What Was Measured?

This page contains the average of the scores of California’s largest HMO and point of service (POS) health plans on 32 National Committee for Quality Assurance (NCQA) HEDIS clinical quality measures collected in 2007 and reported in 2008, compared to the average and 90th percentile scores for HMO and POS plans across the nation. The California plans used for this analysis were Aetna Health of California, Anthem Blue Cross, Blue Shield of California HMO, CIGNA HMO, HealthNet of California, Kaiser Permanente, PacifiCare of California, and Western Health Advantage. The nationwide results are based on health plans located throughout the U.S. including the California plans and were calculated giving equal weight to each plan’s score regardless of the number of enrollees in any single plan.

Why Is It Important?

Everyone would like to think that the quality of care they receive is the best in the country. Comparing California HMO/POS scores to national average and 90th percentile scores shows us where we are doing well and where there are opportunities to improve. The 90th percentile shows how well the best health plans, nationwide, are doing.

What Was the Source?

NCQA collects and reports on HEDIS quality of care measures as part of the voluntary accreditation process for HMOs. Data on HMO and POS enrollees voluntarily reported by California health plans to the National Committee for Quality Assurance (NCQA) is made available through NCQA’s Quality Compass®. This comparison of California HMO/POS health plans to national averages and 90th percentile scores was compiled from data publicly reported in the NCQA 2008 Quality Compass®. HMO and POS data are reported together here because Quality Compass® does not separate HMO and POS membership in its report.

Research and Background About Managed Care in California

California HMO/POS Plans vs. the National Average and the National 90th Percentile Score

 

California Average:

California HMO/POS plans scored on meeting national standards of care

National Average:

National HMO/POS plans scored on meeting national standards of care

National 90th Percentile:

National top HMO/POS plans scored on meeting national standards of care
Asthma Medicine for Adults 91% 91% 94%
Asthma Medicine for Teenagers 92% 94% 97%
Asthma Medicine for Children 96% 97% 100%
Breast Cancer Screening 70% 69% 76%
Cervical Cancer Screening 84% 82% 86%
Colorectal Cancer Screening 57% 57% 66%
Chlamydia Screening Age 16-20 43% 36% 46%
Chlamydia Screening Age 21-25 50% 39% 51%
Eye Exam for Diabetes Patients 59% 55% 68%
Testing Blood Sugar for Diabetes Patients 88% 88% 92%
Controlling Blood Sugar for Diabetes Patients 73% 71% 80%
Testing Cholesterol for Diabetes Patients 85% 84% 88%
Controlling Cholesterol for Diabetes Patients 46% 44% 51%
Testing Kidney Function for Diabetes Patients 84% 80% 87%
Controlling Blood Pressure For Diabetes Patients 68% 64% 70%
Controlling High Blood Pressure 65% 62% 70%
Testing Cholesterol 90% 88% 92%
Controlling Cholesterol 65% 60% 69%
Heart Attack Medication 74% 73% 83%
Visits During Pregnancy 94% 93% 97%
Visits After Giving Birth 84% 83% 89%
Anti-depressant Medication —
Initial Treatment		 63% 62% 70%
Anti-depressant Medication —
Ongoing Treatment		 47% 45% 55%
Follow-up Visit After Mental Illness Hospital Stay 74% 74% 86%
Testing for Cause of Back Pain 78% 75% 82%
Checking Patients on Long-Term Medications 70% 77% 82%
Treating Arthritis With Medications 84% 85% 91%
Treating Bronchitis With Antibiotics 23% 24% 37%
Child Immunizations 78% 77% 85%
Treating Children with Throat Infections 53% 75% 86%
Treating Children with Upper Respiratory Infections 88% 83% 92%
Care for Attention Deficit Disorder 29% 34% 43%
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