California PPO Plans Compared to PPO Health Plans Nationwide

What do the stars mean?

California’s largest PPO health plans’ quality scores are compared to results of PPO health plans throughout the U.S. A set of standard quality measures are used to compare the average performance among PPOs in California to the PPO national average and to the best performing plans in the country — the 90th percentile results are scores that are better than 90 percent of all reporting PPO health plans’ results nationwide. These scores largely are based on patient care provided in 2015.

The California plans’ scores are the average across California PPOs. The nationwide results are from PPO 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 nationwide health plan results include scores from PPO plans. This comparison of California health plans to national scores uses data that was reported in the NCQA 2016 Quality Compass®.

	California Average: California PPO Plans	National Average: PPO Plans Nationwide	National 90th Percentile: Top PPO Plans Nationwide
	79%	76%	84%
	35%	31%	44%
Asthma Medicine for Adults/Adolescents	78%	78%	85%
Asthma Medicine for Children	86%	87%	94%
Testing Lung Disease	35%	40%	49%
Treating Lung Disease – Bronchodilator Medication	82%	80%	88%
Treating Lung Disease – Corticosteroid Medicine	71%	75%	84%
Controlling Blood Pressure for Diabetes Patients	65%	56%	76%
Controlling Blood Sugar For Diabetes Patients	61%	53%	66%
Eye Exam for Diabetes	52%	52%	69%
	62%	61%	68%
Testing Blood Sugar for People with Diabetes	90%	90%	94%
Testing Kidney Function for Diabetes Patients	90%	89%	93%
Controlling High Blood Pressure	59%	58%	75%
Heart Attack Medication	81%	85%	92%
	78%	81%	87%
Visits During Pregnancy	85%	81%	94%
Visits After Giving Birth	76%	71%	87%
Alcohol and Drug Dependence Treatment – Initiation Phase	35%	37%	42%
Alcohol and Drug Dependence Treatment – Ongoing Phase	12%	13%	18%
Antidepressant Medication – First three Months of Treatment	65%	68%	75%
Antidepressant Medication – Six Months Continuation of Treatment	50%	52%	61%
Follow-up Visit Within 7 Days After Mental Illness Hospital Stay	47%	46%	62%
Follow-up Visit Within 30 Days After Mental Illness Hospital Stay	68%	68%	80%
	73%	71%	79%
	74%	74%	82%
	55%	48%	64%
	62%	61%	73%
Checking if Weight Could Cause Health Problems	83%	73%	93%
Giving Lab Tests for Patients Taking Medications for a Long Time	83%	83%	87%
Flu Shots for Adults	52%	50%	60%
Treating Arthritis With Medications	88%	88%	93%
Immunizations for Children	53%	51%	66%
Immunizations for Early Teens	32%	22%	31%
Checking if Children’s Weight Could Cause Health Problems	70%	64%	88%
Checking if Adolescent’s Weight Could Cause Health Problems	70%	62%	86%
Starting Care for Attention Deficit Hyperactivity Disorder	40%	41%	52%
Ongoing Care for Attention Deficit Disorder	47%	47%	59%
Treating Children with Throat Infections	79%	86%	94%

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