HMO Quality Ratings Summary 2015-16 Edition

Quality health care is getting the right care at the right time.


This Report Card shows the quality of health care for millions of Californians who get their care through commercial insurance provided by Health Maintenance Organizations (HMOs). The 10 largest HMOs in the state are included in this Report Card.

The HMO Report Card includes health care quality scores for two major areas:

  • Clinical Performance Scores – See the “HMO Provides Recommended Care” column below. To find more information on 11 health conditions/topics go to the dark blue box in the right column.
  • Patient Experience Scores – See the 3 columns below under “Patients Rate their Experience.” Additional information is found in the light blue box in the right column.

The Report Card also provides other helpful information on each HMO. Click on each health plan name to find its consumer assistance number, service area, website and more.
Learn more about these ratings.

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HMO Provides Recommended Care

The California Office of the Patient Advocate compared HMO members’ records in 2014 to a set of national standards for quality of care to make sure that health plans are offering quality preventive care and service to members.

PATIENTS RATE THEIR EXPERIENCE

Click on plan name for
plan’s star ratings and
information:

Rate
Their HMO
We compared how HMO members rated their care and services with a 9 or 10 on a 0 to 10 scale during 2014.
Getting Care
Easily
Members rated their ease for getting doctor appointments, tests and treatments during 2014.
HMO Helps
Members Get Answers
Members who contacted their plan rated the customer service provided and whether they got accurate information on plan costs and claims payment during 2013 and 2014.
Aetna Health of California, Inc. FairTwo stars GoodThree stars PoorOne star GoodThree stars
Anthem Blue Cross - HMO GoodThree stars GoodThree stars PoorOne star GoodThree stars
Blue Shield of California - HMO GoodThree stars GoodThree stars FairTwo stars GoodThree stars
Cigna HMO GoodThree stars FairTwo stars PoorOne star FairTwo stars
Health Net of California, Inc. GoodThree stars GoodThree stars PoorOne star PoorOne star
Kaiser Permanente - Northern California ExcellentFour stars GoodThree stars GoodThree stars FairTwo stars
Kaiser Permanente - Southern California ExcellentFour stars GoodThree stars PoorOne star GoodThree stars
Sharp Health Plan GoodThree stars ExcellentFour stars PoorOne star GoodThree stars
UnitedHealthcare of California GoodThree stars GoodThree stars PoorOne star FairTwo stars
Western Health Advantage GoodThree stars GoodThree stars PoorOne star GoodThree stars

Data Disclaimer  
The source for data contained in this publication is Quality Compass® 2015 and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass 2015 includes certain CAHPS data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass is a registered trademark of NCQA. CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

Users of the data shall not have the right to alter, enhance, or otherwise modify the data. Anyone desiring to use or reproduce the data without modification for a noncommercial purpose may do so without obtaining any approval from NCQA. All commercial uses must be approved by NCQA and are subject to a license at the discretion of NCQA. Use by health care providers in connection with their own practices is not commercial use. A "commercial use" refers to any sale, license, or distribution of the data for commercial gain, or incorporation of the data into any product or service that is sold, licensed, or distributed for commercial gain, even if there is no actual charge for inclusion of the data. ©2004-2016 National Committee for Quality Assurance, all rights reserved.

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