06/29/2004 - SIXTH ANNUAL NEW YORK STATE HMO REPORT CARD RELEASED
"It is encouraging that New York's HMOs do as well as or better than the national average in many areas," says Anthony Shih, M.D., M.P.H., Vice President, Quality Improvement, IPRO. "On the other hand, it is disturbing that they continue to show a dramatic need for improvement in care provided to those experiencing or recovering from psychiatric illness. While HMO's on average do better than others in the nation, they still need to demonstrate better care for this vulnerable population."
IPRO, an independent health care quality improvement organization and the New York Business Group on Health, New York's leading business coalition for health policy and information, are founding sponsors of the New York State Health Accountability Foundation, along with major New York employers.
The report card provides an overview of the performance of the state's 20 commercial health plans - indicating whether each had improved, worsened, or stayed the same on seven performance measures related to access and service. An additional 10 measures of care for specific health conditions are also reported, covering areas ranging from follow up care after mental illness-related hospitalization to provision of eye exams for HMO members with diabetes. Access and service data are from state-mandated member satisfaction surveys, while patient care measures are derived from a nationally comparable database maintained by the New York State Department of Health.
Of the 11 measures of health plan performance in caring for or preventing specific illnesses, four focus on mental health care. "Our employer steering committee felt it was important that we again look at mental health," says Laurel Pickering, Executive Director, New York Business Group on Health. "In last year's report card, we demonstrated that mental health care in New York was not optimal, and unfortunately, we have not seen much progress since then."
This year's report card shows that the percentage of health plan members in New York who were seen by a mental health professional within 30 days of discharge from a psychiatric hospitalization ranged from 51% to 93%; those who had at least three follow-up visits in the first 12 weeks after a depression diagnosis and treatment initiation varied by HMO from 12% to 43%; those with depression who were treated with antidepressants during the entire 12-week period ranged from 54% to 71%; and those who remained on antidepressants for at least six months ranged from 31% to 53%.
On other performance measures, health plan members with diabetes who had inadequately controlled blood sugar ranged from 18% to 50%, and those with diabetes who had an eye exam in the past two years ranged from 45% to 69%. Female members age 52-69 receiving mammograms within the past two years varied from 68% to 80%, while provision of early prenatal care ranged from 75% to 96%.
Health plan members who rated their HMO "8, 9 or 10" on a 10-point scale varied from 47% to 83%, while those providing this top ranking for their personal doctor or nurse ranged from 64% to 81%. From 17% to 36% of members reported that they had "any problem getting care," and 65% to 87% stated that they were "usually or always" able to get care when they needed it.
"Informed consumers and businesses need good data to make wise health care purchasing decisions," said Theodore O. Will, Chief Executive Officer, IPRO. "By publishing these data, we hope to help purchasers to make the choices that are best for them, while highlighting for the health plans where improvement is needed."
The New York State HMO Report Card was prepared using data that all HMOs operating in New York are required to submit annually to the New York State Department of Health. As part of these Quality Assurance Reporting Requirements (QARR), the Department of Health mandates that each HMO submit information from its database of member care and independently conducted surveys of its members. All of the measures in this report come from HEDIS®, a nationally recognized performance measurement set that serves as a standard measuring tool to compare HMOs. These data are independently validated before they are submitted to the Department of Health. National comparison data are derived from the National Committee for Quality Assurance's (NCQA) Quality Compass™, database of HEDIS®, measures. QARR and Quality Compass data used in this report represent HMO performance in 2002 - the most recent year for which validated data are available.
The New York State Health Accountability Foundation was started with grants from the New York State Department of Health and New York State Legislature, receives continuing funding from the Legislature, and is led by an employer steering committee that includes Louise Ionescu, Director, U.S. Benefits, American Express; Lisa Polk, Director, Health Benefits Program, Office of Labor Relations, The City of New York; and William Shanahan, Vice President, Human Resources, TIAA-CREF.
In addition to the HMO Report Card, the Foundation sponsors a number of other important activities. Its Web site, www.abouthealthquality.org, is an easy-to-use, comprehensive resource for information about the quality of health care services, and is composed of high-quality content from a variety of sources. The site allows consumers to create their own performance reports for health plans, hospitals and physician services, and chronic disease management.
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