California Health Plans Compared to Health Plans Nationwide

What do the scores mean?

California’s health plans’ quality scores are compared to results of health plans throughout the United States. A set of standard patient experience measures are used to compare the average performance among health plans in California to the health plan 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 plan results nationwide. These scores largely are based on patient care provided in 2019. The California plans’ scores are the average across all California health plans. The nationwide results are from health plans located throughout the United States 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 CAHPS measures as part of its nationwide health plan accreditation program. These health plan scores include PPO plans as well as 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 2020 Quality Compass®.
There were concerns about the impact of COVID-19 on CAHPS data collection and response rates, and the potential for response bias because members were asked to reect on their health care experiences over the previous year while simultaneously living through a pandemic. For this reason, NCQA has withheld individual plan performance rates, but is able to provide a high-level average of California health plan performance reliably.
Scores for the CAHPS® topics are based on the percentage of members who gave high scores or the most positive answers ("always" or "usually" for most questions) to the survey question. For most questions, answers are scored using one of four possible choices ranging from the member “always” had a positive experience to the member “never” had a positive experience.


California Average:

California Health Plans

National Average:

Health Plans Nationwide

National 90th Percentile:

Top Health Plans Nationwide
Testing for Cause of Back Pain 81% 77% 85%
Treating Bronchitis: Getting the Right Care 42% 37% 50%
Asthma Medicine for Adults / Adolescents 75% 78% 84%
Asthma Medicine for Children 85% 88% 95%
Testing Lung Disease 37% 40% 50%
Treating Lung Disease – Bronchodilator Medication 80% 79% 89%
Treating Lung Disease – Corticosteroid Medication 71% 76% 87%
Controlling Blood Pressure for People with Diabetes 65% 59% 77%
Controlling Blood Sugar for People with Diabetes 61% 55% 66%
Eye Exam for People with Diabetes 51% 53% 68%
Prescribing Statins for People with Diabetes 65% 63% 70%
Testing Blood Sugar for People with Diabetes 90% 91% 94%
Testing Kidney Function for People with Diabetes 91% 90% 93%
Controlling High Blood Pressure 62% 56% 74%
Heart Attack Medication 81% 85% 93%
Prescribing Statins to People with Heart Disease 81% 81% 88%
Visits After Giving Birth 79% 77% 92%
Visits During Pregnancy 86% 81% 95%
Alcohol and Drug Dependence Treatment – Initiation Phase 38% 36% 42%
Alcohol and Drug Dependence Treatment – Ongoing Phase 13% 13% 18%
Antidepressant Medication – First three Months of Treatment 69% 71% 78%
Antidepressant Medication – Six Months Continuation of Treatment 53% 55% 63%
Follow-up Visit Within 7 Days After Mental Illness Hospital Stay 47% 45% 59%
Follow-up Visit Within 30 Days After Mental Illness Hospital Stay 67% 67% 80%
Breast Cancer Screening 75% 73% 79%
Cervical Cancer Screening 77% 75% 82%
Chlamydia Screening 57% 50% 66%
Colorectal Cancer Screening 65% 64% 75%
Checking if Weight Could Cause Health Problems 82% 79% 95%
Doctor Advises Patient to Quit Smoking 78% 73% 85%
Flu Shots for Adults 56% 55% 66%
Checking if Adolescent’s Weight Could Cause Health Problems 68% 66% 88%
Checking If Children's Weight Could Cause Health Problems 70% 69% 90%
Immunizations for Children 50% 54% 71%
Immunizations for Early Teens 34% 28% 40%
Starting Care for Attention Deficit Hyperactivity Disorder 40% 40% 49%
Ongoing Care for Attention Deficit Disorder 46% 47% 59%
Treating Children with Throat Infections 78% 85% 93%