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PPOs Make Gains in Quality

MANAGED CARE November 2011. © MediMedia USA
News & Commentary

PPOs Make Gains in Quality

MANAGED CARE November 2011. ©MediMedia USA

PPOs are catching up to HMOs in quality, and the health insurance industry is improving quality overall, according to the latest State of Health Care Quality Report from the National Committee for Quality Assurance. The NCQA says that for the first time in the 15-year history of the annual survey, HMOs and PPOs are able to be compared using all measures of care. In the past, HMO performance outpaced PPO performance for several reasons: HMOs traditionally had more tools to manage care, differences in data collection or populations could be a factor, or benefit design might lend itself to better quality measurements.

Performance patterns between Medicare HMOs and PPOs are quite different. While HMOs outperform PPOs on some measures, PPOs outperform HMOs on several others, notably on measures related to drug therapy and monitoring. For example, with the HEDIS measure on “Pharmacological Management of COPD — Systemic Corticosteroids,” the average Medicare PPO rate is 69.6 percent and the average Medicare HMO rate is 66.6 percent.

Several measures showed important gains from 2009 to 2010, including “Colorectal Cancer Screening,” “Use of Spirometry Testing in the Assessment and Diagnosis of COPD,” and “Pharmacotherapy Management of COPD.” Commercial and Medicare PPOs displayed significant performance improvement and showed progress in closing the performance gap with HMOs.