NEW JERSEY: Governor Wants HMO Improvements

      Spurred by a New Jersey report that the state's HMOs are falling behind national averages in providing the most basic preventive care, Gov. Christine Todd Whitman (R) and Health Commissioner Len Fishman Friday ordered the state's 12 largest managed care firms to revamp their efforts to provide services such as mammograms, immunizations and prenatal care. The New York Times reports that according to New Jersey's second annual HMO report card, "one-third of children enrolled last year in the state's 20 largest managed care plans had not received recommended doses of vaccines by age 2 ... only 61% of new mothers received a checkup within six weeks of delivery" and 37% of women between the ages of 52 and 69 had not been tested for breast cancer within the last two years. Fishman said that although some of the measures detailed in the report card represent an improvement, "it's not enough. The health plans can still do better. This isn't about numbers or percentages. This is really about keeping people healthy and saving lives" (11/7). The Bergen Record reports that in "seven key preventive categories, New Jersey's HMOs still rank below regional and national averages."

Shape Up
      The governor and Fishman said they "want every major managed health plan to score higher than the current leader in seven categories that are measured on the state's annual report card on managed care." They are requiring HMOs to submit a plan of action within 90 days, and to post 5% gains within two years in the preventive care categories. The report cards consisted of customer satisfaction data gathered by telephone and from data submitted by the individual companies (Markowitz, 11/7). The Philade lphia Inquirer reports that the New Jersey ranking is "considered by state and federal experts to be among the most reliable of its kind in the country because all HMOs are required to provide information for it. Most other surveys are based on spotty or voluntary data" (Ginsberg, 11/7). State Health Department spokesperson Marilyn Riley called it "premature to discuss which penalties the department would impose if companies failed to meet the deadlines."

Unscientific?
      Whitman's initiative met with a mixed reaction from HMOs and consumer groups. New Jersey Association of Health Plans President Paul Langevin said the 5% goal is not "based on science. He said it was not easy to increase rates of childhood immunization, for example, because many parents are reluctant to vaccinate their children." New Jersey Citizen Action's Anthony Wright said "that the report could help a small number of consumers who are able to choose among HMOs, but noted that most plans were picked by employers." He added, "Most consumers have a larger question about the system in general, about putting profits before patient care. In some cases, it is a moot point to talk about one company over another when the critique is about the system altogether" (New York Times, 11/7). Langevin added that "the general public understands that this is but one tool in choosing a health plan."

Tops In Satisfaction
      The Record reports that in the customer service category, "Aetna US Healthcare and AmeriHealth scored above the New Jersey average for the second year" in a row. Oxford Health Plans and Physicians Health Services of New Jersey both moved to above average. Prudential and HIP Health Plans of New Jersey both sank to below average. Of the HMO enrollees surveyed, 85% found it easy to find a doctor and 81% "were satisfied with their ability to get referrals to specialists" (11/7). Click here to read the complete report, available online at: http://www.state.nj.us/health.