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Home > Insurance Division > Life and Health > Life & Health Actuarial > HMO Performance Report
2012 New Jersey HMO Performance Report
Getting Better/Living with Illness - 1


How well does the HMO care for members who are sick?

HMOs should work with doctors to care for members who are sick or living with chronic illness. HMOs reported on the percentage of their relevant membership who received the following:

  • Management of medicine for depression
  • Care after hospitalization for mental illness
  • Management of medicine prescribed to treat Attention Deficit Hyperactivity Disorder (ADHD) in children
  • Appropriate medications for treatment of asthma in children

The following tables show how well each HMO performed and HMO average in New Jersey.

 
HMO Management of medicine for
depression % 		Care after hospitalization for mental illness % Follow-up Care for children prescribed ADHD medications %
 Appropriate medications for
asthma %
Aetna - HMO/POS 68 79 40 96
AmeriHealth - HMO/POS 65 84 43 97
CIGNA - HMO/POS 65 77 50 95
Horizon - HMO 72 88 44 97
Oxford - HMO/POS 72 78 42 94
 
Management of medicine for depression
People taking medicine for depression need to be monitored. Percent of members given medicine for depression who had follow-up visits:		   Care after hospitalization for mental illness
Therapy after a hospital stay for mental illness is important for recovery. Percent of members hospitalized for mental illness who received care afterwards:
Management of medicine for depression   Care after hospitalization for mental illness
     
Follow-up care for children prescribed ADHD medications
Children prescribed ADHD medications need to be monitored. Percent of members given medicine for Initiation Phase of ADHD who had follow-up visit within 30 days of Initiation-Phase: 		  Appropriate medications for asthma (children)
With appropriate therapies, long term control of persistent asthma can be achieved, resulting in a decrease in hospitalizations and emergency room visits for treatment. Percent of pediatric members aged 5–11 with persistent asthma who received an appropriate therapy in the past year:
Follow-up care for children prescribed ADHD medications   Appropriate medications for asthma (children)
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New Jersey Department of Banking and Insurance