California HMO Plans Compared to HMO Plans Nationwide

What do the scores mean?

California’s largest HMO health plans’ quality scores are compared to results of HMO plans throughout the U.S. A set of standard quality measures are used to compare the average performance among HMOs in California to the HMO national average and to the best performing plans in the country — the 90th percentile results are scores that are better than 90 percent of the HMO results nationwide. These scores largely are based on patient care provided in 2010.

The California plans’ scores are the average across the State’s eight (8) largest HMOs: Aetna Health of California, Anthem Blue Cross HMO, Blue Shield of California HMO, CIGNA HMO, Health Net of California, Kaiser Permanente, PacifiCare of California, Sharp Health Plan, and Western Health Advantage. The nationwide results are from HMO health plans located throughout the U.S. and were calculated giving equal weight to each plan’s score regardless of its number of enrollees.

Why Is It Important?

Comparing California HMO scores to national performance shows the strengths of the HMOs in the State and those areas in which there are opportunities to improve. The 90th percentile results show the performance of the best HMO health plans nationwide.

What Was the Source?

The National Committee on Quality Assurance (NCQA) collects and reports on HEDIS quality of care measures as part of its nationwide health plan accreditation program. These HMO scores include several managed healthcare insurance products which are commonly called HMO and POS (Point of Service) health plans. This comparison of California health plans to national scores uses data that was reported in the NCQA 2011 Quality Compass®.

 

California Average:

California HMO Plans

National Average:

HMO Plans Nationwide

National 90th Percentile:

Top HMO Plans Nationwide
Asthma Medicine for Adults/Adolescents 91% 90% 94%
Asthma Medicine for Children 95% 96% 99%
Testing Lung Disease 38% 43% 56%
Treating Lung Disease 85% 80% 88%
Treating Bronchitis: Getting the Right Care 35% 24% 33%
Breast Cancer Screening 74% 71% 79%
Cervical Cancer Screening 78% 76% 83%
Colorectal Cancer Screening 66% 62% 74%
Chlamydia Screening Age 16-20 48% 42% 56%
Chlamydia Screening Age 21-24 58% 48% 65%
Eye Exam for Diabetes Patients 57% 57% 74%
Testing Blood Sugar for People with Diabetes 90% 90% 95%
Controlling Blood Sugar for Diabetes Patients 65% 61% 71%
Testing Cholesterol for Diabetes Patients 88% 85% 91%
Controlling Cholesterol for Diabetes Patients 54% 48% 58%
Testing Kidney Function for Diabetes Patients 88% 84% 90%
Controlling Blood Pressure For Diabetes Patients 71% 66% 80%
Controlling High Blood Pressure 71% 65% 76%
Testing Cholesterol 90% 88% 94%
Controlling Cholesterol 65% 60% 73%
Heart Attack Medication 77% 81% 91%
Aspirin Use Counseling 44% 50% 56%
Visits During Pregnancy 94% 91% 98%
Visits After Giving Birth 84% 81% 92%
Alcohol & Drug Dependence Treatment 12% 15% 22%
Anti-depressant Medication — Ongoing Treatment 49% 49% 58%
Follow-up Visit After Mental Illness Hospital Stay 80% 76% 89%
Testing for Cause of Back Pain 81% 74% 82%
Doctor Advises Patient to Quit Smoking 77% 78% 87%
Checking if Weight Could Cause Health Problems 70% 55% 82%
Flu Shots for Adults 53% 53% 62%
Treating Arthritis With Medications 86% 88% 94%
Giving Lab Tests for Patients Taking Medications for a Long Time 81% 82% 87%
Immunizations for Children 77% 75% 85%
Immunizations for Early Teens 64% 59% 80%
Checking If Children's Weight Could Cause Health Problems 53% 45% 84%
Checking if Adolescent Weight Could Cause Health Problems 55% 45% 82%
Treating Children with Throat Infections 71% 80% 92%
Treating Children with Upper Respiratory Infections 91% 84% 94%
Care for Attention Deficit Disorder 39% 44% 57%
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