2010 HMO Performance Report
The State of New Jersey
NJ Department of Banking and Insurance
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2010 New Jersey HMO Performance Report


November 2010

Dear Consumers:

We are pleased to present the fourteenth annual New Jersey HMO Performance Report, the fifth produced exclusively by the New Jersey Department of Banking and Insurance. This report contains information on the performance of New Jersey’s health maintenance organizations (HMOs), and how well these HMOs deliver important health care services.

The report is designed to provide information on the quality of New Jersey's HMOs and the coverage they provide. We hope you find this information useful when choosing health coverage for your family or business.

New Jersey is a leader in providing comprehensive, strong consumer and patient protections. We urge you to become familiar with these protections, which are explained in this report.

By providing you with this report, our goal is to help you make the best health care choices for yourself, your family or your employees.

Chris Christie
Governor

Thomas B. Considine
Commissioner
Department of Banking and Insurance

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Introduction

The format for this report was originally developed by the New Jersey Department of Health and Senior Services (DHSS), when it issued the first HMO performance report in 1997 with the cooperation of an advisory group representing HMOs, health care purchasers, providers and consumers. The New Jersey Department of Banking and Insurance (DOBI) assumed responsibility for providing the HMO Performance Report from DHSS in August 2005. All regulatory and oversight matters concerning managed health care in the state are now consolidated in DOBI.

This report includes information on all commercial products currently marketed in New Jersey by HMOs that had at least 2,000 members enrolled in commercial products in both 2008 and 2009. For most HMOs the information combines plan performance for the HMO and POS products.

This following HMOs and products are included in this report:

  • Aetna-HMO/POS (Aetna Health Inc. – a New Jersey Corporation)
  • AmeriHealth-HMO/POS (AmeriHealth HMO, Inc. – New Jersey)
  • CIGNA-HMO/POS (CIGNA HealthCare of New Jersey, Inc.)
  • Horizon-HMO (Horizon Healthcare of New Jersey, Inc.)
  • Oxford-HMO/POS (Oxford Health Plans of New Jersey)

This report does not include HMO performance related to any HMO’s Medicare or Medicaid business or an HMO’s business related to other New Jersey Department of Human Services programs. (See Other Resources for ways you can obtain information on these programs.)

This report is based on a measurement system called HEDIS®, which was developed by the National Committee for Quality Assurance (NCQA) through the combined efforts of many health care experts. It includes measures collected by the HMOs and measures collected through member surveys. All measures are verified by independent auditors.

In prior reports, we included ratings of member satisfaction with HMO services. Now you can find summary measures of customer satisfaction by visiting the NCQA's web site. (See Choosing Your HMO for more information.)

For information on New Jersey HMOs, see Contacting Your HMO

HEDIS® is a registered trademark of the National Committee for Quality Assurance.

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New Jersey Department of Banking and Insurance