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2014 New Jersey HMO and PPO Performance Report
Respiratory Conditions

How well does the HMO or PPO help members with respiratory conditions?

HMOs and PPOs should work with doctors to provide important services that help improve the health of members with respiratory conditions. HMOs and PPOs reported on the percentage of their relevant membership who received the following services:

  • Testing children with pharyngitis for strep
  • Treatment for children with upper respiratory infection (URI)
  • Avoidance of antibiotic treatment in adults with acute bronchitis
  • Use of spirometry testing in the assessment and diagnosis of Chronic Obstructive Pulmonary Disease (COPD)

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 children with pharyngitis for strep %
Treatment for children with upper respiratory infection %
Avoidance of antibiotic treatment in adults w/acute bronchitis %
Use of spirometry testing in diagnosis of COPD %
HMO
Aetna - HMO/POS
82
86
19
45
AmeriHealth - HMO/POS
84
86
23
35
Cigna - HMO/POS
78
88
18
46
Horizon - HMO
83
83
24
47
Oxford - HMO/POS
86
84
30
49
PPO
Aetna - PPO
84
86
20
48
AmeriHealth - PPO
83
89
20
45
Cigna - PPO
82
87
20
49
Horizon - PPO
79
86
31
44
Oxford - PPO
82
89
40
47
United - PPO
83
86
20
47
 
Testing children with pharyngitis for strep

Strep testing is recommended for detection of pharyngitis. The percentage of children 2-18 years of age diagnosed with pharyngitis and dispensed an antibiotic who also received a strep test for the episode.

A higher percentage rate is better for this health measure. A higher percentage shows that more children and adolescents received an appropriate strep test before getting an antibiotic prescription medication to treat pharyngitis.
HMO   PPO
HMO Testing children with pharyngitis for strep   PPO Testing children with pharyngitis for strep
     
Avoidance of antibiotic treatment* for children with upper respiratory infection (URI)

An upper respiratory infection (URI) is one of the most common illnesses, leading to more doctor visits. The percentage of children 3 months to 18 years of age with a diagnosis of upper respiratory infection (URI) and were not dispensed an antibiotic.

A higher percentage rate is better for this health measure. That means more infants, children and adolescents did not get an inappropriate and unnecessary antibiotic prescription.
HMO   PPO
HMO Avoidance of antibiotic treatment for children with upper respiratory infection (URI)
 
PPO Avoidance of antibiotic treatment for children with upper respiratory infection (URI)
*Inappropriate use of antibiotics has been shown to promote resistant bacteria that are more difficult to treat. The federal Centers for Disease Control and Prevention (CDC) and other organizations urge physicians to avoid prescribing antibiotics when not medically indicated.
     
Avoidance of antibiotic treatment* in adults with acute bronchitis

 Use of antibiotics usually is not an appropriate treatment for acute bronchitis. The percentage of adults ages 18-64 years with a diagnosis of acute bronchitis and were not dispensed an antiobiotic prescription.

A higher percentage rate is better for this health measure. A higher percentage rate indicates more adults with acute bronchitis were appropriately treated, but not given unnecessary antiobiotic medication as part of their treatment.
HMO   PPO
HMO Avoidance of antibiotic treatment in adults with acute bronchitis
  
PPO Avoidance of antibiotic treatment in adults with acute bronchitis
*Inappropriate use of antibiotics has been shown to promote resistant bacteria that are more difficult to treat. The federal Centers for Disease Control and Prevention and other organizations urge physicians to avoid prescribing antibiotics when not medically indicated.
     
Use of spirometry testing in the assessment and diagnosis of COPD

Spirometry testing measures air flow through the lungs and can confirm a COPD diagnosis. Members, 40 years of age and older, with a new diagnosis or newly active COPD who received appropriate spirometry testing to confirm the diagnosis.

A higher percentage rate is better for this measure. It means more adults who are 40 and above this age got the best diagnostic test for COPD (a lung function test called spirometry.)
HMO   PPO
HMO Use of spirometry for testing for children with pharyngitis
 
PPO Use of spirometry for testing for children with pharyngitis
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