August 17, 2000 News Release - August 2000 MCPR: Measuring The Quality of Pennsylvania's HMOs

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

FOR IMMEDIATE RELEASE

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

PA HEALTH CARE COST CONTAINMENT COUNCIL (PHC4) RELEASES NEW HMO REPORT

Harrisburg, PA - August 17, 2000 - A new government report suggests that Pennsylvanians belonging to HMOs are more satisfied with the services they receive than HMO members elsewhere. The PHC4 report also notes that rates of hospitalization, complications and readmissions for HMO members vary across select medical categories as well as for preventive measures such as prescriptions for Beta Blockers for heart attack victims, screening for cervical cancer and advice to quit smoking.

"Measuring the Quality of Pennsylvania's HMOs is the first report of its kind to combine 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," stated Marc P. Volavka, Executive Director of PHC4. "While there are significant differences to be found among individual HMOs, overall quality in the categories we examined is generally high."

HMOs and related point-of service programs are a particular type of "managed care" which covered 5.4 million Pennsylvanians as of 1998 - nearly half the insured population in Pennsylvania. This represents an increase of more than four million people since 1990. The PHC4 report does not include members in public sector programs such as Medicare and Medical Assistance.

Managed care plans such as HMOs place an emphasis on preventive, primary care and disease management programs. This approach can minimize or prevent the need for high-cost treatments or procedures that may become necessary when certain types of diseases are not diagnosed, treated and managed in their early stages.

Differences in hospitalization, readmission and complication rates may be driven by provider performance within an HMO's network. In some instances such as asthma, the data suggest that the focus by HMOs on primary care, prevention, disease management and appropriate utilization of services is having a positive effect. In other areas such as hysterectomy, where appropriateness and utilization are issues, the evidence is less clear.

"These differences present HMOs with the opportunities to examine the effectiveness of their disease management programs as well as the performances of specific providers within their networks," said Mr. Volavka.

The PHC4 report includes:

Patient outcome information about the rates of hospitalization, hospital readmissions, complications and mortality for select medical categories: asthma, heart attack, heart failure and hysterectomies;
HEDIS measures for Beta Blocker prescriptions after a heart attack (Beta Blockers reduce how hard the heart must work, lower blood pressure and reduce the likelihood of a subsequent heart attack), Screening for Cervical Cancer and Advising Smokers to Quit. HEDIS stands for Health Plan Employers Data and Information Set and was developed by the National Committee for Quality Assurance (NCQA);
The degree to which Pennsylvania HMO members are satisfied with the services provided and coordinated by their HMO, as measured by the Consumer Assessment of Health Plans Survey (CAHPS), also an NCQA product;
Each participating HMO's NCQA accreditation status;
Financial and other descriptive information about HMO networks.

"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 and to heighten public awareness about the role of managed care in our health care delivery system."

Copies of Measuring the Quality of Pennsylvania's 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.

The Pennsylvania Health Care Cost Containment Council is an independent state agency which provides the public with information that can be used to improve the quality and restrain the cost of health care in Pennsylvania.