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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 - 3


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:

  • Persistence of beta blocker treatment after a heart attack
  • Check-ups for new mothers
  • Use of imaging studies for low back pain
  • Frequencies of selected procedures

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

 
HMO Persistence of beta blocker treatment after heart attack % Check-ups for new mothers %* Use of imaging studies for low back pain %
Frequencies of selected procedures %
Aetna - HMO/POS 85 86* 76 See below
AmeriHealth - HMO/POS NA 84 79 See below
CIGNA - HMO/POS NA 84* 74 See below
Horizon - HMO 88 87 76 See below
Oxford - HMO/POS 83 62* 71 See below
*Aetna, CIGNA and Oxford used 2011 rates for reporting year 2012; NA - Not applicable as data samples are too small
 
Persistence of beta blocker treatment after a heart attack
Beta blockers after a heart attack can help prevent future heart attacks. Percent of members who received persistent beta-blocker treatment for six months after discharge:		   Check-ups for new mothers
During a visit, providers can check a new mother's recovery from childbirth and answer questions. Percent of new mothers who received a check-up within eight weeks after delivery:
Persistence of beta blocker treatment after a heart attack   Check-ups for new mothers
*NJ Average is based on Aetna, Horizon & Oxford rate only. NA - Not Applicable due to the smaller sample size.   *Aetna, CIGNA and Oxford used 2011 rates for reporting year 2012
     

Imaging studies for low back pain
The percentage of members with a primary diagnosis of low back pain who did not have an imaging study (plain x-ray, MRI, CT scan) within 28 days of the diagnosis (a higher rate indicates appropriate treatment of low back pain):
Imaging studies for low back pain    
     
Frequency of selected procedures
This measure summarizes the utilization of two frequently performed procedures:
Frequency of selected procedures
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New Jersey Department of Banking and Insurance