For many Utahns, the months of December and January represent open season for switching their HMO or making changes to existing health coverage. The 2007 Performance Report for Utah Commercial HMOs and Medicaid & CHIP Health Plans, released today by the Utah Department of Health’s (UDOH) Health Data Committee and Division of Health Care Financing, evaluates the quality of performance and member satisfaction of selected Utah health plans covering more than 930,000 members across the state.

The report measures come from data collected by Utah health plans for patient visits in 2006, as well as a consumer satisfaction survey. The report contains information on five commercial HMOs, two Medicaid HMOs, two Medicaid health plans and two Children’s Health Insurance Program HMOs. “The Health Data Committee has a proud tradition of annually publishing these reports for consumers, health care purchasers and policy makers in Utah,” said Sam Vanous, Ph.D., HMO Program Manager.

The report describes how Utah HMOs are performing in selected areas of health care. Results show all commercial HMOs either met or exceeded national averages in providing child immunizations, timely prenatal care, postpartum care and eye exams for diabetics. Commercial HMOs were above national averages for effective treatment of children with throat and upper respiratory infections, though scored lower than national counterparts for adolescent immunizations, well-care visits and children’s access to primary care providers.

Medicaid HMOs scored higher than the national average on several performance measures, including children’s access to primary care practitioners, timeliness of prenatal care, childhood immunizations and adult access to preventive care. One important area where HMOs serving Medicaid clients could improve is managing adolescent immunizations. Medicaid HMOs also fell below national averages in well-care visits for children ages 3 to 6 and chlamydia screenings.

Utah’s CHIP HMOs were on par with or above national averages for child immunizations, well-child visits and use of appropriate medication for people with asthma, but could do better in the treatment of children with upper respiratory infections and adolescent immunizations.

The 2007 Performance Report also details results of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, conducted by independent research firm DataStat Inc., in the spring of 2007. A total of 1,560 enrollees in commercial HMOs answered the survey, as did 1,813 enrollees in Medicaid health plans and 1,199 enrollees in CHIP HMOs. The survey measured consumer satisfaction in several areas of care and service received from the health plan in the past year.

Commercial health plans exceeded national averages in measures like getting care quickly and overall rating of health care, but ranked lower in claims processing and getting needed care. More than four out of five (82%) respondents were satisfied with their personal doctor.

Medicaid health plans scored above national averages in many customer satisfaction measures, including ratings for physicians, specialists, health care received and health plan overall. The report suggests that Medicaid plans need to improve in customer service and doctor communication.

CHIP plans received higher ratings than their national counterparts on all satisfaction measures, sometimes outscoring national counterparts by a large margin.

UDOH is making the HMO reports available online this year to help consumers better understand them. “We encourage all Utahns with HMO coverage to look at the reports to see how their plan is performing,” said Dr. Vanous. “This information can help members make more informed health care decisions for themselves and their families.”

For more information about the report, visit http://health.utah.gov/hda/reports/hmo/.

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