Interested in getting a doctor’s appointment quickly? Perhaps consider a CareFirst insurance plan.
Worried about specific treatments after a heart attack or care for a child with a common cold? Aetna or Mid Atlantic Medical Services plans might be a good fit.
For the first time, Maryland patients who have PPO (preferred provider organization) health insurance plans can evaluate individual companies in certain areas, such as breast cancer screening and patient satisfaction.
The Maryland Health Care Commission’s annual report on health care plans included evaluations of four PPOs, and Maryland is the first state to measure and report on PPOs, according to the commission.
The report, which also evaluates seven HMOs, is designed to help consumers and employers choose the best health plans. HMO (health maintenance organization) plans are required to report to the commission, but PPOs are not.
More Americans are “slowly but surely transitioning” to PPO plans rather than HMO plans, said Bruce Kozlowski, director of the Center for Health Care Financing and Health Policy at the commission.
HMOs tend to cost less, but provide less flexibility, because patients’ care is managed through a primary care physician. PPO plans let patients can choose any provider, Kozlowski said.
“It’s a matter of finding something that meets your price point but also meets your lifestyle,” he said.
In Maryland, 1.4 million people, or 26 percent, are enrolled in an HMO, according to a review from the Kaiser Family Foundation. Nearly 67 million Americans use an HMO.
Sixty-six percent of Americans with health insurance are enrolled in a PPO, according to the American Association of PPOs.
The state commission is phasing in the areas of evaluation for PPOs, because officials may need to tweak the criteria, said Joyce Burton, the commission’s chief of health plan quality and performance.
Including PPOs “meets the market’s demand,” said Dr. John Shematek, senior vice president and chief medical officer for CareFirst, which provided information on its BluePreferred PPO plan.
Collecting data for PPOs can be more difficult, because information from inside and outside the plan’s network of providers isn’t compiled, said Walt Cherniak, Aetna’s spokesman.
The annual evaluation encourages all health plan providers to improve their services, officials said.
“There is value in the process as well,” Cherniak said, “in looking for gaps and things we aren’t doing as well or where the perception is.”
