A common theme that I have seen in comments is that HMO’s will kill people if they are widely adapted.
That is false. Shitty HMOs that are pinching pennies to make next quarter’s numbers will kill people. Shitty PPOs will also kill people while giving them more choices.
Good HMOs are quite possible and they provider very good care.
The National Committee on Quality Assurance (NCQA) is the major credentialing and research entity of payers and providers in this country. Health plans work their asses off to look good for NCQA. Some of the requirements are technical (does the web directory show daily hours?), some are mechanical (how many cardiologists per 10,000 members are in each county or within 20 miles etc), and quite a lot of the NCQA scoring system is based on managing basic prevention. How many kids are seeing the dentist in the past year, how many diabetics have received appropriate nutritional counseling, how many lead screenings occurred, how many functional mobility assessments been paid for people with restricted mobility? Health plans work hard to minimize the NCQA gaps and conform to their technical standards.
The 2014 rankings are the most recent rankings out there as the 2015 data cycle is still ongoing. I am rolled up EPO and PPO plans together as they don’t require PCP gatekeepers, while HMO and POS plans do require gatekeepers. I also counted as an HMO plan anything that contained HMO in the NCQA description. Removing that does not change the basic results.
The best plans in the country according to NCQA are overwhelmingly HMO/PCP gatekeeper plans. This not not an artifact of Kaiser. Removing Kaiser from the Top 20 produces 14 plans, or which 10 are non walled garden HMOs.
Some of this is an artifact of what NCQA measures. Customer satisfaction is only a component of the NCQA score, and PPOs with fewer restrictions usually will score better on customer satisfaction as there are fewer hurdles to jump over. However on the clinical side, the HMOs seem to have better outcomes because the PCP is more involved in patient care.
It is quite possible for an HMO to deliver excellent care, and it is quite possible for an HMO to be completely shitty. The same applies to PPO plan designs. If anything, it is more likely for a PPO to be shitty as setting up a PPO is less involved than setting up an HMO.
Good plans are not dependent on whether or not the a PCP is a required gatekeeper.