NEWS RELEASE
December 17, 1998


Department of Community Health Releases 1996 External Review
of Medicaid HMO's and Clinic Plans

Michigan Department of Community Health Director James K. Haveman, Jr., today released the 1996 External Review of Medicaid HMO's and Clinic Plans. This review included all 17 health plans who had contracted with the Medicaid program during 1996. The report focused on prenatal care, well child care, care for persons with hypertension and for persons with asthma.

"We are extremely pleased that these findings show that health plans had reduced the number of women who received no prenatal care by 64 percent, and that within well child care health plans are doing a better job of performing screening tests," said Haveman. "It is also encouraging to see that asthma patients are not using emergency and hospital services which tells us that they are receiving primary care and avoiding emergency situations."

The External Quality Review of health plans enrolled with Medicaid was conducted by the Michigan Peer Review Organization (MPRO). MPRO evaluated the care provided using generally accepted medical guidelines and evaluated each medical record for quality of care issues applicable to other diagnoses. The results of the studies have been shared with the health plans and they are in the process of preparing Quality Improvement Plans to further improve care to the Medicaid population.

The External review found that health care plans generally demonstrated adherence to the American College of Obstetricians and Gynecologists recommendations for prenatal care and that overall prenatal care provided was appropriate. The total number of beneficiaries who did not receive prenatal care was only five percent, a 64 percent decrease from the previous review.

Immunizations among two year olds in the Medicaid population was 62 percent. Blood lead testing was documented at 31 percent of Medicaid beneficiaries, which is much higher than the national Medicaid average of 19 percent. Of those tested and found to have an elevated blood lead level, the health plans were found to have 100 percent follow up.

Overall, the health plans provided care in accordance with the United States Preventative Task Force on Hypertension and care provided to beneficiaries diagnosed with asthma was in accordance with medical standards. 77 percent did not use the emergency room for asthma related problems, while 89 percent of the total population were not hospitalized for asthma during the 1996 calendar year. The lower percentages of hospitalizations and emergency department visits related to asthma may reflect appropriate management in the office setting.

FOR IMMEDIATE RELEASE PRESS CONTACT: Geralyn Lasher
December 17, 1998 (517) 241-2112