NYSID Guide to HMOs

How is the quality of HMO providers determined?


Current performance area: Quality of Providers
Compare: Selected HMOs
Source: DOH, 2005

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
NV Plan submitted invalid data.
Click here for the pdf version of the table
 
HMO Members†rating their Doctor†or†Nurse
an 8,9 or 10 on a scale
from 0 (worst) to 10 (best)1
Members Responding
that their Doctors Usually or Always
Communicate Well1
Doctors who are Certified
by a Medical Board
Physician Turnover
(Primary Care)
Primary†Care OB/GYN Pediatric
NY HMO Average 77% 93% 87% 80% 76% 5.1%
Aetna Health Not different from average Not different from average Lower than average Not different from average Lower than average 3.4%
Blue Choice Not different from average Not different from average Higher than average Lower than average Not different from average NV
BSNENY-HMO Not different from average Higher than average Higher than average Higher than average Lower than average 4.8%
CDPHP Not different from average Not different from average Not different from average Not different from average Not different from average 4.4%
CIGNA Not different from average Lower than average Higher than average Higher than average Higher than average 7.7%
Community Blue (HealthNow) Lower than average Higher than average Not different from average Higher than average Lower than average 5.6%
Empire HealthChoice Not different from average Not different from average Higher than average Higher than average Higher than average 7%
GHI-HMO Select Not different from average Not different from average Lower than average Lower than average Not different from average 6.8%
Health Net of NY Not different from average Not different from average Lower than average Lower than average Not different from average 5.3%
HIP Lower than average Lower than average Lower than average Not different from average Lower than average 8.4%
IHA Not different from average Higher than average Lower than average Not different from average Not different from average 4.8%
MDNY Not different from average Lower than average Lower than average Not different from average Not different from average 3%
MVP Health Plan Not different from average Not different from average Lower than average Not different from average Lower than average 5.3%
Oxford Not different from average Not different from average Higher than average Lower than average Not different from average 3.8%
Rochester Area HMO (Preferred Care) Higher than average Higher than average Higher than average Higher than average Not different from average 7.2%
UnitedHealthcare of NY Not different from average Not different from average Higher than average Higher than average Lower than average 1.6%
Univera HealthCare Not different from average Not different from average Lower than average Lower than average Not different from average NV
Upstate HMO Not different from average Not different from average Higher than average Lower than average Not different from average NV

NOTE: Symbols show statistically significant differences between each planís score and the New York average. Statistically significant means scores varied by more than could be accounted for by chance.
1
Data are from 2006.


The quality, stability and availability of physicians in an HMO provider network can impact the overall quality of care delivered to HMO members.

Understanding the Table

The quality, stability, and availability of the physicians in an HMO provider network can impact the overall quality of care delivered to health plan members. New York HMOs were rated on these characteristics of their providers.

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.

Rating of Doctor or Nurse
Members rated their doctor or nurse on a scale from 0 (worst possible) to 10 (best possible). The circles are based on the percentage of members who gave their HMO an 8, 9, or 10 rating.

How Well Doctors Communicate
You will find information about how members rated their HMO's quality of in-network providers or nurses (on a scale of 1-10). Members responded "usually" or "always" to questions about the quality of their HMO in-network providers, including overall service and communication such as:

  • How often their doctors listened carefully to them
  • How often their doctors explained things in a way they understand
  • How often their doctors showed respect for what they have to say
  • How often their doctors spent enough time with them during visits

Board Certification
A doctor must receive additional training and pass an exam in his or her specialty to be considered board certified. While board certification is not a guarantee of quality, it shows that the physician has the knowledge that the specialty board considers necessary. The circles in the table are based on the percent of primary care physicians, obstetricians/gynecologists (OB/GYN), and pediatricians who are board certified. A higher percentage means the HMO has more board certified physicians in the practice areas listed.

Note: There are times when it is appropriate for HMOs to contract with physicians who are not board certified, as in the case of older physicians who were trained before board certification was avilable. In addition, an HMO covering rural areas may have a lower percentage of board certified physicians, since a limited number of physicians practice in these regions.

Physician Turnover
Going to the same doctor makes it easier to receive better and more coordinated care. If most doctors stay in an HMO, you are less likely to have to change doctors. The table shows the percentage of primary care physicians who left the HMO's network over the past year. A lower percentage means the HMO's provider network is more stable.

Keep in mind...

These measures indicate how satisfied members are with their health care providers and how many providers have undergone specialized training.

The Quality of Providers category is only one of eight performance areas presented.

 

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Copyright © 2006 New York State Insurance Department