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Home > Insurance Division > Life and Health > Life & Health Actuarial > HMO and PPO Performance Report
2016 New Jersey HMO and PPO Performance Report
Getting Better/Living with Illness - 3

How well does the HMO or PPO care for members who are living with illness?

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:

  • Persistence of beta blocker treatment after a heart attack
  • Check-ups for new mothers
  • Anti-Rheumatic drug therapy in rheumatoid arthritis
  • Use of imaging studies for low back pain

The following table shows how well each HMO and PPO performed. The bar graphs following show the HMOs and PPOs compared to the New Jersey average.

 
 
Persistence of beta blocker treatment after a heart attack

Beta blockers after a heart attack can help prevent future heart attacks. The bar graphs show the percentage of members who received persistent beta-blocker treatment for six months after discharge.

A higher percentage is better for this measure. It means that more adults with a history of having a heart attack received at least six months of beta-blocker treatment.
HMO   PPO
HMO Persistence of beta blocker treatment after a heart attack   PPO Persistence of beta blocker treatment after a heart attack
     
Check-ups for new mothers

During a visit, providers can check a new mother's recovery from childbirth and answer questions. The bar graphs show the percentage of new mothers who received a check-up within eight weeks after delivery.

A higher percentage is better for this performance measure. This means that more women with live birth deliveries received postpartum care in a timely manner.
HMO   PPO
HMO Check-ups for new mothers   PPO Check-ups for new mothers
 
Anti-Rheumatic drug therapy in rheumatoid arthritis

Disease-modifying anti-rheumatic drugs (DMARDs) are proven effective in slowing or preventing joint damage as opposed to just relieving pain and inflammation. The bar graphs show the percentage of members 18 years and older who were diagnosed with rheumatoid arthritis (RA) and who were given a prescription for at least one DMARD in the measurement year.

A higher percentage is better for this measure. This means that more adults 18 years of age and older received DMARD treatment for their RA.
HMO   PPO
HMO Anti-Rheumatic drug therapy in rheumatoid arthritis   PPO Anti-Rheumatic drug therapy in rheumatoid arthritis
     

Imaging studies for low back pain

Imaging studies (plain x-ray, MRI, CT scan) are not needed for a primary diagnosis of lower back pain.

The bar graphs show the percentage of members with a primary diagnosis of low back pain who did not have a plain x-ray, MRI and/or CT scan within 28 days of the diagnosis. A higher percentage rate indicates appropriate treatment of low back pain.
HMO   PPO
HMO Imaging studies for low back pain   PPO Imaging studies for low back pain
 
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