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Home > Insurance Division > Life and Health > Life & Health Actuarial > HMO and PPO Performance Report
2016 New Jersey HMO and PPO Performance Report
Getting Better/Living with Illness - 2

How well does the HMO or PPO care for members with illnesses?

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 with the following conditions:

  • Controlling high blood pressure
  • Blood sugar testing for people with diabetes
  • Blood sugar control for people with diabetes
  • Eye exams for people with diabetes

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.

 
 
Controlling high blood pressure

High blood pressure (hypertension) is a major risk factor for a number of diseases. The bar graphs show the percentage of members aged 18–85 with hypertension whose blood pressure was under control at their most recent medical visit.

A higher percentage rate is better for this health measure. A higher percentage shows that more adults with hypertension were able to adequately control their blood pressure throught treatment.

HMO   PPO
HMO Controlling high blood pressure   PPO Controlling high blood pressure
     
Blood sugar testing for people with diabetes

Controlling blood sugar levels can prevent complications from diabetes. The bar graphs show the percentage of members with diabetes who had a blood sugar (HbA1C) test in the measurement year.

A higher percentage rate is better for this measure. It means that more diabetic adults 18-75 years of age received appropriate HbA1C testing.
HMO   PPO
HMO Blood sugar testing for people with diabetes   PPO Blood sugar testing for people with diabetes
 
HbA1c poor control (>9.0%) for people with diabetes

The bar graphs show the percentage of members aged 18 to 75 years with type 1 and type 2 diabetes who had HbA1c testing during measurement year 2015 and who displayed poor HbAC1 control (>9.0%).

A lower percentage indicates a better performance. It shows better diabetic management, as fewer diabetic adults showed poor control of their HbAC1.

HMO   PPO
HMO HbA1c poor control (>9.0%) for people with diabetes   PPO HbA1c poor control (>9.0%) for people with diabetes
     

Eye exams for people with diabetes

Regular eye exams can reduce the risk of blindness from diabetes. The bar graphs show the percentage of members with diabetes who received an eye exam during the measurement year.

A higher percentage rate is better for this
performance indicator. This means that more adults with diabetes received appropriate retinal examination of the eyes.

HMO   PPO
HMO Eye exams for people with diabetes   PPO Eye exams for people with diabetes
 
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New Jersey Department of Banking and Insurance