It's never been easy to shop for an HMO. Many of them release information selectively, and standardized "report cards" are still in the development stages.
Now there's help from an unlikely source. A.M. Best Co., which has been rating the financial soundness of insurance companies for years, began evaluating HMOs early last year. It now provides ratings for 55 affiliates of eight HMO groups, plus 14 Blue Cross and Blue Shield organizations with HMO affiliates.Although its intent is to gauge financial stability, along the way Best evaluates key consumer issues, such as how an HMO approaches preventive care and what credentials it requires of participating physicians.
To measure an HMO's financial strength, Best assesses how it balances services against costs - reviewing, for instance, how often doctors see patients and how many days members stay in the hospital. It also considers how many new members are signing on and how many old ones are leaving- an indication of how satisfied you might be with the plan.
But no financial picture would be complete without an assessment of the product itself: the medical care. To gauge quality, Best reviews such measures as the immunizations and preventive screenings an HMO provides. It also monitors its progress in seeking accreditation from an independent organization.
Of the HMOs rated so far, none received Best's top (A-plus-plus) rating, but four won an A-plus: Chicago HMO Ltd. and Share Health Plan of Illinois Inc., both affiliated with United HealthCare Corp.; Healthcare Service Corp. (Illinois), a Blue Cross and Blue Shield plan; and PacifiCare of California, an affiliate of PacifiCare Health Systems.
Almost all the others fell between A-minus ("strong") and B-plus-plus ("very good"). Participation was voluntary, and many HMOs sought a rating to gain a competitive edge.
You can take a look at current ratings by checking your library for Best's Managed Care Reports - HMO.