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 2010.

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 2011 Quality Compass®.

California PPO Plans Compared to Health Plans Nationwide


California Average:

California PPO Plans

National Average:

HMO and PPO Plans Nationwide

National 90th Percentile:

Top HMO and PPO Plans Nationwide
Asthma Medicine for Adults/Adolescents 91% 92% 95%
Asthma Medicine for Children 97% 97% 99%
Testing Lung Disease 36% 41% 50%
Treating Lung Disease 76% 76% 86%
Treating Bronchitis: Getting the Right Care 26% 22% 28%
Breast Cancer Screening 66% 69% 77%
Cervical Cancer Screening 76% 76% 81%
Chlamydia Screening Age 16-20 36% 40% 51%
Chlamydia Screening Age 21-24 45% 44% 58%
Eye Exam for Diabetes 46% 53% 71%
Testing Blood Sugar for Diabetes Patients 86% 88% 93%
Controlling Blood Sugar For Diabetes Patients 59% 58% 70%
Testing Cholesterol for Diabetes Patients 81% 83% 90%
Controlling Cholesterol For Diabetes Patients 43% 44% 56%
Testing Kidney Function for Diabetes Patients 78% 80% 89%
Controlling Blood Pressure for Diabetes Patients 58% 61% 75%
Controlling High Blood Pressure 57% 61% 72%
Testing Cholesterol 86% 86% 93%
Controlling Cholesterol 56% 55% 70%
Heart Attack Medication 68% 74% 85%
Visits During Pregnancy 90% 85% 97%
Visits After Giving Birth 79% 75% 90%
Alcohol & Drug Dependence Treatment 12% 16% 22%
Anti-depressant Medication —
Ongoing Treatment
48% 48% 56%
Follow-up Visit After Mental Illness Hospital Stay 70% 76% 87%
Testing for Cause of Back Pain 79% 74% 81%
Flu Shots for Adults 51% 52% 61%
Treating Arthritis With Medications 85% 87% 93%
Checking Patients on Long-Term Medications 74% 80% 85%
Treating Children with Throat Infections 61% 77% 89%
Treating Children with Upper Respiratory Infections 89% 84% 93%
Care for Attention Deficit Disorder 44% 43% 55%