New Report Shows California’s HMOs Deficient in Providing Access to Adequate Substance Abuse Treatment
March 15 2012 - 2:55PM
Business Wire
A new report issued by the state of California reveals that
California health plans are doing an exceedingly poor job of
providing quality care to individuals in need of alcohol and drug
dependency treatment.
The Healthcare Quality Report Card, issued by the California
Office of the Patient Advocate, compares the quality scores of
California’s eight largest HMOs against national performance and
against each other in 38 clinical categories. While the report
acknowledges that “Getting continuous care for substance abuse is
critical to successful treatment,” it uncovers the reality that
“Fewer than one in four people who abuse alcohol or drugs get
treatment; and among those who begin treatment, more than half do
complete their care.”
According to the report, only 13 percent of those adolescents or
adults who were diagnosed with alcohol or other drug dependencies
had the necessary treatment within 30 days of being diagnosed. This
is compared to 92 percent who receive adequate care for asthma, 87
percent who receive cervical cancer screenings, and 88 percent of
diabetics who get properly tested for cholesterol.
“This is the equivalent of getting 13 out of 100 on a test, and
nobody should find that acceptable,” said Phillip Greer, executive
director of the California Treatment Advocacy Foundation. “The
score is disgraceful but sadly not a shock given that for so long
health plans have routinely denied those suffering from substance
abuse access to the care they need.”
As an example, the report revealed that only 10 percent of the
California members of Anthem Blue Cross, the country’s largest
health plan, received access to the substance abuse treatment they
needed. Both Blue Shield of California and HealthNet didn’t fare
much better at 11 percent each. Even the best performing
health plan, Kaiser Permanente – Northern California, scored only
18 percent, still leaving 82 percent of their members lacking
adequate substance abuse care.
“The health plans have had their chance to provide adequate care
on a voluntary basis, and this report clearly demonstrates that
they have failed miserably,” said Greer. “It is now time for the
state to take action and stop health insurance companies from
imposing barriers that reduce access to much-needed chemical
dependency treatment.”
A bill (AB154), which broadens the mental health services
covered by private insurance plans, was recently passed by the
California State Assembly and is currently under review by the
state Senate. CalTAF has proposed an amendment, modeled after
Pennsylvania’s Drug and Alcohol Insurance Law, which would
specifically expand that bill to protect those individuals who have
been prescribed substance abuse treatment by their physicians but
who have been denied care by their health insurance carrier. The
prerequisite is certification and referral by a licensed physician
or a licensed psychologist. The Act also requires most group health
policies to include mandated minimum benefits for treatment of
alcohol and drug addiction.
“Insurers continue to impose unreasonable deductibles and
co-payments or impose care guidelines that keep patients from
receiving the level and amount of treatment that is universally
accepted as necessary,” says Greer. “When this happens the health
and wellness of whole families are jeopardized, and the unnecessary
costs to society ripple across California’s communities. By
requiring health plans to make available treatment that is already
included in most policies, costs to the state decrease and
successful treatment increases,” says Greer.
The California Addiction Treatment Advocacy Foundation is
dedicated to improving access to effective and affordable chemical
dependency treatment throughout the state. Created in 2011 by a
group of concerned California-based providers, CalTAF believes that
through insurance reform, either voluntary or mandated, barriers to
care can be eliminated, thus making it easier for individuals to
get access to the treatment and professionals they need. Further
information on the work of CalTAF may be obtained at
advocate@caltaf.org.