What Was Measured?

California’s largest PPO health plans’ quality scores are compared to results of 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 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 health plans’ results nationwide. These scores largely are based on patient care provided in 2009.

The California plans’ scores are the average across six (6) of the largest California PPOs: Aetna PPO, Anthem Blue Cross PPO, Blue Shield of California/Blue Shield Life PPO, CIGNA PPO, Health Net of California PPO, and United Healthcare (California). The nationwide results are from PPO and 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 PPO scores to national performance shows the strengths of the PPOs in the State and those areas in which there are opportunities to improve. The 90th percentile results show the performance of the best 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 nationwide health plan results include scores from PPO plans and from the managed care 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 2010 Quality Compass®.