Medical Group Report Card ratings for Commercial HMO Plan Members 2016-17 Edition

Quality health care is getting the right care at the right time.


The Medical Group Report Card includes quality health care scores for three major areas:

  • Medical Group Uses Treatments Proven to be Effective – This star rating combines scores for the first 5 of the 9 health conditions/topics listed in the dark blue box in the right column. To see star ratings for each health condition/topic, click on the health condition. Learn more about these ratings.
  • Patients Rate Their Medical Group – This star rating is based on one question that asked a sample of medical group patients to rate their overall care in 2015. Five additional patient experience topics can be found in the light blue box in the right column. Click on a specific topic to see more patient experience star ratings. Learn more about these ratings.
  • Average Annual Payment for Care - This star rating is based on the average amount that health plans and patients of the medical group pay for all of the care provided for a year. More stars are better. Independent research shows that more expensive care does not necessarily mean higher quality care. Many medical groups provide high quality care for less money than other medical groups. Find out why medical groups might have higher costs.
    Learn more about these ratings.

Both quality and cost of care are important to consider when choosing a medical group. Look at the star ratings in all three columns below. More stars are better.

The Report Card also provides other helpful information on each medical group. Click on each medical group name to find its consumer assistance number, service area, website and more.
Click to learn more about these ratings.

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Click on medical group for group’s star ratings and information:

MEDICAL GROUP USES TREATMENTS PROVEN TO BE EFFECTIVE

The California Office of the Patient Advocate compared medical group performance results in 2015 to a set of national standards for quality of care to make sure that medical groups are offering quality preventive care and service to members.

PATIENTS RATE THEIR MEDICAL GROUP

We compared how medical group patients rated their medical group’s care during 2015. Highly rated medical groups received a score of 9 or 10 on a 0 to 10 scale.

AVERAGE ANNUAL PAYMENT FOR CARE

Average Annual Payment for Care:
This star rating is based on the average amount that health plans and patients pay for all of the care for a year. The dollar ranges below do not reflect just out of pocket costs. The dollar ranges include the average amount paid by health plans for things like check-ups and tests such as mammograms and colonoscopies plus the average amount paid by patients for things like co-pays and monthly insurance premiums. Both quality and cost are important to consider when choosing a medical group. Look at the star ratings in all three columns on the page. More stars are better.
Ratings based on comparing average annual payment per patient across all reported medical groups.
ExcellentFour stars $3,394 or less on average for each patient annually (lowest 10% of costs)
GoodThree stars $3,395 - $4,061 average for each patient annually
FairTwo stars $4,062 - $5,023 average for each patient annually
PoorOne star $5,024 or more on average for each patient annually (highest 10% of costs)

The seal represents groups that received the Excellence in Healthcare award from the Integrated Healthcare Association. Groups that earn the award ranked in the top 50% among medical groups across the state for providing high quality health care at lower costs. Learn more about this award.

GoodThree stars
GoodThree stars
GoodThree stars

FairTwo stars
ExcellentFour stars
FairTwo stars

PoorOne star
GoodThree stars
GoodThree stars

The seal represents groups that received the Excellence in Healthcare award from the Integrated Healthcare Association. Groups that earn the award ranked in the top 50% among medical groups across the state for providing high quality health care at lower costs. Learn more about this award.

GoodThree stars
GoodThree stars
GoodThree stars

GoodThree stars
GoodThree stars
FairTwo stars

FairTwo stars
ExcellentFour stars
FairTwo stars

FairTwo stars
FairTwo stars
GoodThree stars

GoodThree stars
GoodThree stars
GoodThree stars

GoodThree stars
Too few patients in sample to report
PoorOne star

GoodThree stars
ExcellentFour stars
PoorOne star

GoodThree stars
ExcellentFour stars
FairTwo stars

PoorOne star
FairTwo stars
FairTwo stars

The seal represents groups that received the Excellence in Healthcare award from the Integrated Healthcare Association. Groups that earn the award ranked in the top 50% among medical groups across the state for providing high quality health care at lower costs. Learn more about this award.

GoodThree stars
GoodThree stars
GoodThree stars

GoodThree stars
ExcellentFour stars
FairTwo stars

GoodThree stars
GoodThree stars
Not enough data to score reliably

Not willing to report
Not rated
Not willing to report









AVERAGE ANNUAL PAYMENT FOR CARE

Higher cost care does not necessarily reflect higher quality care. Other factors – like higher rent and staff salaries, or medical errors that require additional time and resources to correct – may result in higher costs. Additional factors that may result in higher costs include serving higher risk or sicker patients, serving more people without insurance, providing medical education or providing other services that help the community. However, many medical groups provide and coordinate high quality care for less money than other medical groups. A medical group may have lower costs because it:

  • Controls costs associated with rent, staff salaries, equipment or the cost of other providers outside of the medical group.
  • Provides only tests or treatments that patients need.
  • Prevents medical errors―such as giving the wrong diagnosis or the wrong medicine―when providing care to patients, which have to be corrected with additional resources.
  • Follows up with patients and/or their caregivers after a hospital stay, helping to prevent unwanted return visits to the hospital.

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