Aetna U.S. Healthcare Announces 1998 HEDIS Results for California; Aetna U.S. Healthcare's California Operations Excel in Women's Health.SAN RAMON San Ramon (Spanish for "Saint Raymond") may refer to one of the following places:
In 1998 HEDIS HEDIS Health Plan Employer Data & Information Set Managed care An initiative by the National Committee on Quality Assurance to develop, collect, standardize, and report measures of health plan performances. (Health Employer Data Information Set) results, just released by Aetna U.S. Healthcare U.S. Healthcare is a now-defunct healthcare company. The logo had an apple. The merger with Aetna In 1996, the company merged with Aetna, calling it Aetna U.S. Healthcare. The U.S. Healthcare apple logo was next to the Aetna name, and U.S. Healthcare under it. U.S. of California, Inc., the health plan proves to be a leader in women's health Women's Health Definition Women's health is the effect of gender on disease and health that encompasses a broad range of biological and psychosocial issues. . Aetna U.S. Healthcare placed in the top one or two positions in each of the four categories reflecting women's health issues. HEDIS effectiveness of care rates serve as indicators for how well a health plan is doing in providing key preventive health care services. In an effort to provide useful information, to both its members and consumers at large, Aetna U.S. Healthcare voluntarily participates in collecting and reporting this valuable health plan quality information. In California, Aetna U.S. Healthcare has three markets, Northern California Northern California, sometimes referred to as NorCal, is the northern portion of the U.S. state of California. The region contains the San Francisco Bay Area, the state capital, Sacramento; as well as the substantial natural beauty of the redwood forests, the northern , Southern California Southern California, also colloquially known as SoCal, is the southern portion of the U.S. state of California. Centered on the cities of Los Angeles and San Diego, Southern California is home to nearly 24 million people and is the nation's second most populated region, and San Diego, which are each evaluated independently. In a comparison to other health plans operating in the state, one of Aetna U.S. Healthcare's three market areas ranked as number one or two in each of the women's health categories (with a number one ranking in three of the four categories). The Effectiveness of Care measures were originally developed by the National Committee for Quality Assurance National Committee for Quality Assurance Medical practice A private, not-for-profit organization which has become the leading accreditor of managed care plans; in site visits, NCQA reviewers evaluate a managed care plan in terms of quality management, physicians' (NCQA NCQA National Committee on Quality Assurance, see there ), a national organization established to review the quality and medical management systems of HMOs and other managed care plans. Starting with the 1999 accreditation cycle, these Effectiveness of Care measurements also serve as a key factor in determining a health plans NCQA accreditation status. To receive accreditation, NCQA reviews health plans against 60 specific standards in the areas of quality management and improvement, physician credentialing, preventive health services health services Managed care The benefits covered under a health contract , utilization management, members' rights and responsibilities, and medical records. In California, each of Aetna U.S. Healthcare's three regions has received Commendable accreditation ratings. "As the nation's leading health benefits organization, we understand that it is important for employers and consumers to make informed decisions when selecting a health plan," said Howard Arkans, M.D., Medical Director for Aetna U.S. Healthcare's Western Region. "Through efforts like this we not only provide information on how we are doing at providing access to key health services, but we demonstrate our commitment to getting our members the care they need." For each of Aetna U.S. Healthcare's three California regions, the following effectiveness of care indicators were collected: cervical cancer Cervical Cancer Definition Cervical cancer is a disease in which the cells of the cervix become abnormal and start to grow uncontrollably, forming tumors. screening, childhood immunization childhood immunization Children's vaccination, childhood vaccination In the US, it is recommended that all children receive vaccination against Diphtheria, tetanus, pertussis, HBV, H influenzae , adolescent immunization immunization: see immunity; vaccination. , breast cancer screening This article or section recently underwent a major revision or rewrite and needs further review. You can help! X-ray mammography Mammography is still the modality of choice for screening of early breast cancer, since it is relatively fast, reasonably accurate, and , prenatal care prenatal care, n the health care provided the mother and fetus before childbirth. , check-ups after delivery, diabetic retinal exams, cholesterol management after acute cardiovascular event and use of beta blockers Beta Blockers Definition Beta blockers are medicines that affect the body's response to certain nerve impulses. This, in turn, decreases the force and rate of the heart's contractions, which lowers blood pressure and reduces the heart's demand for (attached is a table with each market's score and a comparison to California health plan averages). A percentage is shown for each category for the number (percent) of members that are receiving these important health screenings. To ensure members receive access to these key screenings Aetna U.S. Healthcare has developed and implemented a number of special initiatives. L'il Appleseed is part of an overall women's health program designed to get pregnant members the care and information they need to help ensure a healthy pregnancy and delivery. In addition to educational material on pregnancy, prenatal care and infant care (i.e., breastfeeding and immunization schedules), this program also provides individual patient management for members at high-risk and also includes post-delivery check-ups for both the mother and new baby. Not only does this help to improve effectiveness of care rates, but in every region of the country in which this program has been rolled-out, Aetna U.S. Healthcare has seen an increase in overall birth weights and a reduced need for babies to spend time in the neonatal intensive care unit Noun 1. neonatal intensive care unit - an intensive care unit designed with special equipment to care for premature or seriously ill newborn NICU ICU, intensive care unit - a hospital unit staffed and equipped to provide intensive care . Aetna U.S. Healthcare's HealthCheck programs have been developed for prostate, colorectal, cervical and breast cancer. These cancer screening programs provide educational information and access to routine preventive screenings for members in age categories at risk for these diseases. For breast cancer, women receive annual recommendations and referrals for a mammogram mammogram /mam·mo·gram/ (mam´o-gram) a radiograph of the breast. mam·mo·gram n. An x-ray image of the breast produced by mammography. beginning at age 40. Members over the age of 50 each receive an annual colorectal test kit which is then sent to a centralized laboratory to screen for colon cancer colon cancer, cancer of any part of the colon (often called the large intestine). Colon cancer is the second most common cancer diagnosed in the United States. . In the area of diabetes, Aetna U.S. Healthcare has developed a diabetes disease management program that helps to monitor members with diabetes. In addition to recommending and providing annual retinal eye exams, the program also covers foot screenings and provides free glucometers for each member enrolled in the program. "We are proud to report that our effectiveness of care rates continue to improve, comparing well against both California and national health plan averages, said Dr. Milton Schwarz, Quality Management Medical Director for Aetna U.S. Healthcare's Western Region. "Our goal is to continue to build strong programs that will help to improve the care and services that our members receive, thereby improving our effectiveness of care rates every year. As we have focused on women's health, we are tremendously pleased that these efforts have proven successful and show that we are truly a leader in women's health issues." In California, Aetna U.S. Healthcare provides health coverage to more than 500,000 members through its HMO HMO health maintenance organization. HMO n. A corporation that is financed by insurance premiums and has member physicians and professional staff who provide curative and preventive medicine within certain financial, and more than 1.2 million members through all of its health benefits products. Aetna U.S. Healthcare is the nation's leading health and related benefits organization, providing a full spectrum of products ranging from health maintenance organizations (HMO) to indemnity health insurance, group life and disability products, and dental, vision and pharmacy benefits to more than 21 million Americans. -0-
Aetna US Healthcare
1998 Plan Report Card
AETNA U.S. San Diego Northern Southern All Plan
HEALTHCARE California California Average(4)
MARKETS
Cervical Cancer
Screening 81(a) 78(a) 78(a) 73
Childhood
Immunization(1) 79(a) 72(a) 64(b) 68
Adolescent
Immunization
(MMR only)(2) 56(a) 65(a) 38(b) 44
Breast Cancer
Screening 77 78(a) 78(a) 74
Prenatal Care 95(a) 92(a) 88 88
Check Ups
After Delivery 84(a) 80(a) 79(a) 73
Diabetic
Retinal Exam 49(a) 51(a) 47 43
Cholesterol
Management
After Acute
Cardiovascular
Event(3) (6) 79(a) (6) 57
Beta Blocker (6) 73 76 79
Antidepressant
Medication
Management
Follow up Care (5) (5) (5) (7)
Medication x 3 mo (5) (5) (5) (7)
Medication x 6 mo (5) (5) (5) (7)
Key Performance Strata
00(a) = above average
00 = average
00(b) = below average
(1) The measure reports vaccines provided to children up to two years
old. In other reports, health plan results for the measure may
include chicken pox or additional hepatitis B shot.
(2) This measure reports measles, mumps and rebella (MMR). In other
reports, health plan results for this measure may include chicken
pox or hepatitis B, in addition to MMR.
(3) This measure includes heart attack, heart bypass surgery or
coronary angioplasty.
(4) This average includes all plans collecting data through CCHRI. It
also includes some other California health plans that submitted
audited HEDIS results so that CCHRI could measure its results
against a more comprehensive California average.
(5) Plan did not submit data for this measure.
(6) Results not reported because minimum population size requirements
not met.
(7) This is a first year measure. CCHRI did not compute an all plan
average or performance strata due to the newness of the measure
and unresolved data collection issues for a number of plans.
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