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UPMC Health Plan Receives Nation's Highest Rating for Breast Cancer Screening

PITTSBURGH (October 12, 2004) UPMC Health Plan set the nationwide benchmark for breast cancer screening rates and had higher scores for women's health care coverage than any other insurer in Pennsylvania, according to a report by the National Committee for Quality Assurance (NCQA).

"We are extremely proud of our efforts to improve women's health," said Diane P. Holder, president of UPMC Health Plan. "It is part of our mission to help women in western Pennsylvania to get the care that they need."

The Health Plan was recognized by the NCQA in a report titled, "The State of Health Care Quality: 2004." The Health Plan is the only western Pennsylvania insurer to earn a top-five rating for effectiveness of care in the Middle Atlantic region, which consists of Pennsylvania, New Jersey and New York.

The report found that nearly nine out of ten members of the Health Plan who met the criteria for needing breast cancer screening were tested. No other health plan in the nation performed better in this measure.

"It's certainly gratifying to be recognized not only in women's health but in our overall quality of care measures," said Ms. Holder. "But what's most important is what we did to get that recognition and its impact on the health of the community."

Here are some examples:

  • The Health Plan takes full advantage of its relationship with the University of Pittsburgh Medical Center (UPMC) to provide continuous feedback to physicians on members with identified gaps in service. These include people with diabetes who have not had an annual physician visit or screening, and people with asthma in need of medical management.

  • The Health Plan develops pilot programs with its large physician groups that focus on collaborative member management.

  • While most health plans use vendors for health and case management, UPMC Health Plan programs are in-house and include outreach to members and referrals to appropriate resources.

  • The Health Plan makes regular contact with members through reminder mailings and newsletter articles.

For behavioral health, UPMC Health Plan was rated among the top 10 plans nationally for antidepressant medication management. Contributing to its success was the Health Plan's relationship with UPMC's Community Care Behavioral Health (CCBH), a Pittsburgh-based behavioral health management company.

"This kind of recognition is especially gratifying because it reflects the dedication and hard work done by everyone in our network - doctors, nurses, hospitals, case management workers, our employees and all other health care providers. This honor shows our overall commitment to quality," said Ms. Holder.

"This also demonstrates that our position as the primary portal to the premier services and facilities of UPMC continues to help us improve the health of our members and our community."

UPMC Health Plan received a "Best in Class" designation and was rated in the top five percent nationally for six measures. These include Childhood Immunization (Combination 1); Breast Cancer Screening; Comprehensive Diabetes Care - Monitoring of Nephropathy; Timeliness of Prenatal Care; Antidepressant Medication Management - Optimal Practitioner Contacts; and Antidepressant Medication Management - Effective Continuation Phase Treatment.

In all, the Health Plan rated in the top 10 percent nationally for 11 of 23 measures. The top plans were determined by the Effectiveness of Care measures established by the Health Plan Employer Data Information Set (HEDIS). HEDIS is a set of standardized performance measures designed to ensure that purchasers and consumers have the information they need to reliably compare the performance of managed health care plans.

NCQA is an independent, not-for-profit organization that evaluates managed care organizations. NCQA analyzes HEDIS data from 262 commercial health plans covering more than 69 million Americans. The data in "The State of Health Care Quality: 2004," are drawn from NCQA's Quality Compass report.

(HEDIS is a registered trademark of NCQA.)

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