News Release

New Jersey Department of
Banking and Insurance

Commissioner Steven M. Goldman

For Immediate Release:
October 17, 2007

For Further Information:
Jim Gardner (609) 292-5064

Report card for New Jersey HMOs shows consistency over past year

Clinical measures steady, but customer satisfaction measures in decline

TRENTON – New Jersey’s health maintenance organizations (HMOs) have remained consistent in most performance categories while customer satisfaction measures have deteriorated somewhat, according to the eleventh annual HMO report card, issued by the Department of Banking and Insurance (DOBI).

This is the second year that DOBI has issued the report. The Department of Health and Senior Services prepared the report card prior to the transfer of the Office of Managed Care to DOBI in October 2005.

According to the 2007 New Jersey HMO Performance Report: Compare Your Choices, there was little or no change in ten of 12 clinical performance areas – the exceptions being the control of high blood pressure and cholesterol management of heart patients, but these changes are a result of the change in measurement standards by the National Committee for Quality Assurance (NCQA), the system on which the report card was based.

“While New Jersey’s health maintenance organizations have continued to maintain admirable standards, there is always room for improvement,” said DOBI Commissioner Steven M. Goldman. “These are certainly issues to consider for consumers when they are shopping for a health plan, and should serve as a guide for the industry on how they can better serve their customers.”

The state’s six commercial HMOs with at least 2,000 members are included in the report. In addition to comparing plans in 12 measures of preventive care and treatment, the report includes seven areas of customer satisfaction.

According to the report card, none of the other clinical measures changed by more than two percent. These areas include testing for breast cancer, testing for cervical cancer, check-ups for new mothers, immunization for children, management of medicine for depression, appropriate medication of children with asthma, care after hospitalization for mental illness, blood sugar testing for diabetics, beta blocker treatment after a heart attack, and eye exams for diabetics.

The customer satisfaction categories, however, are a different matter.

The percentage of consumers who rated their HMO at least a nine on a scale of zero to ten dropped from 36 percent to 33 percent, while the percentage of consumers who said they never had a problem getting the doctor or specialist they needed plummeted from 76 percent to 44 percent. The percentage of HMO members who were satisfied with claims processing dropped from 47 to 43 percent, and those who rated their quality of care at least a nine on a scale of zero to ten dropped from 49 percent to 44.

Meanwhile, the state’s HMOs posted big gains in three other key areas of customer satisfaction. The percentage of customers who said they received care quickly increased from 43 to 58 percent, while ratings of personal doctors increased from 52 to 60 percent. Good communications by doctors increased from 59 to 68 percent. But it is important to note that some of the more significant changes in customer satisfaction could be as a result of changes in the format of the customer satisfaction questionnaire.

In individual New Jersey plan performance, all six HMOs in the report – Aetna, AmeriHealth, CIGNA, Health Net, Horizon, and Oxford – posted declines in five or more of the clinical performance measures, with each reporting decreases of at least 6 percent for one or more measures. CIGNA, Health Net and Oxford reported the strongest performance improvements for 2007, as all three posted improvements for five of the 12 clinical performance measures.

The HMO report is available on the web at: www.state.nj.us/dobi/lifehealthactuarial/hmo2007.

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