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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 - 1

How well does the HMO or PPO care for members who are sick?

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:

  • Management of medicine for depression
  • Care after hospitalization for mental illness
  • Management of medicine prescribed to treat Attention Deficit Hyperactivity Disorder (ADHD) in children
  • Appropriate medications for treatment of asthma in children

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

 
HMO/POS & PPO
Management of medicine for depression %
Care after hospitalization for mental illness %
Follow-up care for children prescribed ADHD medications %
Appropriate medications for asthma (children) %
HMO
Aetna - HMO/POS
71
76
38
97
AmeriHealth - HMO/POS
68
60
19
100
Cigna - HMO/POS
60
84
NA*
NA*
Horizon - HMO
74
76
40
93
Oxford - HMO/POS
66
70
46
96
PPO
Aetna - PPO
76
75
42
96
AmeriHealth - PPO
72
61
37
97
Cigna - PPO
58
72
49
95
Horizon - PPO
75
68
36
95
Oxford - PPO
68
64
54
87
United - PPO
61
78
42
96
NA* - not applicable due to insufficient data
 
Management of medicine for depression

People taking medicine for depression need to be monitored. Percent of members given medicine for depression who had follow-up visits in the measurement year.

A higher percentage is better for the effective acute phase treatment. That means that more adults with depression were effectively treated with 12 weeks of antidepressant medication during the acute phase of treatment.
HMO   PPO
HMO Management of medicine for depression   PPO Management of medicine for depression
     
Care after hospitalization for mental illness

Therapy after a hospital stay for mental illness is important for recovery. Percent of members hospitalized for mental illness who received care afterwards.

A higher percentage rate for the follow-up within 30 days of discharge is better. This means that more members who were hospitalized for treatment of mental health disorders received timely follow-up within 30 days of discharge.
HMO   PPO
HMO Care after hospitalization for mental illness   PPO Care after hospitalization for mental illness
     
Follow-up care for children prescribed ADHD medications

Children prescribed ADHD medications need to be monitored. Percent of members given medicine for Initiation Phase of ADHD who had follow-up visit within 30 days of Initiation-Phase.

For the Initiation phase of follow-up care for children prescribed ADHD medications, a higher percentage rate is better; this means that more children got a follow-up visit during the 30-day initiation phase.
HMO   PPO
HMO Follow-up care for children prescribed ADHD medications   PPO Follow-up care for children prescribed ADHD medications
NA* - not applicable as data samples are too small    
     
Appropriate medications for asthma (children)

With appropriate therapies, long term control of persistent asthma can be achieved, resulting in a decrease in hospitalizations and emergency room visits for treatment. Percent of pediatric members aged 5–11 with persistent asthma who received an appropriate therapy in the past year.

A higher percentage rate is better for this performance indicator. This means that more children ages 5-11 years with asthma were appropriately prescribed asthma medications.
HMO   PPO
HMO Appropriate medications for asthma (children)   PPO Appropriate medications for asthma (children)
NA* - not applicable as data samples are too small    
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