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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
Staying Healthy

Does the HMO or PPO help members stay healthy and avoid illness?

HMOs and PPOs should work with doctors to provide important preventive services that help members stay healthy. HMOs and PPOs reported on the percentage of their relevant membership who received the following services:

  • Breast cancer screening
  • Cervical cancer screening
  • Colorectal cancer screening
  • Childhood immunizations
  • Well-child visits in the third, fourth, fifth and sixth years of life
  • Adolescent immunizations
  • Adolescent well-care visits

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.

 

Breast cancer screening

Mammograms are recommended for detection of breast cancer. The bar graphs show the percentage of women aged 42–69 who received a mammogram within the past two years.

A higher percentage rate is better for the breast cancer screening measure. It shows that more women got a mammogram within the measurement year.

HMO   PPO
HMO - Breast Cancer Screening   PPO - Breast cancer screening
     
Cervical cancer screening

Pap smears are recommended for detection of cervical cancer.
The bar graphs show the percentage of women aged 21–64 who received a Pap test within the past three years.

A higher percentage rate is better for the cervical cancer screening measure. It shows that more women got a Pap test within a given timeframe.

HMO   PPO
HMO - Cervical cancer screening
  PPO - Cervical cancer screening
 
Colorectal cancer screening

Colonoscopy is recommended to look for early signs of colorectal cancer. The bar graphs show the percentage of members aged 50-75 who had appropriate screening for colorectal cancer.

A higher percentage rate is better for the colorectal cancer screen measure. It shows that more adults in the 50-75 age group were screened for colorectal cancer.


HMO   PPO
HMO - Colorectal cancer screening
 
PPO - Colorectal cancer screening
     
Childhood immunizations

Immunizations prevent childhood diseases such as polio, measles, mumps, rubella and whooping cough. The bar graphs show the percentage of children who received recommended immunizations by age two.

A higher percentage rate is better for the childhood immunization status. A higher percentage shows that more children received all of the required immunizations.

HMO   PPO
HMO - Childhood immunizations
 
PPO - Childhood immunizations
     
Well-child visits in the third, fourth, fifth and sixth years of life

The percentage of children 3-6 years of age who had one or more well-child visits with a primary care provider (PCP) during the measurement year 2015.

For this measure, a higher percentage rate is better, which means that more young children had one or more well-child visits to a primary care physician and that fewer young children had zero visits.
HMO   PPO
HMO - Well-child visits in the third, fourth, fifth and sixth years of life
 
HMO - Well-child visits in the third, fourth, fifth and sixth years of life
 
 
Adolescent immunizations

Adolescent immunizations prevent adolescent diseases such as meningococcal, tetanus, diphtheria toxoids and acellular pertussis. The bar graphs show the percentage of adolescent children who received recommended immunizations by age 13 in the measurement year 2015.

A higher percentage rate is better for the adolescent immunization status. A higher percentage shows that more adolescent children who turned 13 years of age during the measurement year had received all of their required immunizations.
HMO - Adolescent immunizations
 
PPO - Adolescent immunizations
 
Adolescent well-care visits

The bar graphs show the percentage of members 12-21 years of age who had at least one comprehensive well-care visit with a primary care provider (PCP) or an obstetrician/gynecologist (OB/GYN) practitioner during the measurement year 2015.

A higher percentage rate is better for this measure. A higher percentage shows that more adolescents and young adults have one or more well-care visits to a PCP or an OB/GYN.
HMO - Adolescent well-care visits
 
PPO - Adolescent well-care visits
 
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New Jersey Department of Banking and Insurance