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News Release

New Jersey Department of
Banking and Insurance

Commissioner Steven M. Goldman

For Immediate Release:
October 17, 2006

For Further Information:
Jim Gardner (609) 292-5064

New Jersey HMO Report Card Shows Improvements and Areas of Concern

TRENTON – New Jersey’s tenth annual report card on health maintenance organizations (HMOs) shows progress in several areas, but highlights others in need of improvement, according to state Banking and Insurance Commissioner Steven M. Goldman.

This marks the first year that the state Department of Banking and Insurance (DOBI) has issued the report. The Department of Health and Senior Services prepared the report card prior to the transfer of the Office of Managed Care to DOBI in October 2005.

According to the 2006 New Jersey HMO Performance Report: Compare Your Choices, managed care plans overall improved their scores in eight of 12 clinical performance areas and declined – albeit only slightly – in three others. One of the areas cannot be compared to last year’s data due to a change in definition.

“Certainly we are pleased to see overall improvements in the managed care industry, but there is room for improvement. In these areas, we encourage HMOs to use this data when evaluating the services they deliver,” Goldman said. “For consumers, this report card is an invaluable resource they can use to select a health plan; for the industry, it can be an equally valuable tool in improving the quality of health care services they deliver.”   

Eight commercial HMOs are included in the report. In addition to comparing plans in 12 measures of preventive care and treatment, the report includes eight areas of customer satisfaction, including the ability to get care quickly and physicians’ ability to communicate with patients. The measure for claims processing improved 2 percent in the customer satisfaction category, otherwise there were no substantial changes from 2005 to 2006.

According to the report card, managed care organizations posted the largest gains in eye exams for diabetes patients (up 4 percent); childhood immunization status (up 3 percent); and antidepressant medication management (up 3 percent). Treatment of children with asthma showed a significant increase, but this is due to a change in the definition of asthmatics and cannot be compared to 2005 data.  

The three areas where declines were observed, the change from the 2005 report was small. Cholesterol management declined 2 percent, while breast cancer screening and cervical cancer screening each declined by 1 percent.

Overall, plans scored the highest in giving patients beta blockers after a heart attack, at 98 percent. Plans scored lowest – 30 percent – in properly managing people taking antidepressants, although that was an increase of three percentage points over 2005.

In individual New Jersey plan performance, CIGNA, Oxford and UnitedHealthcare reported performance declines in five or more of the clinical performance measures, with each reporting decreases of at least 6 percent for one or more measures. Horizon, WellChoice and AmeriHealth each had a more mixed performance, reporting more improvements than declines and each reporting increases of 4 percent or more for at least one measure.

Health Net and Aetna reported the strongest performance improvements for 2006, with each reporting improvements for eight measures and each reporting improvements of 7 percent or more for two measures.

The HMO report is available on the web at: http://www.state.nj.us/dobi/lifehealthactuarial/2006hmoperformancereport.pdf.