MCPR 2003 - Measuring the Quality of Pennsylvania's Commercial HMOs - Key Findings
All Pennsylvania HMOs performed better than the national HMO Average in the following categories: testing blood sugar levels for members with diabetes; cholesterol screening for members with diabetes; controlling "bad" cholesterol for members with diabetes; providing the recommended childhood immunizations; controlling "bad" cholesterol after acute cardiovascular events; and controlling high blood pressure.
On average, Pennsylvania HMOs improved from the prior year in 12 of the 16 "Staying Healthy" measures.
On average, Pennsylvania HMOs showed improvements over the prior year in their rates of controlling the "bad" cholesterol of diabetic members (an 11.2% improvement), providing childhood immunizations (a 10.3% improvement), and controlling high blood pressure (an 8.8% improvement).
All plans reported an increase from the prior year in the percent of plan members who gave their HMO the highest satisfaction rating.
On average, Pennsylvania HMOs outperformed their national counterparts in all the Member Satisfaction measures for which a national average was available.
There were significant increases in HMO hospitalization rates since last year for: adult asthma (+40.4%), pediatric asthma (+27.1%), adult ear nose and throat infections (+14.0%), pediatric ear nose and throat infections (+22.0%), and kidney/urinary tract infections (+16.5%).
Hysterectomy procedure rates vary widely among HMO plans: adjusted rates varied from 33.3 to 89.9 per 10,000 adult female members, and the state average was 56.8. Five of the HMOs had lower than expected rates and the other five HMOs had higher than expected hysterectomy rates.
The HMO in-hospital complication rate for abdominal hysterectomy decreased significantly (-22.7%) from 2000 to 2003. However, the complication rate for HMOs was significantly higher (25.5%) than the rate for fee-for-service plans.
The neck and back procedure rate for HMOs increased significantly (+8.4%) over the previous year; significantly more (9.4%) of those procedures included a fusion as well.
The five clinical conditions listed under "Preventing hospitalizations through primary care" (adult and pediatric ear, nose, and throat infections; high blood pressure; gastrointestinal infections; and kidney/urinary tract infections) show 4,418 hospitalizations, 11,268 inpatient days and $51.8 million charges in 2003.
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