One organization’s approach to addressing financial toxicity
HMOs have reported HEDIS measures to the National Committee for Quality Assurance (NCQA) for more than a decade, and PPOs began reporting in 2005. NCQA says that the gap between HMO and PPO performance is narrowing. The findings are reported in The State of Health Care Quality 2009.
| HMO vs. PPO performance on select HEDIS measures | |||
|---|---|---|---|
| Measure | HMO | PPO | Difference |
| Annual monitoring of patients on chronic medications | 78.9 | 75.8 | 3.1 |
| Avoidance of antibiotic treatment in adults with acute bronchitis | 24.6 | 26.8 | -2.2 |
| Breast cancer screening | 85.7 | 81.5 | 4.2 |
| DMARD therapy for rheumatoid arthritis | 70.2 | 66.0 | 4.2 |
| Follow-up after hospitalization for mental illness (30 days) | 76.1 | 71.4 | 4.7 |
| Follow-up after hospitalization for mental illness (7 days) | 57.2 | 49.8 | 7.4 |
| Follow-up for children prescribed medications for ADHD (continuation) | 40.2 | 37.1 | 3.1 |
| Follow-up for children prescribed medications for ADHD (initiation) | 35.8 | 34.1 | 1.7 |
| Persistence of beta blocker therapy for heart attack patients | 75.0 | 68.8 | 6.2 |
| Pharmacotherapy management of COPD (bronchodilator) | 76.1 | 68.1 | 8.0 |
| Pharmacotherapy management of COPD (systemic corticosteroid) | 67.0 | 58.2 | 8.9 |
