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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
Staying Healthy

Does the HMO or PPO help members stay healthy and avoid illness?

HMOs and PPOs should work with doctors to provide important preventive services that help members stay healthy. HMOs and PPOs reported on the percentage of their relevant membership who received the following services:

  • Testing for breast cancer
  • Testing for cervical cancer
  • Testing for colorectal cancer
  • Immunizations for children

The following tables show how well each HMO and PPO did and how well HMOs and PPOs in New Jersey performed on average.


HMO/POS & PPO
Testing for
breast cancer %
Testing for cervical
cancer %
Testing for colorectal
cancer %
Immunizations
for children %
HMO
Aetna - HMO/POS
69
78
64
77
AmeriHealth - HMO/POS
67
76
50
71
Cigna - HMO/POS
71
81
61
79
Horizon - HMO
66
67
62
74
Oxford - HMO/POS
67
77
53
70
PPO
Aetna - PPO
67
79
57
75
AmeriHealth - PPO
72
80
58
70
Cigna - PPO
65
79
53
80
Horizon - PPO
62
66
55
70
Oxford - PPO
68
76
53
67
United - PPO
65
78
58
68
 

Testing for breast cancer

Mammograms are recommended for detection of breast cancer. Percentage of women aged 42–69 who received a mammogram within the past two years.

A higher percentage rate is better for the breast cancer screening measure. It shows that more women did get a mammogram within the measurement year.

HMO   PPO
HMO Testing for breast cancer   PPO Testing for breast cancer
     
Testing for cervical cancer

Pap smears are recommended for detection of cervical cancer. Percentage of women aged 21–64 who received a Pap test within the past three years.

A higher percentage rate is better for the cervical cancer screening measure. It shows that more women did get a Pap test within a given timeframe.
HMO   PPO
HMO Testing for cervical cancer
  PPO Testing for cervical cancer
 
Colorectal Cancer Screening

Colonoscopy is used to look for early signs of colorectal cancer. Percentage of members aged 50-75 who had appropriate screening for colorectal cancer.

A higher percentage rate is better for the colorectal cancer screen measure. It shows that more adults of 50-75 age groups did get screened for colorectal cancer.
HMO   PPO
HMO Colorectal Cancer Screening
 
PPO Colorectal Cancer Screening
     
Immunizations for children

Immunizations prevent childhood diseases such as polio, measles, mumps, rubella and whooping cough. Percentage of children who received recommended immunizations by age two.

A higher percentage rate is better for the childhood immunization status. A higher percentage shows that more children did get all of their required immunizations.

HMO   PPO
HMO Immunizations for children
 
PPO Immunizations for children
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New Jersey Department of Banking and Insurance