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UPMC Health Plan Among "Best" Nationwide

PITTSBURGH (October 3, 2005)UPMC Health Plan is among the highest ranked health plans in the country, according to a national organization that ranks managed care companies on their preventive health and quality programs. The results were published in U.S. News & World Report magazine.

The National Committee for Quality Assurance and U.S. News & World Report listed UPMC Health Plan as one of the top-50 health plans in the United States. The Health Plan was the highest-ranked managed care company in the nation for breast cancer screening, for the second consecutive year, and highly ranked statewide, as well.

U.S. News & World Report used a star system to rank health plans in specific categories. UPMC Health Plan earned five stars in the categories of "Prevention" and "Treatment." UPMC Health Plan is the only Pennsylvania health plan on the list to do so.

UPMC Health Plan's high rankings were based primarily on NCQA's review of preventive health data, which showed that Health Plan members received procedures such as breast cancer screenings, diabetes preventive health tests, and other similar measures at a high rate.

The rankings were published as "America's Best Health Plans 2005" in U.S. News & World Report's October 10 edition and are now available in the health section of the magazine's website. The magazine publication marks the first time NCQA has released the information through a media partner.

"Exceptional rankings never come easily," said Diane P. Holder, president of UPMC Health Plan. "The recognition that NCQA bestowed on our company is the result of hard work by our clinical staff and by the great physicians that participate in our network."

Nationally, UPMC Health Plan's top ranking in breast cancer screening means Health Plan members were screened for breast cancer at a greater rate than were members of any other surveyed managed care company in the United States.

UPMC Health Plan received five-star ratings in two categories (Prevention and Treatment) and in five sub-categories (child and adolescent access to care, child and adolescent immunizations, women's reproductive health, diabetes care, and behavioral health).

The Health Plan was recognized through the U.S. News & World Report/NCQA America's Best Health Plans 2005 listing in the news magazine.

Here are some examples of how UPMC Health Plan encourages preventive health:

  • UPMC Health Plan takes full advantage of its unique relationship with its health care provider network to develop preventive health methodology.

  • The Health Plan offers continuous feedback to its provider network and members to identify 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 provides a full suite of online tools and information that allow members to track their own health parameters and research health topics.

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

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

"Prevention" and "Treatment" are defined by NCQA as described below.

Prevention: Ten measures: early-childhood immunizations, adolescent immunizations, treating children with upper respiratory infections, testing children with sore throats, timely prenatal care, timely postpartum care, chlamydia testing for young women, regular mammograms, regular Pap testing, colorectal cancer screening.

Treatment: Twenty measures: medicating asthma appropriately; in diabetics, checking eyes, testing and controlling blood sugar, checking LDL cholesterol, and monitoring kidney disease; administering beta blockers after heart attack, controlling high blood pressure; controlling LDL cholesterol in heart patients; advising smokers to quit and offering strategies and medications for quitting; providing suitable specialists to manage acute depression and medicating depression appropriately; following up after hospitalization for mental illness; initiating and continuing treatment for alcoholism and substance abuse.

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and manages the evolution of HEDIS, the tool NCQA uses to measure and report on the performance of the nation's health plans.

(Note: Reporters interested in producing local health care "report cards" should contact the NCQA Communications Department at (202) 955-3518 to discuss data needs.)

About UPMC Health Plan
UPMC Health Plan, a leading health care benefits company located in Western Pennsylvania, is backed by the University of Pittsburgh Medical Center (UPMC), one of the nation's top-ranked health systems. As part of an integrated health care delivery system, UPMC Health Plan partners with UPMC to improve clinical outcomes as well as the health of the greater community. The National Committee for Quality Assurance and U.S. News & World Report listed UPMC Health Plan as the top ranked health plan in Pennsylvania, and one of the top 20 health plans in the United States. The Health Plan is the only Pennsylvania plan to receive five stars in the categories of "Prevention" and "Treatment," and is the highest-ranked managed care company in the nation for breast cancer screening, for the second consecutive year. The UPMC Insurance Services Division - which includes UPMC Health Plan, UPMC for You (Medical Assistance), Community Care Behavioral Health, and EAP Solutions - serves over 700,000 members through a network that includes UPMC providers as well as affiliated hospitals and physicians, totaling more than 80 hospitals and more than 7,000 physicians in a 28-county region.

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