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News Release

 
   PO 360
   Trenton, NJ 08625-0360

   For Release:
   October 19, 2001

George T. DiFerdinando, Jr., MD, MPH
Acting Commissioner

For Further Information Contact:
Laura Otterbourg or Marilyn Riley
(609)984-7160

New Jersey Managed Care Plans Make Steady Gains
in Fifth Annual Report Card


TRENTON -Acting Health and Senior Services Commissioner George T. DiFerdinando, Jr. MD, today released New Jersey's fifth annual managed care report card, which shows the state's HMOs continued to make steady gains in delivering quality health care.

2001 New Jersey HMO Performance Report: Compare Your Choices -- which details the performance of 10 health plans that offer HMO and point-of-service plans -- was released today at a press event in Trenton.

"New Jersey continues to be a national leader both in protecting patients' rights and giving consumers high-quality information about managed care plans," said acting Governor Donald DiFrancesco. "This report card will help individual and businesses choose the health plans that best suit their needs."

"By shining a spotlight on performance, the report card encourages HMOs to keep improving their health care quality," said acting Commissioner DiFerdinando. "I'm pleased with the progress health plans have made since last year, but we need to do even better. These are standards every HMO can meet."

Dr. DiFerdinando noted that New Jersey's State Health Benefits Program (SHBP) has won a national award for its use of the report card. The National Healthcare Purchasing Institute gave the SHBP the National Purchaser of Healthcare Award for providing employees with quality information about their health plan choices and for using health plan performance data as part of its contracting standards.

The report card outlines managed care plan performance both in consumer satisfaction and in delivering quality health care. The plans are compared in 20 areas of preventive health care, medical treatment and customer service.

Since last year, New Jersey plans improved their scores in five of the nine health measures included in both the 2001 and the 2000 report card. The biggest gain was in the plans' performance in controlling cholesterol levels in members with heart disease. The percent of members with controlled cholesterol rose 19 points, from 38 percent to 57 percent. This is important because reducing cholesterol lowers the chances of having a heart attack.

Other gains were seen in the percent of members receiving beta blocker treatment after a heart attack The 2001 report card showed that 90 percent of members received this treatment, which can help prevent future heart attacks, compared with 83 percent the prior year.

Cervical cancer screening rates were up seven points, from 67 percent to 74 percent, and breast cancer screening rates rose four points, from 65 percent to 69 percent. The percent of members with diabetes who received an eye exam rose five points, from 38 to 43 percent.

Essentially unchanged were the percent of people with diabetes who had their blood sugar tested (71 percent); the percent of new mothers who received a check-up within eight weeks of delivery (69 percent); the childhood immunization rate (64 percent); and the percent of people hospitalized for mental illness who received care afterwards (68 percent).

This year's report also contains three new measures that deal with important chronic health problems -- controlling high blood pressure (43 percent with blood pressure controlled); children with asthma receiving appropriate medication (60 percent), and adults with asthma receiving appropriate medication (60 percent).

The remaining measures dealt with overall consumer satisfaction, such as satisfaction with one's doctor, with customer service and with getting care quickly. The highest score was in the area of getting needed care, where 74 percent of members reported no problem getting care.

Despite the gains in a number of areas, New Jersey continues to lag in regional and national scores in most measures. New Jersey's cholesterol management rate does top the national average by four percentage points, and the state matches the national rate for beta blocker treatment and asthma medications for children.

"Over the five years we've been doing this report, we've seen steady performance gains by the HMOs. As people and businesses continue to use this report, and as HMOs find ways to improve their health care delivery, I think we'll see these scores rise," Dr. DiFerdinando said.

The print version of the report is being mailed to more than 2,000 businesses in the state. A web-based version of the report card allows consumers to conduct their research on-line. Consumers can log on at www.state.nj.us/health, and create and print customized charts comparing the performance of the plans they're researching.

Both the web and print version of the report feature a one-page summary of each plan's overall performance in both customer service and preventive health care to allow for easier comparisons among plans. There are also sections on consumer rights, appealing a health plan decision, choosing a health plan and contacting your health plan.

The consumer guide includes data for 10 managed health care organizations. Seven offer both HMO and POS plans: Aetna U.S. Healthcare, AmeriHealth, CIGNA HealthCare, Oxford Health Plans, Physicians Health Services, United Healthcare and University Health Plans. Three offer HMOs only: Horizon Healthcare, One Health Plan and WellChoice HMO.

Information in the guide comes from two sources. Consumer satisfaction data comes from a statewide survey of more than 6,000 health plan members. Performance data on health care delivery comes from measures developed by the National Committee on Quality Assurance (NCQA), a non-profit group that assesses managed care quality nationwide. HMOs and POS plans submitted 2000 data to the department, which were audited for accuracy.

The guide is available on the department's web site at www.state.nj.us/health and may be viewed, printed or downloaded at no charge. Copies of the guide may be obtained by calling 800-418-1397 or by contacting the Office of Research and Development, New Jersey Department of Health and Senior Services, P.O. Box 360, Trenton, 08625-0360. The guide may also be requested by e-mail at hmo@doh.state.nj.us. There is a fee for multiple copies.

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Department of Health and Senior Services
P. O. Box 360
Trenton, NJ 08625-0360

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