Survey Finds Disparities in Pennsylvania MCO Hospitalization Rates

Some Pennsylvania MCOs are doing a "better job than others" of keeping patients healthy enough that they do not need hospitalization, a new report from the Pennsylvania Health Care Cost Containment Council finds. Council Executive Director Mark Volavka said, "One of the selling points of HMOs is that they can help patients avoid unnecessary trips to the hospital through better preventive and primary care. For the first time, the council was able to use its clinical data to test this theory and the analysis suggests that, for the most part, this approach seems to be working." The report analyzes hospitalization rates in six categories of illnesses primary care physicians often treat. The Pittsburgh Post-Gazette reports that the report highlights some "dramatic differences" among health plans in Pennsylvania. For example, Highmark Blue Cross Blue Shield had 123.3 hospitalizations for diabetes per 10,000 beneficiaries, compared with 318.5 hospitalizations for Aetna U.S. Healthcare. Aetna had higher hospitalization rates than the council expected in four of the six illness categories, the Post-Gazette reports. Volavka said, "Aetna might have significant questions it wants to explore further." Aetna's Senior Medical Director Dr. Donald Liss wrote to the council, "We are unable to ascertain whether a statistically higher-than-expected hospitalization rate is indicative of missed opportunities to prevent hospitalization through primary care intervention or might indicate better access to necessary procedures ... which is likely to improve health." The report examined specialized categories of mental health, breast cancer and neck and back treatments, but the council "was hesitant" to make conclusions in those areas (Snowbeck, Pittsburgh Post-Gazette, 6/27). To read the report, click here. Please note this link is available to Web readers only.