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PO Box 360
Trenton, NJ 08625-0360

For Release:
October 05, 2004

Clifton R. Lacy, M.D.
Commissioner

For Further Information Contact:
Marilyn Riley or Jennifer Sciortino
(609) 984-7160


 
Department Releases Eighth Annual HMO Report Card


 

          TRENTON -- According to the state’s eighth annual HMO report card, New Jersey’s managed care organizations continue to make modest gains, but still do not consistently deliver the highest quality health care, Health and Senior Services Commissioner Clifton R. Lacy, M.D. announced today.

          “In the eight years that our Department has been reporting on HMOs, managed care companies have significantly improved performance in many areas.  This has resulted in better health care for their members,” Dr. Lacy said.

          “These tests and treatments are central to high-quality care and should be given to all eligible patients.  Physicians, patients and HMOs must continue to strive to attain a score of 100 percent on every measure,” the Commissioner added. 

          2004 New Jersey HMO Performance Report: Compare Your Choices includes information on eight commercial HMOs and six point-of-service plans.  The report compares plans and provides statewide averages in 12 areas of preventive health care and medical treatment.  Customer satisfaction is also measured in eight areas, such as ability to get care quickly and physicians’ ability to communicate with patients.

          According to the 2004 HMO report, plans overall scored highest – 96 percent – in giving patients beta blockers after a heart attack.  Beta blockers can decrease the risk of heart attack and death.  Plans scored lowest – 26 percent – in properly managing people taking antidepressants.

          Overall, the plans improved in nine of 12 health measures.  The greatest gains were seen in the percentage of children with asthma receiving proper medication (from 63 percent in 2003 to 73 percent in 2004) and in the percentage of cardiac patients with controlled cholesterol (from 66 to 73 percent).  Controlled cholesterol can reduce heart attack risk.

          The plans also increased the percentage of: people on antidepressants being properly monitored (from 23 to 26 percent); patients whose high blood pressure is controlled (from 55 to 59 percent); children who were properly immunized (from 72 to 75 percent); women screened for cervical cancer (78 to 80 percent); new mothers receiving check-ups (74 to 76 percent); people hospitalized for mental illness receiving proper follow-up (73 to 75 percent); and people with diabetes who had their blood sugar tested (79 to 80 percent).

          Remaining unchanged were the percentage of heart attack patients receiving beta blockers (96 percent) and the percentage of women screened for breast cancer (70 percent).  

          Performance declined in one measure – people with diabetes receiving eye exams (from 50 percent in 2003 to 46 percent in 2004).  However, plan performance in this area fell nationwide after the National Committee on Quality Assurance (NCQA) changed its definition of the measure.  New Jersey uses the nationally recognized NCQA measures in its report card.

          In individual plan performance, Horizon, Aetna and HealthNet showed significant improvement over last year.  Results were mixed for other plans.

          Historically, New Jersey’s scores have trailed both regional and national averages. The 2004 report card shows that the state continues to close the gap and, in fact, exceeds national and regional averages in some measures.

          The HMO report card is one of a number of Department of Health and Senior Services initiatives to improve health care quality and patient safety.  In July, the Department released the state’s first annual hospital performance report on the treatment of heart attack and pneumonia.  The sixth cardiac surgery report card will be released later this fall.  These report cards give consumers information they can use to make health care choices, while also encouraging continued quality improvement throughout the health care community. 

          In addition, the Department is preparing to implement the Patient Safety Act, which was enacted in April and takes effect on October 23rd.  Among other things, the law requires reporting serious medical errors to the Department, and makes these reports confidential to encourage full and frank reporting.

          The 2004 HMO report is also available on the web at http://www.state.nj.us/health/hmo2004/.  The web-based version allows consumers to create and print customized charts comparing performance of the plans.

          Additional charts are also available on the web showing each plan’s five-year performance on each health measure as well as state, regional and national score comparisons for the same time period.  Consumers may also view New Jersey scores on every measure included in the report card since 1997.

          For those seeking more technical, detailed information, the Department publishes The Comprehensive HMO Report on the web.  It includes additional measures related to diabetes, cardiac care, and other health conditions covered in the HMO consumer report.  The Comprehensive HMO Report also outlines plan performance in areas of health care other than those included in the annual consumer report.   The 2003 comprehensive report is currently available and the 2004 report will be posted later this year.

          To obtain copies of the report card, call 1-800-418-1397 or contact the Health Care Quality Assessment Office, 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 hmo@doh.state.nj.us.  There is a fee for multiple copies.

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