Correspondence

HMOs: The Good and the Bad

N Engl J Med 1998; 339:1242-1243October 22, 1998

Article

To the Editor:

Mr. Kuttner is seriously misinformed when he describes the Health Insurance Plan of Greater New York (HIP) as “notorious for poor management” (May 21 issue).1 HIP is led by chairman and chief executive officer Anthony L. Watson, who is a presidential appointee to the recently formed National Commission on the Future of Medicare. HIP received the 1998 Sachs Group seal of excellence for health care consumer loyalty. HIP was 1 of only 16 health maintenance organizations (HMOs) nationwide to receive the award.

During its 50th anniversary in 1997, year-long attention was focused on HIP as one of the nation's leading HMOs. Before Mr. Watson's presidential appointment, the National Committee for Quality Assurance granted HIP full accreditation for three years. HIP was ranked first in the New York metropolitan area in patient care, doctor training, and member satisfaction by U.S. News and World Report in its 1997 national survey. A 1997 survey of Medicare HMOs by CareData Resources ranked HIP first in New York. The mayor of New York City, Rudolph Giuliani, honored HIP for its leadership in forming and helping to fund an alliance with Victim Services to establish a program to identify and provide medical services and social referrals to victims of domestic violence.

HIP was ranked second among 11 HMO plans in New York State by health care purchasers surveyed by Watson Wyatt Worldwide, one of the world's leading human-resources and risk-management consulting companies. The study, “Measuring Value: 1997 Tri-State HMO Valuation,” was based on purchasers' experience in 1996. The study noted that the purchasers gave HIP the second-highest relative value score primarily on the basis of their perception of HIP's quality and provider reimbursement. HIP was one of only three HMOs to join with the American Association of Retired Persons in calling for increased regulation of managed health care, because it believes that all health plans should be subject to legally enforceable national standards.

HIP is a not-for-profit, prepaid group-model HMO. The groups are privately owned by the physicians who practice together in state-of-the-art medical centers. HIP contracts with the groups to provide its members with comprehensive health care. To offer its members greater choice and an even wider selection of physicians, HIP has built an expanded health care delivery system of 12,000 to 14,000 qualified physicians who practice out of their own offices. In addition to its plan in New York, HIP has developed highly rated health plans in New Jersey, Pennsylvania, and Florida.

Mr. Kuttner owes HIP an apology.

Daniel T. McGowan
Health Insurance Plan of Greater New York, New York, NY 10001

1 References

1. 1

   Kuttner R. Must good HMOs go bad? The commercialization of prepaid group health care. N Engl J Med 1998;338:1558-1563
   Full Text | Web of Science | Medline

Author/Editor Response

Mr. Kuttner replies:

To the Editor: Different HMO rankings produce different results. HIP does not score as well as most nonprofit HMOs on many rankings. Its Health Plan Employer Data and Information Set (HEDIS) statistics are mixed; HEDIS scores HIP below the national average on patient satisfaction. Consumers Union's most recent member survey of HMOs gave HIP an overall rating of 65, on a scale that ranged from 61 to 85. New York State's assessment scored HIP above average in a few categories, but well below average in several others that should be among the strengths of a nonprofit HMO, such as childhood immunizations, first-trimester prenatal care, and some types of cancer screening. The report of the New York City public advocate found that HIP had the worst record on unresolved patient complaints; it ranked HIP last among 12 HMOs on telephone access, and 9th on spending on physicians per member.

Yes, HIP did score well on some rankings, and it may well be that HIP's management is on an upswing. In fairness, I do regret that my mention of HIP was so abbreviated. I did not have space to do a complete profile of every HMO and simply wanted to suggest in this context that the quality of management of both for-profit and nonprofit HMOs varies, but I should not have been quite so categorical about HIP in so few words.

Robert Kuttner
, Cambridge, MA 02138