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 health 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 2015.

The California plans’ scores are the average across California HMOs. 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.

What Is the Source?

The National Committee for 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 2016 Quality Compass®.

 

California Average:

California HMO Plans

National Average:

HMO Plans Nationwide

National 90th Percentile:

Top HMO Plans Nationwide
Asthma Medicine for Adults/Adolescents 76% 76% 84%
Asthma Medicine for Children 86% 86% 94%
Testing Lung Disease 43% 46% 62%
Treating Lung Disease – Corticosteroid Medication 76% 77% 85%
Treating Lung Disease – Bronchodilator Medication 86% 83% 93%
Treating Bronchitis: Getting the Right Care 39% 31% 63%
Breast Cancer Screening 77% 74% 83%
Cervical Cancer Screening 77% 73% 83%
Colorectal Cancer Screening 66% 64% 76%
Chlamydia Screening Age 16-20 55% 41% 63%
Chlamydia Screening Age 21-24 63% 52% 71%
Eye Exam for Diabetes Patients 56% 56% 76%
Testing Blood Sugar for People with Diabetes 92% 89% 95%
Controlling Blood Sugar for Diabetes Patients 65% 54% 70%
Testing Kidney Function for Diabetes Patients 91% 91% 94%
Controlling Blood Pressure For Diabetes Patients 72% 64% 82%
Heart Attack Medication 85% 85% 93%
Controlling High Blood Pressure 70% 65% 84%
Aspirin Use Counseling 35% 44% 54%
Visits During Pregnancy 88% 82% 97%
Visits After Giving Birth 77% 72% 92%
Alcohol and Drug Dependence Treatment – Initiation Phase 31% 32% 39%
Alcohol and Drug Dependence Treatment – Ongoing Phase 11% 10% 16%
Antidepressant Medication – First three Months of Treatment 64% 67% 78%
Antidepressant Medication – Six Months Continuation of Treatment 46% 50% 61%
Follow-up Visit Within 7 Days After Mental Illness Hospital Stay 72% 56% 74%
Follow-up Visit Within 30 Days After Mental Illness Hospital Stay 83% 73% 87%
Testing for Cause of Back Pain 83% 78% 88%
Checking if Weight Could Cause Health Problems 88% 79% 95%
Flu Shots for Adults 52% 50% 62%
Treating Arthritis With Medications 91% 90% 94%
Giving Lab Tests for Patients Taking Medications for a Long Time 85% 84% 90%
Doctor Advises Patient to Quit Smoking 80% 77% 87%
Immunizations for Children 81% 76% 89%
Immunizations for Early Teens 75% 74% 89%
HPV Vaccine for Female Adolescents 27% 21% 33%
Checking If Children's Weight Could Cause Health Problems 76% 65% 95%
Checking if Adolescent’s Weight Could Cause Health Problems 79% 63% 96%
Treating Children with Throat Infections 83% 81% 94%
Treating Children with Upper Respiratory Infections 96% 88% 97%
Starting Care for Attention Deficit Hyperactivity Disorder 43% 44% 57%
Ongoing Care for Attention Deficit Disorder 47% 53% 71%
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