The OPA Fights for Quality Health Care in California

Posted: July 12, 2016

by John Hansen

The Complaint Department at the Office of the Patient Advocate Gives Consumers an Outlet to Address Quality

The Office of the Patient Advocate (OPA) is a research organization that serves the 16.7 million consumers of health care in California. They research California health plans along with 207 network providers. They also receive and report on complaints related to the quality of health care in California.

SB 1135 Gives the OPA a New Role in the Fight for Quality Health Care

SB 1135, legislation written by California State Senator Monning determined that the OPA would publish complaint data related to health care quality. The mission of the OPA has changed from being a consumer assistance organization to public reporting, so this seemed to fit. Now the OPA not only reports data they have gathered regarding California health plans and network providers, but they are also compiling and reporting consumer complaints.

Currently there is no national set of definitions for complaints related to quality health care. Elizabeth Abbott, director of the OPA, feels that this would be helpful to make complaint data more understandable to consumers.

Complaint Reporting

Based on this legislation, the OPA is charged to gather the following information for its quality health care reporting:

• Who is complaining
• Race
• Sex
• County
• Primary language
• Zip code
• Health plan
• Resolution (and how long it took)
• Agency the complaint was filed with

One of the most helpful pieces of data is the number of complaints. Elizabeth Abbott, the director of the Office of the Patient Advocate, stated, “If you own your own health plan and you get 150 complaints and you have 180 members, that’s bad. But if you have 1.4 million members, that’s better.”

Helping Consumers Find Quality Health Care

Consumers, when looking for California health benefits, can see how many complaints a health plan has. This can be incredibly helpful information to assist consumers in choosing a health plan. Also, it can put pressure on California health plans to make sure they are providing great service and quality health care for their members. 

According to OPA data, only 3% of complaints were from non-English speakers. This statistic is a disappointment to OPA director Elizabeth Abbott. She would like to see the research be more reflective of the population of California.

The #1 complaint is denial of claim. Consumers get quality health care services and file a claim with their health plan, but the claim gets denied. This can result in huge medical bills for consumers. In such cases, consumers can get assistance from Ombudsman or the Department of Managed Health Care (DMHC). Abbott says, “Usually, the DMHC is the best place to go.”