Hospital Quality a Factor, but Price, Network Size Key

Quality of care isn’t a deal clincher for companies choosing workers’ health coverage, according to insurance brokers and consultants.

It’s cost and network size that are the ultimate keys, though quality “is going to become more important (in the future),” said Ron Mason, health and welfare practice leader at consultant Towers Perrin Tillinghast’s Irvine office.

Mason expects report cards and other quality measurements to become more important as the “consumer-driven” healthcare concept takes off.

But providing information on hospital quality is necessary to help employers change how they deliver health plans, Mason said. He also said that getting quality information out to workers would help in making them more accountable.

For Karen Nixon, a Corona del Mar insurance broker, clients tend to see a hospital network’s breadth as a factor, as well as perceived quality, in picking a health plan. Nixon’s clients, she said, want enough hospitals in their network to give their workers choices for where they can go for treatment.

Quality measurement topics have been thrown about in healthcare for the better part of 10 years, but are gaining more attention thanks to the nascent “healthcare consumerism” movement. Healthcare consumerism aims to get workers to buy health services based on price and quality, similar to what is done in other segments of the economy.

If that happens, poor performing and overpriced healthcare providers could be weeded out, which in turn could help cut rising healthcare costs, observers said.

So various groups, including health plan operators such as Cypress-based PacifiCare Health Systems Inc., the Joint Commission on Healthcare Accreditation, Health Grades Inc., Leapfrog Group, Pacific Business Group on Health and even U.S. News and World Report, are rushing to supply information about hospital and doctor quality.

A recent example comes from Health Grades, which released a report card on stroke care in U.S. hospitals. The Lakewood, Colo.-based consultant used mortality data from the federal government to come up with its ratings.

Two local hospitals that received top five-star grades for their stroke care: Long Beach-based Memorial Health Services Inc.’s Orange Coast Memorial Medical Center in Fountain Valley and Santa Barbara-based Tenet Healthcare Corp.’s Fountain Valley Hospital Regional Medical Center.

Orange Coast uses rankings as part of an overall quality initiative that involves working with its physicians, said Marcia Manker, the hospital’s chief executive.

“We use these reporting tools as a guide that we can track our progress against,” Manker said. “Do I like having a five-star designation? You bet, but regardless of the score we get in any of the surveys, we’re always going to strive to improve.”

Meanwhile, UCI Medical Center, a teaching hospital in Orange, landed a berth on U.S. News