News Release | Measuring the Quality of Pennsylvania's HMOs | MCPR 2000

MCPR 2000 - Measuring the Quality of Pennsylvania's HMOs - News Release

FOR IMMEDIATE RELEASE

Contact: Joe Martin, Communications Director
717-232-6787 or

PA's HMOs DO IT BETTER

Harrisburg, PA - May 22, 2002 - When it comes to illness prevention, Pennsylvania's HMOs receive higher marks than HMOs elsewhere, according to a new government report out today. PA's HMOs had better ratings in all 16 preventive care measures covered in a new report by the Pennsylvania Health Care Cost Containment Council (PHC4), and beat their own previous marks in categories where more than one year of data was available. And for the third consecutive year, Pennsylvania HMO members were more satisfied with their care than HMO members elsewhere, with 85% reporting no problems in receiving the care they felt they needed and 65% giving HMOs the highest overall satisfaction rating.

"In general, Pennsylvania's HMOs outperformed those throughout the rest of the country on illness prevention and patient satisfaction measures," stated Marc P. Volavka, Executive Director of PHC4. "However, there are still differences among plans, particularly in the area of surgical complications. Because Pennsylvania is the only state reporting such clinical outcome results for HMO plans, this report can help purchasers and consumers ask more detailed questions, and choose more wisely among plans."

In addition, the new report, titled Measuring the Quality of Pennsylvania's Commercial HMOs, suggests that HMOs that focus heavily on preventive care may be helping to keep their members out of the hospital for related conditions. PHC4's study showed lower hospitalization rates for diabetes and hypertension for those HMOs who helped high percentages of their members control their blood sugar and blood pressure levels. Because of its unique database, PHC4 has the ability to analyze the HEDIS/CAHPS prevention and member satisfaction measures against HMO-specific inpatient clinical data. The combination of these analyses is beginning to demonstrate statistically significant relationships between prevention measures and hospitalization rates.

"An ounce of prevention equals a pound of cure," said Mr. Volavka. "In some instances, there is a statistically significant relationship between a heavy focus on prevention and lower hospital admission rates."

REPORT HIGHLIGHTS

HMOs in Pennsylvania outperformed their national counterparts in all 16 prevention and primary care-related categories included in this report;
In each of ten prevention categories where more than one year of data was available, HMOs in Pennsylvania improved their results over previous years;
In some areas, the data in this report suggest that providing good preventive care may lead to fewer hospitalizations. The report showed a statistically significant correlation between well-controlled blood pressure levels and lower hospitalization rates for hypertension, and between well-controlled HbA1c levels (average amount of blood sugar over several months) and lower hospitalization rates for diabetes;
HMOs in Pennsylvania achieved member satisfaction rates that were higher than national averages for HMOs for the third consecutive year;
The percent of HMOs with higher than expected rates of abdominal hysterectomies decreased between 1998 (the last year hysterectomy data was reported) and 2000;
In the surgical procedure categories covered by this report, HMO members were more likely to experience complications than those in fee-for-service plans, with the exception of back operations with fusion;
There was significant variation in breast reconstruction surgery following mastectomy (in the same admission) among the HMOs in Pennsylvania. Studies have cited variation in preoperative counseling, surgeon preferences, availability of trained surgeons, patient preferences and practice patterns as possible reasons for such differences.

"The participating HMOs are to be congratulated for their involvement in this project," said Mr. Volavka. "Through their voluntary efforts, these companies are helping to report meaningful performance data about health care in Pennsylvania."

An HMO is a prepaid health insurance plan that requires members to use participating doctors and hospitals, and to get referrals from primary care physicians before seeing specialists. Some point of service (POS) plan data is also included in the report; POS plans are similar to HMOs but give members some coverage for services outside the network of preferred providers. Not included in the report are Medicare HMOs, which serve older and disabled people and Medical Assistance HMOs that serve low-income individuals.

The Pennsylvania Health Care Cost Containment Council is an independent state agency that provides the public with information that can be used to improve the quality and restrain the cost of health care in Pennsylvania. Copies of Measuring the Quality of Pennsylvania's Commercial HMOs are free and can be ordered by calling the Council at 717-232-6787 or downloaded from the Council's website at http://www.phc4.org.