Trenton, NJ 08625-0360
December 22, 1999
Rita Manno or Dennis McGowan
TRENTON - Governor Christie Whitman joined Health and Senior Services Commissioner Christine Grant today in issuing the state's third annual report on the performance of managed health care plans, an important tool for consumers and businesses when it comes to evaluating and choosing their health care plans.
Gov. Whitman said that while New Jersey plans improved in several areas during the past year and she is pleased at the number of plans that showed some improvement, the performance was not as strong as she'd like to see - or as New Jerseyans deserve.
"We also found that HMOs and point-of-service plans lag behind national and regional averages in most measures of preventative care. That's unacceptable, and I call upon our managed care providers to catch up and start leading the way," she said.
1999 New Jersey HMO Performance Report: Compare Your Choices gives consumers information on how well the eight largest commercial HMOs and seven point-of-service (POS) plans are delivering quality health care and customer service. The report card compares the plans in 24 different areas.
"HMOs must strive for - and consumers and government must insist on - the highest levels of quality care and service," said Gov. Whitman. "These standards ensure HMOs are held accountable for their performance and consumers receive the best medical services available."
Gov. Whitman said the State Health Benefits Program (SHBP), the sixth largest public employee benefit plan in the country, will use the report card as a rate-setting tool in its contract with managed care plans. Using data from the 2000 report card, plans participating in the SHBP will have to reach or exceed the statewide average on at least 70 percent of the customer satisfaction and performance measures on the report card. If they don't, they will lose as much as five cents on every dollar the state pays them in administrative fees. If a plan is below the mean on any measure, the plan must submit a correction plan to the SHBP.
The report card is a valuable tool for businesses and employees and also helps regulators and the managed care industry identify trends and areas where improvements need to be made, Commissioner Grant said. The report has been endorsed by such groups as the New Jersey Business and Industry Association, PSE&G, and the Consumer Coalition for Quality Health Care, Washington, D.C.
Areas where HMOs showed improvement in the 1999 report card include getting adolescents immunized, providing prenatal care, and ensuring persons with diabetes received retinal exams. HMOs did a worse job, however, in providing after-care services for members who have been hospitalized due to mental illnesses. And HMOs in New Jersey continue to trail regional and national rates for mammograms, cervical cancer screenings and cholesterol screenings.
"We are seeing a steady improvement in HMO performance in some areas, but it's simply not good enough," said Commissioner Grant. "The health plans have to redouble their efforts to keep people healthy and serve them well in times of illness."
Last year the department challenged all managed care plans to perform 5 points better than the best score by its competitors in seven preventive health categories by the year 2000 report.
Grant said her department will work with the New Jersey Association of Health Plans, a trade group representing 10 of the largest HMOs in the state, to identify and overcome barriers to improvement. The association will sponsor provider workshops in 2000 with experts in specific fields on how best to increase performance in six critical areas: pre- and post-natal care, cancer screenings, immunization, mental health, diabetes management and cardiovascular health.
To improve mental health hospitalization follow-up services, the department will ask the five HMOs that had significant performance decreases or were unable to report data in this area -- Aetna U.S. Healthcare, AmeriHealth, Horizon, Physicians Health Services and United Healthcare -- to provide the department with an analysis by January 31, 2000, explaining the reduction and outlining their corrective action plan. The analysis will, in part, look at what functions have been delegated to mental health contractors and how the plans monitor these services. The plans will also be required to provide quarterly progress reports and to submit updated mental health screening data in May 2000 so the department can see if results are improving.
The consumer guide includes data for eight managed health care organizations, all but one offering both HMO and POS plans in the state. The plans are: Aetna U.S. Healthcare, AmeriHealth, CIGNA HealthCare, Horizon Healthcare (HMO only), Oxford Health Plans, Physicians Health Services, Prudential HealthCare, and United Healthcare. Together, they represent 97 percent of the state's managed care commercial market.
Among this group, childhood immunization rates rose slightly, from 62 to 63 percent, while immunization for adolescents rose 8 points to 50 percent. While the rate for childhood immunization is 2 points higher than the national average, adolescent immunizations were 2 points lower. Pre-natal care in the first trimester of pregnancy improved 8 points and now matches the national average of 84 percent. The percentage of new mothers getting check-ups after delivery increased from 51 to 69 percent, just one point below national averages.
Retinal exams for persons with diabetes rose from 32 to 39 percent, while the percentage of women screened for cervical and breast cancers rose from 63 to 65 percent, and 62 to 66 percent, respectively. All three measures are below both regional and national rates.
In addition to childhood immunization rates, New Jersey plans scored better than plans in other states in just one other measured category, providing beta blocker medication for members who have suffered a heart attack to prevent future heart attacks 82 percent of the time.
Providing follow-up care to members who had been hospitalized for mental illnesses has dropped in each of the three years New Jersey has published its report card, from 74 percent in the 1997 report, to 67 percent in 1998, to 51 percent in 1999. The national average in 1999 was 67 percent. Just how much this decrease is a reflection of deficient care or reporting practices has yet to be determined.
Information in the guide comes from two sources. Performance data on health care delivery comes from a set of measures developed by the National Committee on Quality Assurance, a non-profit group that assesses the quality of care provided by HMOs nationwide. HMOs and POS plans submitted 1998 data to the department, which were audited for accuracy.
Consumer satisfaction date comes from a statewide survey of health plan members conducted by the Eagleton Institute's Center for Public Interest Polling at Rutgers University. Over the summer, more than 12,000 consumers were asked how they rate their plan, their physician and their overall quality of care, whether the plan's customer service staff is helpful, and whether medical office staff is courteous.
Copies of the guide may be obtained by calling 1-888-393-1062, or writing the Office of Managed Care, New Jersey Department of Health and Senior Services, P.O. Box 360, Trenton, NJ 08625-0360. The guide may also be requested by e-mail at email@example.com. There is a fee for multiple copies. The guide is also available on the department's web site at www.state.nj.us/health and may be viewed, printed or downloaded at no charge.