NJ Dept. of Health & Senior Services'
Actions to Improve HMO Performance

To improve quality of care in preventive measures . . .

• The department challenged plans to achieve performance levels by the year 2000 report card that are 5 points higher than the best scores in last year's report card.
• The New Jersey Association of Health Plans, a trade organization representing 10 of the largest managed care organizations in the state, has agreed to sponsor a series of workshops during the year 2000 that will focus on best practices to improve performance in preventive measures.
• The workshops will evaluate and recommend improvement strategies in the areas of pre- and post-natal care, breast and cervical cancer screening, immunization, mental health hospitalization follow-up care, 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 submit updated mental health performance data in May 2000 so the department can see if results are improving.

To improve childhood and adolescent immunization rates . . .

• The department will work with managed care plans on a mailing to share with providers best practices for getting children and adolescents properly immunized.
• Best practices may include such tactics as giving quality incentive report cards to providers; giving providers lists detailing members' immunization status so they can get children in for shots; and having providers send reminder cards to members with children who require immunizations.
• The medical directors of HMOs have pledged that they will make improving immunization rates a top priority.