Cover Letter Quality Matters Performance Summary Service and Access Doctors and Medical Care Staying Healthy Getting Better /Living with Illness (Part 1) Getting Better /Living with Illness (Part 2) Choosing Your Health Plan Taking Responsibility forYour Health Care Contacting Your Health Plan Appeals and Complaints Other Important Resources HMO and POS Differences Consumer Bill of Rights Return to Cover Page Performance Report (PDF) Plan Comparison Tool Allows you to choose specific plans for comparison
			October 2001 Dear Consumers: We are pleased to present the fifth annual New Jersey HMO Performance Report. This report looks at the performance of New Jersey’s managed health care plans, how well these plans deliver important health care services, and what members think about the services they receive. This year we have added two new measures that focus on how well the health plans help members manage two common chronic illnesses that affect millions of Americans: controlling high blood pressure and use of appropriate medications for people with asthma. The report is designed to give both consumers and employers information on the quality of New Jersey’s managed health care plans. We believe that you will find this information useful when choosing a health plan for your family or business. New Jersey has some of the strongest consumer and patient protections in the country. We urge you to become familiar with these protections, which are explained in this report. We wish you good health and hope this report helps you choose the health plan that best serves you and your family. Donald T. DiFrancesco, Acting Governor George T. DiFerdinando, Jr., M.D. Acting Commissioner Department of Health and Senior Services

The New Jersey Department of Health and Senior Services developed this report with the cooperation of the New Jersey health plans. The Department was guided by an advisory group representing health plans, health care purchasers, providers and consumers.

This report includes information on New Jersey commercial health plans’ health maintenance organization (HMO) and point-of-service (POS) products. The report includes all such health plans, currently marketed in New Jersey that had at least 2,000 members in both 1999 and 2000. For most plans the information combines plan performance for the HMO and POS products. For Horizon Health Care, One Health Plan and WellChoice, only the HMO product is included. See HMO and POS Plan Differences for more information about the distinction between HMO and POS products.

This report does not cover the performance of health plans that serve Medicare beneficiaries or beneficiaries of Medicaid and other New Jersey Department of Human Services programs. See Other Important Resources for ways you can obtain information on these plans.

This report is based on a measurement system called HEDIS®, which was developed by the National Committee for Quality Assurance (NCQA) through the combined efforts of many experts in health care. It includes measures collected by the health plans and measures collected through member surveys. All measures are verified by independent auditors.

This report contains information on the following health plans:

• Aetna USHC—HMO/POS (Aetna U.S. Healthcare–New Jersey)
• AmeriHealth—HMO/POS (AmeriHealth HMO)
• CIGNA—HMO/POS (CIGNA HealthCare of New Jersey)
• Horizon—HMO (Horizon Healthcare of New Jersey)
• One Health—HMO (One Health Plan of New Jersey)
• Oxford—HMO/POS (Oxford Health Plans–New Jersey)
• PHS—HMO/POS (Physicians Health Services of New Jersey)*
• United—HMO/POS (United Healthcare of New Jersey)
• University—HMO/POS (University Health Plans)
• WellChoice—HMO (WellChoice HMO of New Jersey)^

*Physicians Health Services has applied to use the name Health Net.
^WellChoice was formerly known as Empire HealthChoice.

For information on contacting these and other New Jersey health plans, see page 16.

For additional copies of this report, please contact the Office of Research and Development, New Jersey Department of Health and Senior Services, P.O. Box 360, Trenton, New Jersey, 08625-0360; telephone (800) 418-1397, fax (609) 292-6523. There is a charge for multiple copies.

This report is also available on the Department’s Web site: www.state.nj.us/health or can be requested by e-mail: hmo@doh.state.nj.us This document may only be reproduced in its entirety. No portion of this document may be reproduced without the permission of the New Jersey Department of Health and Senior Services.

© 2001 New Jersey Department of Health and Senior Services HEDIS® is a registered trademark of the National Committee for Quality Assurance.