What Was Measured?

California’s largest HMO health plans’ quality scores are compared to results of HMO plans throughout the U.S. A set of standard quality measures are used to compare the average performance among HMOs 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 the HMO results nationwide. These scores largely are based on patient care provided in 2010.

The California plans’ scores are the average across the State’s eight (8) largest HMOs: Aetna Health of California, Anthem Blue Cross HMO, Blue Shield of California HMO, CIGNA HMO, Health Net of California, Kaiser Permanente, PacifiCare of California, and Western Health Advantage. The nationwide results are from 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 HMO scores to national performance shows the strengths of the HMOs 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 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 2011 Quality Compass®.

California HMO Plans Compared to HMO Plans Nationwide

 

California Average:

California HMO Plans

National Average:

HMO Plans Nationwide

National 90th Percentile:

Top HMO Plans Nationwide
Asthma Medicine for Adults/Adolescents 92% 92% 95%
Asthma Medicine for Children 96% 97% 99%
Testing Lung Disease 35% 41% 50%
Treating Lung Disease 81% 76% 86%
Treating Bronchitis: Getting the Right Care 29% 22% 28%
Breast Cancer Screening 74% 69% 77%
Cervical Cancer Screening 79% 76% 81%
Colorectal Cancer Screening 65% 56% 71%
Chlamydia Screening Age 16-20 49% 40% 51%
Chlamydia Screening Age 21-24 57% 44% 58%
Eye Exam for Diabetes Patients 61% 53% 71%
Testing Blood Sugar for Diabetes Patients 91% 88% 93%
Controlling Blood Sugar for Diabetes Patients 66% 58% 70%
Testing Cholesterol for Diabetes Patients 88% 83% 90%
Controlling Cholesterol for Diabetes Patients 54% 44% 56%
Testing Kidney Function for Diabetes Patients 88% 80% 89%
Controlling Blood Pressure For Diabetes Patients 71% 61% 75%
Controlling High Blood Pressure 71% 61% 72%
Testing Cholesterol 91% 86% 93%
Controlling Cholesterol 66% 55% 70%
Heart Attack Medication 73% 74% 85%
Visits During Pregnancy 95% 85% 97%
Visits After Giving Birth 85% 74% 90%
Alcohol & Drug Dependence Treatment 13% 16% 22%
Anti-depressant Medication —
Ongoing Treatment
47% 48% 56%
Follow-up Visit After Mental Illness Hospital Stay 81% 76% 87%
Testing for Cause of Back Pain 80% 74% 81%
Checking if Weight Could Cause Health Problems 63% 32% 73%
Flu Shots for Adults 51% 52% 61%
Treating Arthritis With Medications 87% 87% 93%
Checking Patients on Long-Term Medications 79% 80% 85%
Child Immunizations 76% 63% 83%
Immunizations for Early Teens 50% 47% 71%
Checking If Children's Weight Could Cause Health Problems 45% 28% 76%
Checking if Adolescent Weight Could Cause Health Problems 49% 27% 72%
Treating Children with Throat Infections 62% 77% 89%
Treating Children with Upper Respiratory Infections 91% 84% 93%
Care for Attention Deficit Disorder 41% 43% 55%
352.100a