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How well do HMOs help members maintain good health and avoid illness?

Understanding the Table

Current performance area: Staying Healthy and Living with Illness
Compare: Selected HMOs
Source: DOH, 2006

Plans are listed in alphabetical order.

Skip Legend
Performance Compared to the New York HMO Average
Better than average Significantly better than the NY HMO average
Not different from average Not significantly different than the NY HMO average
Worse than average Significantly worse than the NY HMO average
SS Rate not suitable for comparison because of a small sample size.
NV Plan submitted invalid data.
Click here for the pdf version of the table
 
Access to Care and ServiceStaying Healthy and Living with IllnessQuality of ProvidersGrievances
ComplaintsPrompt Pay ComplaintsInternal AppealsExternal Appeals
   
HMO Follow-up within 30 days of Prescribing ADHA Medication for Children Adolescent Preventive Care with Body Mass Index (BMI) Screening Avoidance of Antibiotics for Adults with Acute Bronchitis Breast Cancer Screening Cholesterol Level Controlled for Patients with Cardiovascular Conditions
NY HMO Average 36% 46% 27% 68% 54%
Aetna Health Inc. Not different from average Lower than average Higher than average Lower than average Not different from average
Blue Choice Not different from average Higher than average Lower than average Higher than average Higher than average
BSNENY-HMO Higher than average Lower than average Lower than average Higher than average Lower than average
CDPHP Not different from average Not different from average Lower than average Higher than average Not different from average
CIGNA Healthcare of NY, Inc. Not different from average Not different from average Higher than average Lower than average Not different from average
Community Blue (HealthNow) Not different from average Not different from average Lower than average Higher than average Higher than average
Empire HealthChoice HMO, Inc. Not different from average Lower than average Not different from average Lower than average Not different from average
GHI HMO Select, Inc. Not different from average Not different from average Lower than average Lower than average Not different from average
Health Net of NY, Inc. Not different from average Lower than average Higher than average Lower than average Higher than average
HIP HMO Lower than average Lower than average Not different from average Lower than average Lower than average
Independent Health Association, Inc. (IHA) Not different from average Higher than average Lower than average Higher than average Not different from average
MVP Health Plan, Inc. Higher than average Not different from average Lower than average Higher than average Higher than average
Oxford Health Plans of NY, Inc. Not different from average Lower than average Higher than average Not different from average Lower than average
Rochester Area HMO, Inc. (Preferred Care) Not different from average Not different from average Lower than average Higher than average Higher than average
UnitedHealthcare of NY Not different from average Lower than average Higher than average Lower than average Lower than average
Univera HealthCare Not different from average Not different from average Not different from average Higher than average Higher than average
Upstate HMO SS Higher than average Not different from average Higher than average Not different from average

NOTE: Symbols show statistically significant differences between each plan’s score and the New York average. Statistically significant means scores varied by more than could be accounted for by chance.


New York HMOs were rated on how well they help people maintain good health and recover from illness.

Understanding The Table

The circles show how each HMO compares to the average for all New York HMOs. Look for HMOs with a Better than average in the table. These HMOs performed better than the New York HMO average. In other words, a greater percentage of members who received these services.

Follow-up within 30 Days of Prescribing ADHD Medication for Children
Medications used to treat Attention Deficit/Hyperactivity Disorder (ADHD) have known side effects and, like all medications, need to be closely monitored. Close supervision fosters early detection and response to any problematic side effects from medication. HMOs were rated on the percentage of children ages 6 to 12 with a new prescription for ADHD medication who had one follow-up visit during the 30 days after beginning the medication.

Adolescent Preventive Care with Body Mass Index (BMI) Screening
The Centers for Disease Control and Prevention(CDC) states that overweight children and adolescents are more likely to become obese as adults. Assessing Body Mass Index (BMI) allows healthcare professionals to identify adolescents at high risk and implement preventive care. HMOs were rated on the percentage of adolescents aged 14-18 who had a least one well-care visit with a PCP or OB/GYN during 2006 and had documentation of a BMI or BMI percentile.

Avoidance of Antibiotics for Adults with Acute Bronchitis
Antibiotics are commonly misused and overused for a number of viral respiratory conditions where antibiotic treatment is not clinically indicated. Antibiotics are not recommended for the treatment of adults with acute bronchitis who do not have a another condition or other infection for which antibiotics may be appropriate. HMOs were rated on the percentage of healthy adults, ages 18 to 64, with acute bronchitis who did not receive a prescription for antibiotics.

Breast Cancer Screening
The earliest sign of breast cancer is often an abnormality detected on a mammogram before it can be felt by the woman or a health care professional. HMOs were rated on the percentage of women between the ages of 42 and 69 who had a mammogram in the past two years.

Cholesterol Level Controlled for Patients with Cardiovascular Conditions
Individuals with cardiovascular disease can reduce their risk of the disease worsening and premature death by managing cholesterol levels. HMOs were rated on the percentage of members, who had a heart attack, or heart surgery, or heart related procedures, or have had a diagnosis of ischemic vascular disease within the last year and received a cholesterol screening test whose cholesterol level LDL-C result was < 100mg/dL (recommended level of control).

Keep in mind...

These measures indicate how well an HMO delivers preventive care to help members stay healthy. Evaluate the importance of each performance measure to you and your family. The Staying Healthy category is only one of eight performance areas presented.

 

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State of New York
David A. Paterson
Governor
State of New York
Department of Insurance
Eric R. Dinallo
Superintendent of Insurance
State of New York
Department of Health
Richard F. Daines, M.D.
Commissioner
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