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PO Box 360
Trenton, NJ 08625-0360

For Release:
October 05, 2005

Fred M. Jacobs, M.D., J.D.
Commissioner

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


 
New Jersey Releases Ninth Annual Managed Care Report Card


 

TRENTON – Health and Senior Services Commissioner Fred M. Jacobs, M.D., J.D., today released the ninth annual HMO report card, which shows managed care plans continued to make small gains in delivering high-quality patient care.

According to the 2005 New Jersey HMO Performance Report: Compare Your Choices, managed care plans overall improved their scores in seven of 12 areas of preventive health care and medical treatment included in the report card. 

“This is care that can lead to better health and quality of life.  Every eligible patient should receive this high-quality care, and managed care plans must continue striving for 100 percent on every measure,” Commissioner Jacobs said. 

“For consumers, the report is a valuable resource they can use when choosing a health plan for themselves and their families,” he added.  “Our online version of the report card even allows you to create customized charts comparing the specific plans you’re considering.”

Eight commercial HMOs and six point-of-service plans 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, such as ability to get care quickly and physicians’ ability to communicate with patients.  Plan scores can be compared with statewide averages.

Also included are helpful sections on consumer rights, information on filing appeals and complaints, and advice on choosing a health plan.  The report lists contact information for all plans and for other state and federal resources consumers might need.

According to the report card, plans overall scored highest – 96 percent – in giving patients beta blockers after a heart attack.  That score was unchanged from 2004.  Beta blockers can decrease the risk of heart attack and death.  Plans scored lowest – 27 percent – in properly managing people taking antidepressants, although that was an increase of one percentage point over 2004.

Plans made the greatest improvement in the percentage of patients whose high blood pressure is controlled -- up from 59 percent in 2004 to 68 percent in 2005.  Other improvements were seen in the percentage of:

  • Children properly immunized (from 75 percent in 2004 to 78 percent in 2005)
  • People with diabetes receiving eye exams (from 46 to 48 percent)
  • New mothers receiving check-ups (from 76 to 78 percent)
  • People with diabetes who had their blood sugar tested (from 80 to 82 percent)
  • People hospitalized for mental illness receiving proper follow-up (from 75 to 76 percent) 

The four measures showing declines were:  women screened for breast cancer (from 70 to 67 percent); women screened for cervical cancer (80 to 79 percent); children with asthma receiving proper medication (from 73 to 72 percent); and cardiac patients with controlled cholesterol (from 73 to 70 percent).  Controlled cholesterol can reduce heart attack risk.

Historically, New Jersey’s scores have trailed both regional and national averages.  In recent years, the state has been closing the gap and even exceeding the nation and region in some measures.  That progress slowed this year.  However, since the first report card in 1997, New Jersey has made substantial improvement in nearly all measures.

In individual New Jersey plan performance, several plans showed consistent improvement since 2004 – CIGNA, Health Net, Oxford, UnitedHealthcare and WellChoice. Performance was mixed for Aetna. 

Horizon’s scores went down this year – by more than five percentage points in many cases -- although it remains the only plan with a higher-than-average overall performance in preventive health care and treatment measures. AmeriHealth also declined in many measures, although the declines were smaller. 

          The HMO report card is one of the Department of Health and Senior Services initiatives to improve health care quality and patient safety.  The department also publishes a hospital performance report and a cardiac surgery report. These reports 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 implementing the Patient Safety Act, which requires health care facilities to confidentially report serious medical errors to the department, and also submit plans to systematically prevent similar errors in the future.

          The HMO report is available on the web at http://www.state.nj.us/health/hmo2005.  Also available are additional charts showing each plan’s five-year performance on each health measure, as well as state, regional and national score comparisons.  Consumers may also view New Jersey scores on every measure included in the report card since 1997.

          For those seeking more detailed information, the department publishes The Comprehensive HMO Report on the web.  It includes performance data for areas not covered in the consumer report, as well as additional measures on health conditions that are in the consumer version. The 2004 report is now on the web and the 2005 report will be posted in several months.

          To obtain copies of the consumer report, call 1-800-418-1397, or contact the Office of Health Care Quality Assessment, Division of Health Care Quality and Oversight, New Jersey Department of Health and Senior Services, P.O. Box 360, Trenton 08625-0360.  The guide may be requested by e-mail at hmo@doh.state.nj.us.  There is a fee for multiple copies.

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