NCQA/Consumer Reports 2010 HMO Rankings

By Clive Riddle, October 7, 2010

NCQA has released its rankings of HMO and Point of Service plans around the nation for 2010, via Consumer Reports.

According to NCQA, themeasures and methodology used to rank plans did not change from 2009. Details on the methodology and guidelines are listed at .

Below are the top ten ranked private plans (excluding Medicaid and Medicare plans). You will note that regional and non-profit plans (vs. national for-profit) and integrated plans are well-represented.

NCQA 2010 National Ranking of HMOs: Top Ten Private Plans

  1. Harvard Pilgrim Health Care (MA, ME)
  2. Tufts Associated Health Maintenance Organization (MA, RI)
  3. Harvard Pilgrim Health Care of New England (NH)
  4. Capital Health Plan (FL)
  5. Geisinger Health Plan (PA)
  6. Grand Valley Health Plan (MI)
  7. Group Health Cooperative of South Central Wisconsin (WI)
  8. Fallon Community Health Plan (MA)
  9. Kaiser Foundation Health Plan of Colorado (CO)
  10. Health New England (MA)


Source: Consumer Reports: The 2010 rankings of HMOs from the National Committee on Quality Assurance

Source URL:

Notes: Private plans exclude Medicaid and Medicare.  This year, the NCQA ranked 227 HMOs and point-of-service plans with a total enrollment of about 42 million. Not all HMOs are on the list; some do not submit data to the NCQA, or submit insufficient data, and others decline to make it public.


Kaiser Permanente Goes “Open Source” With Their Internal Medical Terminology

by Clive Riddle, October 1, 2010

In Meaningful Use news, Kaiser Permanente has announced that they are donating their “Convergent Medical Terminology (CMT) to the International Healthcare Terminology Standards Development Organisation (IHTSDO©) for U.S. distribution through the U.S. Department of Health and Human Services (HHS) so that all health care providers—large and small—can benefit from the translation-enabling technology.”

The stated objective is to make KP’s experience and formerly proprietary system available to help U.S. health professionals and hospitals achieve key meaningful use standards set forth by the Office of the National Coordinator of Health IT and the Center for Medicare and Medicaid Services.

HHS Secretary Kathleen Sebelius has commented that “one of the key challenges to achieving a coherent health record for every U.S. consumer is the need for consistent data across all systems and institutions. This donation of the Convergent Medical Terminology from Kaiser Permanente addresses that critical need by making it easier for health professionals and patients to create standardized data in electronic health records."

Jack Cochran, MD, Executive Director of The Permanente Federation added that “utilizing a common terminology that translates complex medical concepts into language that is both clinician- and patient-friendly has helped us coordinate teams, improve the quality of care for our patients and enhance efficiency in our organization. We would like to share the tool we developed with the country."

Kaiser’s system involves “the production of structured health data by creating and linking clinician- and patient-friendly terminology to the health data standards now required for U.S.-wide use. The Convergent Medical Terminology[CMT] has been developed by clinicians and technologists over many years. It is in active use to document thousands of patient encounters every day.”

Kaiser Permanente's CMT donation incorporates the following:

  • terminology content KP has already developed
  • a set of tools to help create and manage terminology,
  • processes to control the quality of terminology that is developed.
  • mappings to classifications and standard vocabularies, such as the Systematized Nomenclature of Medicine – Clinical Terms (SNOMED CT©) already accepted by U.S. and international health policy makers

Kaiser provided the following additional information about their CMT system:

  • CMT is used in the underlying architecture of Kaiser Permanente's HIT systems to support data flow between health care providers. It provides mapping to standardize the use of terminology and ensure systems, some already in use in most U.S. medical offices, can talk to each other effectively. The utilization of CMT will support a common set of medical concept descriptions so that one doctor's diagnosis can be reconciled with another's. CMT includes the key taxonomies required for stage one of the Meaningful Use program such as problem list sets in SNOMED CT. Thus, it can help clinicians map to the standards set forth by the Office of the National Coordinator of Health IT and the Center for Medicare and Medicaid Services.
  • CMT is a core component of Kaiser Permanente's comprehensive electronic health record, KP HealthConnect®, helping physicians communicate with their patients more clearly. KP HealthConnect is the world's largest private electronic health record, connecting more than 8.6 million people to their physicians, nurses, and pharmacists, personal information, and the latest medical knowledge.
  • CMT is also utilized by Kaiser Permanente's personal health record, My Health Manager, on so that patients can get a better understanding of their medical care. My Health Manager provides patients with secure, timely access to their lab test results, medication information and refill capabilities, summaries of their health conditions, and other important health information at just the click of a mouse. The technology empowers patients to manage their health by allowing them to access health information and tools and securely e-mail their doctor.

World Alzheimer's Day- September 21st

by Clive Riddle, September 21, 2010

In observance of World Alzheimer's Day, Alzheimer’s Disease International has issued the World Alzheimer Report 2010. Here’s ten quick facts we gathered from the report:

  1. There are 35.6 million people living with dementia worldwide in 2010
  2. The total estimated worldwide costs of dementia are US$604 billion in 2010
  3. Total dementia costs account for around 1% of the world’s gross domestic product
  4. The total estimated worldwide costs of dementia are US$604 billion in 2010
  5. Direct medical costs account for 16% of total dementia costs
  6. Direct social care costs account for 42% of total dementia costs
  7. Costs of informal care (unpaid care by families, etc.) account for 42% of total dementia costs
  8. About 70% of worldwide dementia costs occur in Western Europe and North America
  9. If dementia care were a country, it would be the world’s 18th largest economy, ranking between Turkey and Indonesia
  10. If dementia were a company, it would be the world’s largest by annual revenue, exceeding Wal-Mart (US$414 billion) and Exxon Mobil (US$311 billion).

Dr Daisy Acosta, Chairman of Alzheimer’s Disease International tell us,. "this is a wake-up call that Alzheimer’s disease and other dementias are the single most significant health and social crisis of the 21st century. World governments are woefully unprepared for the social and economic disruptions this disease will cause."

Here, verbatim, is what the report recommends at this point in time:

  • Governments worldwide should act urgently to make Alzheimer’s disease a top priority and develop national plans to deal with the social and health consequences of dementia. Several countries have moved forward to develop national plans, including France, Australia and England. It is critical for other governments to follow suit.
  • Governments and other major research funders must increase research funding to a level more proportionate to the economic burden of the condition. Recently published data from the UK suggests that a 15-fold increase is required to reach parity with research into heart disease, and a 30-fold increase to achieve parity with cancer research.
  • Governments worldwide must develop policies and plans for long-term care that anticipate and address social and demographic trends and have an explicit focus on supporting family caregivers and ensuring social protection of vulnerable people with Alzheimer’s disease and other dementias.
  • The scale of what is facing us elevates this to a global challenge, which must be addressed as a top WHO priority and on the G-20/G-8 agenda.

Analytics in the People's Republic of China

By Clive Riddle, September 17, 2010

 This week, the National Predictive Modeling Summit was held in the Washington DC area. During the Thursday afternoon workshop on International Analytics issues, Rong Yi, PhD, Senior Consultant at Milliman, Inc. gave a presentation on Predictive Analytics and the People's Republic of China.

Here’s some of what Rong had to share on health care and analytics in the People's Republic:

  • 22% world’s population, 2% world’s health care resources.
  • China’s health care spending is 4.7% of GDP.
  • 2/3 of the population are in the rural area, supported by only 20% of health care resources.
  • Chronic conditions account for 80% of deaths in China
  • Hypertension: 18.1% of population (160 mil), increased by 33% in 10 years.
  • Diabetes: 9.7% (92 mil) adult diabetes, 15.5% (148 mil) prediabetes.
  • Overweight and Obesity: 8.1% children age 7-17, 22.4% adults
  • 14 different ministries and commissions are involved in China’s public health and healthcare policymaking
  • Rural Coverage: the New Cooperative Medical System started in 2003,  with 100% reach at village level as of 2010
  • Urban Coverage: Workers medical insurance started in 1998; Residents medical insurance started in 2007
  • Private insurance: Chinese insurers dominant, foreign insurers 5% in market share; Starting in 2011 foreign insurers are allowed to enter the China market for individual and group health insurance
  • Reform includes an investment of 2,000 new hospitals in 2009-2012; 3,700 new community health services centers, and 11,000 new community health services stations
  • State of Predictive Analytics:  (1) No claim-based predictive modeling at the present time; (2) commercial use of scoring methods and HRA tools include-  HRA research committee under China’s CDC, Proprietary HRA tools developed on China’s data, and specific scoring tools, e.g., ICU scoring systems, disease-specific scoring; (3) Disease risk prediction models based on health screening data on large population in which long term risks are modified using long-term factors such as lifestyle and behavioral factors (smoking, exercise)

Workers Comp: Medical Benefits Slice of the Pie is now the biggest

by Clive Riddle, September 10, 2010

The National Academy of Social Insurance (NASI) has just released a 112 page report: Workers Compensation Benefits, Coverage and Costs 2008 which provides  comprehensive data on workers' compensation cash and medical payments for the nation and for each state, the District of Columbia, and federal programs.

This year, for this first time ever, the report finds that medical benefit claims exceed cash compensation payouts. Here is a summary data table provided by the NASI:

Figure 1: Workers' Compensation Spending, 2008


Type of Spending

Billions of Dollars

Percent  Change


Total benefits paid




  Medical payments




  Cash benefits




Employer costs




Amount per $100

of Covered Wages

Per $100 of Payroll

Dollar Change


Benefits paid




   Medical payments




   Cash payments to workers




Employer costs




Source: National Academy of Social Insurance, 2010.


Continual health care inflation, utilization and other medical cost escalators are blamed. John F. Burton, Jr., chair of the report panel tells us: The growth in medical spending may reflect both higher prices for medical care and greater use of services. The increase is the continuation of a long-term trend since 1980, but this is the first year that payments for medical care were more than half of all workers' compensation benefits."

However, one additional factor is probably in play. Given 2008 data would be the first year to reflect the great recession, intuitively one might assume the cash compensation slice of the pie was diminished by a shrunken work force.  So while health care costs are an easy target and typically a deserved scapegoat, the economy would seem an equal explanation for why the pie is being sliced up differently.