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HMO–PPO performance gap narrows













HMOs have reported HEDIS measures to the National Committee for Quality Assurance (NCQA) for more than a decade, and PPOs began reporting in 2005. NCQA says that the gap between HMO and PPO performance is narrowing. The findings are reported in The State of Health Care Quality 2009.

HMO vs. PPO performance on select HEDIS measures
Measure HMO PPO Difference
Annual monitoring of patients on chronic medications 78.9 75.8 3.1
Avoidance of antibiotic treatment in adults with acute bronchitis 24.6 26.8 -2.2
Breast cancer screening 85.7 81.5 4.2
DMARD therapy for rheumatoid arthritis 70.2 66.0 4.2
Follow-up after hospitalization for mental illness (30 days) 76.1 71.4 4.7
Follow-up after hospitalization for mental illness (7 days) 57.2 49.8 7.4
Follow-up for children prescribed medications for ADHD (continuation) 40.2 37.1 3.1
Follow-up for children prescribed medications for ADHD (initiation) 35.8 34.1 1.7
Persistence of beta blocker therapy for heart attack patients 75.0 68.8 6.2
Pharmacotherapy management of COPD (bronchodilator) 76.1 68.1 8.0
Pharmacotherapy management of COPD (systemic corticosteroid) 67.0 58.2 8.9

Source: National Committee on Quality Assurance. The State of Health Care Quality 2009

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