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Home > Insurance Division > Life and Health > Life & Health Actuarial > HMO and PPO Performance Report
2015 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
  • Follow-up care for children prescribed Attention Deficit Hyperactivity Disorder (ADHD) medications
  • Appropriate medications for treatment of asthma in children

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.

 
HMO & PPO
Management of medicine for depression %
Care after hospitalization for mental illness %
Follow-up care for children prescribed ADHD medications %
Appropriate medications for treatment of asthma in children %
HMO
Aetna - HMO/POS
74
75
38
97
AmeriHealth - HMO/POS
74
65
35
NA
Cigna - HMO/POS
65
NA
NA
NA
Horizon - HMO
76
76
36
94
Oxford - HMO/POS
64
68
37
94
PPO
Aetna - PPO/EPO
72
77
40
95
AmeriHealth - PPO/EPO
78
49
NA
NA
Cigna - PPO
67
71
45
96
Horizon - PPO/EPO
76
69
36
96
Oxford - PPO/EPO
67
73
44
NA
United - PPO/EPO
65
79
47
96
NA - not applicable due to small sample size
 
Management of medicine for depression

 People taking medicine for depression need to be monitored. The bar graphs show the percentage of members given medicine for depression who had follow-up visits in the measurement year.

A higher percentage is better for 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. The bar graphs show the percentage 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
NA - Not applicable due to small sample size    
     
Follow-up care for children prescribed ADHD medications

Children prescribed ADHD medications need to be monitored. The bar graph shows the percentage of members given medicine for the Initiation Phase of ADHD who had follow-up visits within 30 days of the 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 received 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 due to small sample size   NA - not applicable due to small sample size
     
Appropriate medications for treatment of asthma in 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. The bar graphs show the percentage 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 due to small sample size   NA - not applicable due to small sample size
 
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New Jersey Department of Banking and Insurance