06/06/2005 - SEVENTH ANNUAL NEW YORK STATE HMO REPORT CARD RELEASED

Contact: Dennis Tartaglia/Kelly Peterson

212/481-7000

Spencer Vibbert

516/326-7767 ext. 652

"While New York's HMOs generally do well compared with national averages, we have again identified some areas that require the health plans' attention," says Anthony Shih, M.D., M.P.H., Vice President, Quality Improvement, IPRO. "One of the most significant of these is in the area of caring for people with depression. While this is a very complicated area of care and one in which health plans across the nation have not done well, we think the state's HMOs should look at how they can do better." (See attached charts for comparisons of state, national and 2005-2004 averages.)

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 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 reported, covering areas ranging from the provision of immunizations to children, to controlling cholesterol levels of the HMOs' heart patients. Data on five of the access and service measures are from state-mandated member satisfaction surveys, while two cover physician board certification and turnover rates (from the HMOs' records). Patient care measures are derived from a nationally comparable database maintained by the New York State Department of Health.

As in last year's Report Card, four of the measures of health plan performance focus on mental health care. "Mental illness continues to be a disease area that takes a significant toll on employees, as well as on work place productivity," says Laurel Pickering, Executive Director, New York Business Group on Health. "This year's Report Card demonstrates again that mental health care in New York is suboptimal. Progress can and should be made in this area."

This year's Report Card shows a wide variation in performance between health plans across these and other measures. The percentage of health plan members in New York who were seen by a mental health professional within 30 days of discharge from psychiatric hospitalization ranged from 63% to 95%; those who had at least three follow-up visits in the first 12 weeks after a depression diagnosis/initiation of treatment varied from 13% to 38%; those with depression who were treated with antidepressants during the entire 12-week period ranged from 44% to 73%; and those who remained on antidepressants for at least six months ranged from 28% to 55%.

Health plan members with diabetes who had inadequately controlled blood sugar ranged from 18% to 41%, and those with diabetes who had an eye exam in the past two years ranged from 44% to 67%. Between 46% and 68% of HMO members with heart disease had low cholesterol levels, while 82% to 100% of heart attack victims received beta blockers. Childhood immunization rates in the HMOs ranged from 48% to 82%, while HMO members of all ages with asthma received recommended medications between 66% and 78% of the time.

Health plan members who rated their HMO "8, 9 or 10" on a 10-point scale varied from 50% to 80%, while those providing this top ranking for their personal doctor or nurse ranged from 68% to 82%. From 65% to 84% of members reported that they had "no problem getting care," and 64% to 86% stated that they were "usually or always" able to get care when they needed it. Between 46% and 77% of HMO members reported no problems with HMO customer service. Ninety % to 97% of primary physicians stayed with their HMO over time, while board certification rates varied between 81% and 91%.

"We continue to publish the HMO Report Card because health plan performance varies so widely and consumers and businesses need quality data to make wise health care choices," says Theodore O. Will, Chief Executive Officer, IPRO. "We also see the need to keep 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 2003 - 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.

In addition to the HMO Report Card, the Foundation sponsors a number of other important activities. Its Web site, www.abouthealthquality, 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 Foundation plans to publish its first Hospital Report Card later this year.