News Release | Measuring the Quality of Pennsylvania's HMOs | MCPR 2005

MCPR 2005 - Measuring the Quality of Pennsylvania's Commercial HMOs - News Release

FOR IMMEDIATE RELEASE

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

PENNSYLVANIA HMOs SCORE HIGH ON MEMBER SATISFACTION, BUT HOSPITALIZATION RATES RISE FOR SOME CONDITIONS

Harrisburg, PA - April 6, 2007 - Overall, Pennsylvania HMOs outperformed their national counterparts in all member satisfaction measures for which a national average was available, according to a new report by the Pennsylvania Health Care Cost Containment Council (PHC4). Additionally, all Pennsylvania HMOs reported an increase from the prior year in the percent of plan members who gave their HMO the highest satisfaction rating.

"While member satisfaction among the state's HMOs remains high, rising hospitalization rates for certain conditions indicate areas where HMOs could focus additional quality improvement efforts," said Marc P. Volavka, Executive Director of PHC4. "This year's report shows significant increases in HMO hospitalization rates for chronic obstructive pulmonary disease, asthma, gastrointestinal infections, and ear, nose and throat infections."

Also noteworthy is that diabetes hospitalization rates for HMO members decreased 14.2% statewide from 110.0 per 10,000 adult members in 2004 to 94.3 in 2005. However, some individual plans' rates, which were age and sex adjusted, decreased by up to 42.4% while other plans' adjusted rates increased by up to 11.5% during this same period. In 2005, adjusted hospitalization rates for the HMOs ranged from 65.9 to 133.6 per 10,000 adult members with diabetes.

Measuring the Quality of Pennsylvania's Commercial HMOs is PHC4's eighth report about the quality of care that HMO networks offer. The report, which includes data from Calendar Year 2005, combines clinical results, preventive measures and member satisfaction information to give purchasers, policymakers and consumers a more complete picture of how well HMOs serve their members.

Enrollment in commercial managed care plans has been steadily decreasing. In 2005, 25.9% of Pennsylvanians under age 65 were enrolled in such plans, compared to 39.2% in 2000.

Other findings:

The hospitalization rates for gastrointestinal infections increased 16.6% from 3.4 per 10,000 members in 2004 to 3.9 in 2005.
The hospitalization rates for adult ear, nose and throat infections increased 24.0% from 2.1 per 10,000 adult members in 2004 to 2.6 in 2005. The hospitalization rates for pediatric ear, nose and throat infections increased 46.4% from 4.7 per 10,000 pediatric members in 2004 to 6.8 in 2005.
The hospitalization rates for chronic obstructive pulmonary disease (COPD) increased 24.4% from 3.8 per 10,000 adult members in 2004 to 4.7 in 2005.
The hospitalization rates for adult asthma increased 24.4% from 7.2 per 10,000 adult members in 2004 to 8.9 in 2005. The hospitalization rates for pediatric asthma increased 9.0% from 13.4 per 10,000 pediatric members in 2004 to 14.6 in 2005.

PHC4 is an independent state agency charged with addressing the cost and quality of health care in Pennsylvania. Copies of the new report are free and are available on the PHC4 website at www.phc4.org or by calling PHC4 at 717-232-6787.

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