Managed Care Review

Managed Care Performance Monitoring

For immediate release:
January 8, 2003

ANNUAL MANAGED CARE REVIEW FINDS ROOM FOR IMPROVEMENT

Managed care plans in the state of Missouri still need to improve basic services to their members, according to a new report released today by the Missouri Department of Health and Senior Services. "Over the past few years, the performance of managed care plans has improved overall. However, there is still room for improvement, especially in preventive services," said Garland Land, Director of the Center for Health Information Management and Evaluation.

According to the report, 2002 Consumer's Guide: Commercial Managed Care in Missouri , an average of only 58 percent of two-year-old children within managed care plans had received all recommended immunizations, versus the national average of 68 percent. Only 28 percent of adolescents (ages 12 through 21) had received well-care visits in the state's managed care plans, compared to the national average of 34 percent.

"Childhood immunizations and annual well-child checkups are important to keeping children healthy," Land said. "We would like to see managed care organizations do a better job of putting an emphasis on preventive health care for children," he added.

He said that Missouri managed care plan performance was near or lower than the national averages for other measures, including: Breast Cancer Screening 72% (nationally 75%), Diabetic HbA1C Testing 80% (nationally 81%), and Beta Blocker Treatment after a Heart Attack 83% (nationally 92%). Land stressed that "Missouri should be leading the way in health care instead of remaining slightly below the national average in these areas. Managed care organizations should make a concerted effort to actively identify members who may be at risk for certain preventable diseases, and then provide services needed by those identified as having the disease."

Access to care is another key component to effective health care management. Reminder notices and educational efforts directed to members, and case management for complex and multiple illnesses, are examples of plan services that help to ensure the delivery of appropriate care to plan members.

"Understanding which plans offer their members these services plays a critical role in ensuring that Missourians have access to quality health care," said Land. He noted that nine of the 18 plans did not provide educational materials on identifying and treating breast and cervical cancer. Seven of the plans did not provide screening for asthma. Five of the plans did not send childhood immunization reminder notices.

"The simple act of providing the various reminder notices could enhance members' health by preventing or catching disease early," Land said.

Land said that one area of improvement has been a steady increase in member satisfaction scores. Generally since the 1999 data year, satisfaction with customer service has increased from 63 percent to 65 percent; claims processing, from 80 percent to 83 percent; getting needed care, from 76 percent to 79 percent; and how well doctors communicate, from 90 percent to 91 percent. The following table shows whether plans ranked "high" or "low" in several areas of member satisfaction:

Members' Ratings of Selected Managed Care Services

The next table shows how members typically rated their managed care plans overall. Each plan's rating is a comparison to the statewide average of 61 percent. However, when choosing a health plan, members should always talk to their doctor, family and friends about their experiences with different plans. No one indicator is a sole direct measure of a health plan's performance.

Members' Overall Rating of Health Plan

Copies of the commercial managed care brochure ($1) may be ordered from:
Department of Health and Senior Services at the address listed under Contact Us.