MCPR 2001 - Measuring the Quality of Pennsylvania's Commercial HMOs - News Release

For Immediate Release

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

Pennsylvania's HMOs Receive High Marks

Harrisburg, PA - March 31, 2003 - HMOs received high marks today from a government agency, especially in the health categories that HMOs have claimed they do best: primary care and preventive medicine. For the second year in a row, Pennsylvania's HMOs not only improved their results in all 15 preventive care measures found in the report, but they also outperformed their national counterparts in these categories. The new report released today by the Pennsylvania Health Care Cost Containment Council (PHC4) also noted that for the fourth consecutive year, Pennsylvania HMOs achieved higher member satisfaction rates than the national average, with 86% reporting no problems in receiving the care they felt they needed.

"For the second year, we observed a correlation between HMOs that emphasized preventive care and lower hospitalization rates," stated Marc P. Volavka, Executive Director of PHC4. "Through better preventive care, patients can avoid unnecessary trips to the hospital and purchasers can avoid unnecessary costs."

Measuring the Quality of Commercial HMOs provides comparisons about the quality of care that Pennsylvania HMOs offer. The report combines clinical results, preventive measures and member satisfaction measures to give Pennsylvanians a more complete picture of how well HMOs serve their members. Each participating HMO's accreditation status and contact information is also listed.

The report shows that there are statistically significant correlations between prevention measures and lower hospitalization rates in some instances; one example is between well-controlled blood pressure levels and lower hospitalization rates for high blood pressure. Furthermore, overall hospitalization rates for diabetes decreased, which also may suggest that HMO prevention measures are having a positive effect.

The report also found, however, that there are still differences among plans, particularly in regards to surgical procedures. There continues to be significant variation in breast reconstruction surgery following mastectomy among the HMOs in Pennsylvania. In addition, while the complication rate for both abdominal and vaginal hysterectomies decreased between 1998 and 2001, the procedure rate for all hysterectomies increased from 42.7 to 55.8 per 10,000 female members during the same time period.

Also noteworthy is that for each of the surgical procedure categories covered in this report, HMO members were more likely to experience complications than those in fee-for-service plans. Moreover, HMO members who had hysterectomies were more likely than fee-for-service members to have an abdominal hysterectomy, which has a higher length of stay and complication rate than a vaginal hysterectomy.

"With health care cost increases on the rise, this report will help HMOs find additional opportunities for quality improvement and cost containment, and will assist health care purchasers, policy makers and consumers with their health care decision-making," said Mr. Volavka. "These findings continue to suggest that there are opportunities for dialogue between managed care companies and their network providers regarding quality improvement."

The Pennsylvania Health Care Cost Containment Council (PHC4) is an independent state agency charged with collecting, analyzing and reporting information that can be used to make more informed decisions, thereby improving the quality and restraining the cost of health care in Pennsylvania. Copies of this report are free and are available on the Council's website at or by calling PHC4 at 717-232-6787.