TRENTON – Although New Jersey’s Health Maintenance Organizations (HMOs) continue to demonstrate improvement in performance, they still do not consistently provide all the prevention and treatment services that are the hallmark of high quality health care, Health and Senior Services Commissioner Clifton R. Lacy M.D. said today in releasing the state’s seventh annual managed care report card.
“Since appropriate use of these interventions translates into improved survival and quality of life, New Jerseyans should not be satisfied until all the scores in the report card approach or reach 100 percent,” Commissioner Lacy said. “Health plans, health care providers, and consumers must work together to close the remaining gaps and achieve this goal.”
2003 New Jersey HMO Performance Report: Compare Your Choices outlines the performance of eight HMOs, six of which also offer point-of-service plans. The plans are compared in 20 areas of preventive health care, medical treatment and customer satisfaction.
The report is just one aspect of New Jersey’s commitment to improving health care quality and patient safety. The Department of Health and Senior Services will release an updated cardiac surgery report card later this year and the state’s first-ever hospital quality report card in 2004.
“Our plans are committed to making high quality health care available to all members. That commitment has led to rising scores over the years. However, we acknowledge that much more needs to be done, not only by HMOs but by the front-line health care providers who deal with patients every day,” Michele K. Guhl, President of the New Jersey Association of Health Plans said in a provided statement. “New Jersey’s HMOs will continue to work hard to improve performance in all areas.”
For the first time, as part of the report card release, the department is providing on its web site summary data showing each plan’s performance from 1999 to 2003 on key indicators. Other charts detail statewide performance since last year and since 1997, compare New Jersey’s performance to the region and the nation, and compare the state’s improvement over the years to that seen regionally and nationally. The report card and charts are available on the DHSS web site at www.state.nj.us/health/hmo2003.
Since last year, New Jersey’s overall scores improved in nine of the 12 health measures included in both the 2003 and 2002 report cards, and no significant declines were noted.
The biggest gains were seen in the percentage of people receiving beta-blocker treatment after a heart attack (from 90 percent in 2002 to 96 percent in 2003), and in the percentage of cardiac patients with controlled cholesterol (from 62 to 66 percent). Appropriate use of each of these interventions, beta-blocker therapy and cholesterol control, decreases risk of heart attack and death.
“Although progress in performance is being made, significant improvement is still needed,” said Commissioner Lacy, a cardiologist. “These best practices in health care have been clearly established and widely recognized for many years. They should be uniformly employed for the benefit of New Jerseyans. It is unacceptable that one out of three HMO cardiac patients in the state does not have his or her cholesterol controlled.”
Gains were also noted in the percentage of members receiving proper follow-up after hospitalization for mental illness (70 to 73 percent), the percentage of children with asthma receiving proper medicine for their conditions (from 60 to 63 percent), and the percentage of children properly immunized (70 to 72 percent).
One-point gains were seen (78 to 79 percent) in blood sugar testing for people with diabetes and (22 to 23 percent) in proper management of people receiving antidepressant medication (although HMOs report problems in collecting all the data related to this measure).
Cervical cancer screening rates were unchanged (78 percent) and one-point declines were seen in breast cancer screening (71 to 70 percent) and eye exams for people with diabetes (51 to 50 percent).
In individual plan performance, Horizon, Health Net, and CIGNA each improved in at least nine of the 12 performance measures compared with last year. Aetna demonstrated the most decline in performance, with decreased scores in eight of 12 measures. United HealthCare declined in six measures.
Historically, New Jersey’s managed care plans have scored below regional and national averages. However, data provided in this year’s report card show that the gap has been closing. Since 1999, the state has improved its scores on most performance measures from 9 to 22 points. Smaller improvements were seen at regional and national levels, where significant gaps in the percentage of members who benefit from best practices remain.
The HMO performance report will be mailed to more than 2,300 businesses in the state. There is also a web version of the report card, which allows consumers to create customized performance charts for the plans in which they are considering enrolling. The State Health Benefits Program (SHBP), which covers more than 700,000 current and retired state employees and family members, provides a summary of the report card results to each member. HMOs that participate in the SHBP must meet specific standards on the report card’s quality measures or face penalties.
Information in the report card comes from two sources. Performance data on health care delivery comes from measures developed by the National Committee on Quality Assurance (NCQA), a non-profit group that assesses managed care quality nationwide. HMOs and Point of Service (POS) plans submitted to the department 2002 performance data, which were audited for accuracy. Consumer satisfaction data come from a 2003 statewide survey of about 3,000 plan members.
The web guide may be viewed, printed or downloaded at no charge. Copies may be obtained by calling 800-418-1397 or by contacting the Office of Research and Development, New Jersey Department of Health and Senior Services, P.O. Box 360, Trenton, 08625-0360. The guide may also be requested by e-mail at firstname.lastname@example.org. There is a fee for multiple copies.
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