HMO and PPO Quality Ratings Summary 2019-20 Edition

Quality health care is getting the right care at the right time.


This Report Card shows the quality of health care for millions of Californians who get their care through Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). The 10 largest HMOs and 6 largest PPOs in the state are included in this Report Card.

What’s the difference between HMOs and PPOs?
With an HMO you can only see doctors in your HMO’s network. You will have a primary care doctor and a medical group who refers and coordinates your care to specialists when needed. With a PPO you can choose to see out-of-network doctors. You are responsible to manage and pay the cost for out-of-network visits.

Click on each health plan name to find its consumer assistance number, service area, website and more.



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QUALITY OF MEDICAL CARE






The California Office of the Patient Advocate compared health plan members' records in 2022 to a set of national standards for quality of care to make sure that health plans offer quality preventive care and treatment services to members. More stars are better.

The star ratings below are based on quality of medical care data collected in 2022 and reported in 2023.

Patient Experience is a separate rating. Ratings for Patient Experience are in the column to the right, Patients Rate Overall Experience.

PATIENTS RATE OVERALL EXPERIENCE





The California Office of the Patient Advocate compared how people with health insurance rated their experience with the care and services offered by their health plan during 2022. More stars are better.

The star ratings below are based on patient experience data collected in 2022 and reported in 2023.



Data Disclaimer  
The data source for data for the Report Cards is Quality Compass® 2023 and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass® 2023 includes Healthcare Effectiveness Data and Information Set (HEDIS®) and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors. NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass and HEDIS are registered trademarks of NCQA. CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

Users of the data shall not have the right to alter, enhance, or otherwise modify the data. Anyone who wants to use or reproduce the data without modification for a noncommercial purpose may do so without obtaining any approval from NCQA. All commercial uses must be approved by NCQA and are subject to a license at the discretion of NCQA. Use by healthcare providers in connection with their own practices is not commercial use. A "commercial use" refers to any sale, license, or distribution of the data for commercial gain, or incorporation of the data into any product or service that is sold, licensed, or distributed for commercial gain, even if there is no actual charge for inclusion of the data. ©2004-2023 National Committee for Quality Assurance, all rights reserved.

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