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Home > Insurance Division > Life and Health > Life & Health Actuarial > HMO and PPO Performance Report
2015 樱花视频 HMO and PPO Performance Report
Respiratory Conditions

How well does the HMO or PPO help members with respiratory conditions?

HMOs and PPOs should work with doctors to provide important services that help improve the health of members with respiratory conditions. HMOs and PPOs reported on the percentage of their relevant membership who received the following services:

  • Testing children with pharyngitis for strep
  • Avoidance of antibiotic treatment for children with upper respiratory infection (URI)
  • Avoidance of antibiotic treatment for adults with acute bronchitis
  • Use of spirometry testing in the assessment and diagnosis of Chronic Obstructive Pulmonary Disease (COPD)

The following table shows how well each HMO and PPO performed. The bar graphs following show the HMOs and PPOs compared to the 樱花视频 average.



HMO & PPO
Testing children with pharyngitis for strep %
Avoidance of antibiotic treatment for children with URI %
Avoidance of antibiotic treatment for adults with acute bronchitis %
Use of spirometry testing in diagnosis of COPD %
HMO
Aetna - HMO/POS
85
86
19
49
AmeriHealth - HMO/POS
86
90
16
43
Cigna - HMO/POS
88
95
18
40
Horizon - HMO
89
85
19
51
Oxford - HMO/POS
89
86
26
52
PPO
Aetna - PPO/EPO
88
88
19
51
AmeriHealth - PPO/EPO
89
89
20
38
Cigna - PPO
85
89
20
53
Horizon - PPO/EPO
87
86
22
46
Oxford - PPO/EPO
89
89
33
44
United - PPO/EPO
87
87
20
47
 
Testing children with pharyngitis for strep

Strep testing is recommended for detection of pharyngitis. The bar graphs show the percentage of children aged 2-18 who received a strep test to diagnose pharyngitis and then given an antibiotic.

A higher percentage rate is better for this health measure. A higher percentage shows that more children and adolescents received an appropriate strep test before getting an antibiotic prescription medication to treat pharyngitis.
HMO   PPO
HMO Testing children with pharyngitis for strep   PPO Testing children with pharyngitis for strep
     
Avoidance of antibiotic treatment* for children with upper respiratory infection (URI)

An upper respiratory infection (URI) is one of the most common illnesses, resulting in more doctor visits. The bar graphs show the percentage of children 3 months to 18 years of age with a diagnosis of URI and were not dispensed an antibiotic.

A higher percentage rate is better for this health measure. It means more infants, children and adolescents did not get an inappropriate and unnecessary antibiotic prescription.
HMO   PPO
HMO Avoidance of antibiotic treatment for children with upper respiratory infection (URI)
 
PPO Avoidance of antibiotic treatment for children with upper respiratory infection (URI)
*Inappropriate use of antibiotics has been shown to promote resistant bacteria that are more difficult to treat. The federal Centers for Disease Control and Prevention (CDC) and other organizations urge physicians to avoid prescribing antibiotics when not medically indicated.
     
Avoidance of antibiotic treatment* for adults with acute bronchitis

Use of antibiotics usually is not an appropriate treatment for acute bronchitis. The bar graphs show the percentage of adults ages 18-64 years with a diagnosis of acute bronchitis who were not dispensed an antibiotic prescription.

A higher percentage rate is better for this health measure. A higher percentage rate indicates more adults with acute bronchitis were appropriately treated, but not given unnecessary antibiotic medication as part of their treatment.
HMO   PPO
HMO Avoidance of antibiotic treatment in adults with acute bronchitis
  
PPO Avoidance of antibiotic treatment in adults with acute bronchitis
*Inappropriate use of antibiotics has been shown to promote resistant bacteria that are more difficult to treat. The federal Centers for Disease Control and Prevention (CDC) and other organizations urge physicians to avoid prescribing antibiotics when not medically indicated.
     
Use of spirometry testing in the assessment and diagnosis of COPD

Spirometry testing measures air flow through the lungs and can confirm a COPD diagnosis. The bar graphs show the percentage of members, 40 years of age and older, with a new diagnosis or newly active COPD who received appropriate spirometry testing to confirm the diagnosis.

A higher percentage rate is better for this measure. It means more adults who are 40 and above received the best diagnostic test for COPD (a lung function test called spirometry.)
HMO   PPO
HMO Use of spirometry for testing for children with pharyngitis
 
PPO Use of spirometry for testing for children with pharyngitis
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