Most California insurers fail to control chronic conditions


Although California health insurers and their contracted doctors are successfully monitoring the care of members with chronic conditions, they're failing to control those conditions, which leads to higher costs and healthcare spending, a recent report finds.

The California Office of the Patient Advocate said insurers' networked doctors, on average, effectively monitor the blood sugar and cholesterol levels of between 82 percent and 91 percent of their patients with diabetes or heart disease. But they only effectively control these conditions in 44 percent to 67 percent of the patients, according to the report card.

For example, only 64 percent of Kaiser Permanente's members with asthma received the right combination of medications to help control the disease, compared with a national average of 83 percent.

"The report cards reveal a significant performance gap between monitoring the care of their patients with diabetes and heart disease and successfully controlling these chronic conditions," Amy Krause, director of the Office of the Patient Advocate, said Tuesday in a statement accompanying the report. "The quality of care for patients with diabetes or heart disease, while improving on some measures, varies widely in California and often depends on where someone lives or which HMO, PPO or medical group is providing care."

The California Association of Health Plans highlighted the report's findings that insurers received high ratings for providing recommended care. The report shows "health plans and doctors are effectively monitoring care, but controlling chronic conditions like diabetes is a three-way partnership between individuals, doctors and plans," CAHP CEO Patrick Johnston said Tuesday in a statement.

To learn more:
- here's the OPA statement and report card (.pdf)
- read the CAHP statement (.pdf)

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