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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 - 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
  • Care after prescribed Attention Deficit Hyperactivity Disorder (ADHD) medications for 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.

 
 
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 during the 12 week acute phase treatment period in the measurement year.

A higher percentage is better for effective treatment. That means more adults with depression were effectively treated when taking antidepressant medications and following up with their physician during their 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 is better. This means that more members who were hospitalized for the 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
     
Follow-up care for children prescribed attention disorder hyperactivity disorder (ADHD) medications

Children prescribed ADHD medications need to be monitored. The bar graphs show the percentage of members given medicine for the Initiation Phase of ADHD who had a follow-up visit within 30 days of the Initiation Phase.

For 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
 
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