For Release:
  October 24, 2002

Clifton R. Lacy, M.D.
Commissioner

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

TRENTON - Although New Jersey's sixth annual managed care report card shows HMOs have made modest gains, the state's and the nation's health care systems still fall short in delivering the highest-quality health care to help people live longer, healthier lives, Health and Senior Services Commissioner Clifton R. Lacy, M.D. said today.

"New Jersey's scores mirror national and regional statistics in most screening, treatment and medical management measures in the report card. We must aggressively move to improve our performance in delivering care that has been scientifically proven to positively impact longevity and quality of life," Commissioner Lacy said.

"The fact that this is a national phenomenon suggests that there is no one simple solution," Dr. Lacy added. "What's needed is a sustained effort of all our partners in health care to identify and implement performance improvement strategies to make New Jersey a national leader in health care and specifically managed care-delivered health care"

Early next year, the Department of Health and Senior Services will host a scientific symposium on established best practices in patient care. The conference, which is being planned in conjunction with the federal Agency for Healthcare Research and Quality, will be aimed at health care providers and managed care plans.

The Commissioner made his comments today in releasing 2002 New Jersey HMO Performance Report: Compare Your Choices -- which details the performance of nine health plans that offer HMO and point-of-service plans. The department also released the results of the 2001 New Jersey Experience of Care and Health Outcomes (ECHO) Study, a survey of consumers' experience with managed care behavioral health services.

The HMO report card outlines managed care plan performance both in consumer satisfaction and quality health care delivery. The plans are compared in 20 areas of preventive health care, medical treatment and customer satisfaction. A one-page summary of each plan's overall performance allows for easy comparisons among plans.

Since last year, New Jersey's scores improved in nine of the 11 health measures included in both the 2002 and 2001 report cards. The average scores of health plans ranged from a low of 22 percent, for the percent of people taking medication for depression receiving follow-up visits, to a high of 90 percent for people receiving beta blocker treatment after a heart attack. Most measures were in the 60-to-80 percent range.

The biggest gains were seen in areas where the plans' rates were low. For example, the percent of members with controlled blood pressure improved from 43 percent in the 2001 report card to 53 percent in 2002. Controlled blood pressure reduces the risk of heart disease, stroke and renal failure. The percent of diabetics receiving eye exams increased from 43 to 51 percent. Regular eye exams are needed to prevent degenerative eye diseases that are a complication of diabetes.

In addition, the percentage of cardiac patients with controlled cholesterol improved from 57 to 62 percent, children properly immunized by age two increased from 64 to 70 percent, and the percentage of members receiving blood sugar testing improved from 71 to 78 percent. The percentage of new mothers receiving a check-up within eight weeks of delivery increased from 69 to 73 percent, and cervical cancer screening rates increased from 74 to 78 percent.

Small gains were seen in breast cancer screening (69 to 71 percent) and proper follow-up care for people hospitalized with mental illness (68 to 70 percent). Essentially unchanged from the 2001 were the percentage of people receiving beta blocker treatment after a heart attack (90 percent) and the percentage of children with asthma receiving appropriate medication for their condition (60 percent). Beta blockers can help prevent future heart attacks. Proper medical management of asthma can reduce hospitalization and emergency room visits.

The report card's remaining measures deal with overall consumer satisfaction, such as satisfaction with one's doctor, with customer service and claims processing, and with getting needed care promptly. The highest score was in the area of accessing needed care, where 76 percent of members reported no problem.

"New Jersey continues to be a national leader in protecting patients' rights and providing high-quality consumer information," Commissioner Lacy said. "October and November are generally open enrollment months for both private and public sector employees. This report is an excellent tool both consumers and businesses can use in researching health plans for their families or employees."

Information in the guide 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 POS plans submitted 2001 performance data to the department, which were audited for accuracy. Consumer satisfaction data comes from a 2002 statewide survey of approximately 3,000 health plan members.

The consumer satisfaction survey, known as CAHPS (Consumer Assessment of Health Plans), has been the nationally recognized standard for assessing consumer experiences with medical care. When development is completed, the ECHO survey is likely to become the national standard for reviewing consumer views of behavioral health care services.

ECHO was developed by Harvard Medical School and pilot-tested in New Jersey in 2001 under a grant from the Robert Wood Johnson Foundation. Behavioral health-care users and non-users were surveyed in the state's seven largest HMOs. Results were compared with the 2001 CAHPS survey. According to the results, members are satisfied with the quality of the actual care they receive, whether it's medical care or behavioral health care counseling. However, behavioral health care users are less satisfied than medical care users with the managed care plan itself.

The print version of the HMO report is being mailed to more than 2,300 businesses in the state. Through the web-based version, consumers can log on at www.state.nj.us/health, and create and print customized charts comparing the performance of the plans they're researching. An interactive web version of the report card allows consumers to conduct on-line research of managed care plans.

The State Health Benefits Program, 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. The SHBP has been recognized by the National Health Care Purchasing Institute as a model program for its using HMO performance data both to inform enrollees and as standards in contracts with participating managed care organizations.

The web-based 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 There is a fee for multiple copies.

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