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Home > Insurance Division > Life and Health > Life & Health Actuarial > HMO and PPO Performance Report
2014 New Jersey HMO and PPO Performance Report
Getting Better/Living with Illness - 2

How well does the HMO or PPO care for members with illnesses?

HMOs and PPOs should work with doctors to care for members who are sick or living with chronic illness. HMOs and PPOs reported on the percentage of their relevant membership who received the following:

  • Controlling high blood pressure
  • Cholesterol management of heart patients
  • Blood sugar testing for people with diabetes
  • Eye exams for people with diabetes

The following tables show how well each HMO and PPO performed and the average in New Jersey.

 
HMO/POS & PPO
Controlling high blood
pressure %
Cholesterol management of heart patients %
Blood sugar testing for people with diabetes %
Eye exams for people with diabetes %
HMO
Aetna - HMO/POS
59
51
86
55
AmeriHealth - HMO/POS
60
64
87
44
Cigna - HMO/POS
68
60
89
54
Horizon - HMO
66
56
86
55
Oxford - HMO/POS
44
88
86
46
PPO
Aetna - PPO
54
53
88
52
AmeriHealth - PPO
62
63
84
47
Cigna - PPO
63
65
88
49
Horizon - PPO
67
52
88
47
Oxford - PPO
45
NR
86
42
United - PPO
47
NR
86
45
NR- Not reported
 
Controlling high blood pressure

High blood pressure (hypertension) is a major risk factor for a number of diseases. Percent of members aged 18–85 with hypertension whose blood pressure was under control at their most recent medical visit.

A higher percentage rate is better for this health measure. A higher percentage shows that more adults with hypertension did get adequate control of their blood pressure.
HMO   PPO
HMO Controlling high blood pressure   PPO Controlling high blood pressure
*2012 data   *2012 data
     
Cholesterol management of heart patients

Reducing cholesterol lowers the chances of having a heart attack. Percentage of members with heart conditions who had their cholesterol level controlled.

For the cholesterol management measure, a higher percentage is better. This means that more adults ages 18-75 years achieved good cholesterol control with LDL-C levels <100mg/dl, due to close monitoring of LDL cholesterol.
HMO   PPO
HMO Cholesterol management of heart patients   PPO Cholesterol management of heart patients
    NR - Not reported
     

Blood sugar testing for people with diabetes

Controlling blood sugar levels can prevent complications from diabetes. Percent of members with diabetes who had a blood sugar (HbA1C) test in the measurement year.

A higher percentage rate is better for this measure. It means that more diabetic adults 18-75 years of age received appropriate HbA1C testing.

HMO   PPO
HMO Blood sugar testing for people with diabetes   PPO Blood sugar testing for people with diabetes
     

Eye exams for people with diabetes

Regular eye exams can reduce the risk of blindness from diabetes. Percent of members with diabetes who received an eye exam during the measurement year.

A higher percentage rate is better for this

performance indicator. This means that more adults with diabetes received appropriate retinal examination of the eyes.

HMO   PPO
HMO Eye exams for people with diabetes   PPO Eye exams for people with diabetes
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