

“We view that as a service to our patients,” he said. “We view that as the distinguishing element of our medical group.”

McLeod pointed out that according to the patient survey data used by OPA, of the 19 Bay Area medical groups - seven of which are affiliated with Kaiser and three are affiliated with Sutter - Sutter’s Redwoods group was rated highest for overall health care.

“Those same patients rated our office staff as number one,” McLeod said. “We put a strong emphasis in putting patients first in all interactions.”

Meritage Medical Network, which partners with 150 medical groups and providers across a number of counties including Marin, Napa and Sonoma, was able to achieve a number of three-star rankings. Meritage CEO Joel Criste said his organization partners with Annadel Medical Group, Northern California Medical Associates and just about every other Sonoma County medical group not affiliated with Sutter or Kaiser.

The network must work even harder to make sure physicians in the different groups are able to communicate with each on patient care.

“We do put a lot of effort into coordinating information between the different practices,” Criste said.

The report card allows consumers to dig deeper into specific categories of health care, such as asthma care, checking for cancer, chlamydia screening, diabetes care and heart care.

For example, in asthma care, the Permanente Medical Group in Santa Rosa increased its ranking this year from fair to a three-star good grade. Sutter dropped from a four-star excellent rating to a good ranking.

In the “checking for cancer” category, both Sutter and Kaiser local medical groups increased their ranking from three to four stars. Under heart care, Kaiser went from three to four stars and Sutter went from two to three stars.

There are also rankings for non-clinical categories, such as communicating with patients; coordinating patient care; health promotion; and helpful office staff.

Kaiser’s Dr. Mortensen said modern health care metrics used to track a medical group’s performance has greatly altered the health care industry.

“It’s revolutionary,” she said. “Before in private practice, I didn’t have any way to know who wasn’t getting what they needed. … I didn’t get feedback on my performance. All you could do is do your diligent best to assess what they needed.”

Now, she said, every health care worker who comes into contact with the patient is “connected to the quality goals and knows how to achieve those goals.”

The OPA’s report card webpage also includes rankings for statewide PPOs, as well as links to report cards for other health insurance coverage, such as Medi-Cal managed care plans, Medicare physician groups, hospital and longterm care facilities and CalPERS members’ health plans.

You can reach Staff Writer Martin Espinoza at (707) 521-5213 or ?martin.espinoza@pressdemocrat.com. On Twitter @renofish.