HMOs Criticized Over Refusal to Give Data

SACRAMENTO â€”  Some of the largest health maintenance organizations in California are drawing fire from minority activists for refusing to give state regulators information about services provided to patients who don’t speak English.

According to regulators, Blue Shield of California Inc., Cigna Healthcare of California Inc. and Aetna Inc. -- with a total of 3.4 million Golden State members -- declined to voluntarily submit the data to the Office of the Patient Advocate. Western Health Advantage, a smaller Sacramento-based HMO, also declined.

The state agency, which serves as an ombudsman for HMO consumers, had requested information on the efforts of HMOs to provide translators and other foreign-language help to their patients as part of its annual HMO Quality of Care Report Card, to be released today. Twenty-four other California HMOs submitted information for the so-called cultural-linguistic rating.

The refusal by the three large plans, representing about 13% of California HMO members, “sends the wrong message to the non-English-speaking community,� said Patricia Diaz, policy director of the Latino Coalition for a Healthy California in Sacramento. She said one-third of all Californians and half of Los Angeles County residents speak a language other than English at home.

Diaz’s group, which lobbies for better healthcare for immigrants and their families, joined seven similar organizations in denouncing the four HMOs that refused to file data on foreign-language services. The other groups include the Pan-Ethnic Health Network, the Western Center for Law and Poverty and the Asian & Pacific Islander American Health Forum.

Leanne Gassaway, vice president of the California Assn. of Health Plans, an HMO trade group, said her members have made strong commitments to serving non-English-speaking patients. She said most of the health plans, including those who voluntarily turned in the language information, had qualms with the methodology of the state survey.

“It’s important for consumers to get accurate information,� Gassaway said.

She said the HMOs, during months of negotiations, asked the Office of the Patient Advocate to stick with the system it used in last year’s report card, which listed specific services available from each health plan. This year, regulators insisted on distilling the information into a simple chart, featuring upward- and downward-pointing arrows that indicate whether a plan’s cultural-linguistic services are average, above average or below average.

Such a scheme has “intrinsic flaws,� said Gwyn Dilday, a spokeswoman for Cigna. Noelle Debortole, assistant to the chief executive of Western Health Advantage, complained that the rating system was skewed against small plans. Rachelle Cunningham of Aetna said her company had “concerns about the criteria� and how the state would present its findings.

Patrice Smith, spokeswoman for Blue Shield of California, said the plan regretted that it didn’t submit information to the state and would do so next year.

Ed Mendoza, the Office of the Patient Advocate’s acting director, defended the methodology, noting that it was based on three years’ worth of data and had been developed by Leo F. Estrada, an expert in racial and ethnic demographic trends at UCLA.

The new rating system measures an HMO’s “relative effort� in providing a quantity and range of services, Mendoza said. “We acknowledge it’s not perfect, and we’re continuing to refine it, but I think it’s a reasonable first step,� he said.

Creating the new rating system is consistent with the goal of the Office of the Patient Advocate and its sister agency, the Department of Managed Health Care, “to provide consumers with as much information as we can,� Mendoza added.

The foreign-language component of the HMO report card, although a work in progress, is a useful tool to make HMOs accountable to customers, said Daniel Zingale, a former Managed Health Care director.

“We’ve learned that you cannot reform the HMO system without shining a light on the performance of the HMOs,� he said. “That’s true in the operating room and the waiting room and in how we can better communicate with our patients.�