Gap on guideline use between HMOs and PPOs narrows

Patients insured by HMOs are likelier to receive guideline-based wellness, preventive and chronic disease care from their physicians than patients covered by preferred-provider organizations, but the gap between the two types of health plans is shrinking.

For the first time, the National Committee for Quality Assurance publicly reported in October how PPOs compared with HMOs on all of its performance metrics.

The committee's dozens of process and outcome performance measures, largely based on the Healthcare Effectiveness Data and Information Set, cover areas such as antibiotic use, childhood immunizations, cholesterol management, medication management, mental illness and hypertension. The publicly reported data are intended to give patients and employers a way to choose among plans on the basis of how well they encourage quality care.

In 2005, for example, 65% of HMO patients with diabetes received eye exams, compared with 55% of patients in PPOs. By 2010, the gap virtually disappeared. HMO and PPO patients with asthma receive the right medications to treat the condition nearly 92% of the time.

On a majority of metrics, HMOs still fare better. For example, 45% of HMO patients who smoke get advice on quitting from their doctors, compared with 39% of PPO patients.

Fifty-five percent of American workers are covered by a PPO, said a Sept. 27 Kaiser Family Foundation report. Seventeen percent are insured by HMOs, 17% are in high-deductible plans and 10% are in point-of-service plans.

Yet the NCQA report found that commercial HMO patients are more highly satisfied with their plans. In 2010, 40% of HMO patients gave their health plan a rating of nine or 10 on a zero-to-10 scale. Only 34% of PPO patients were similarly satisfied with their insurance packages, which typically feature broader coverage networks than HMOs but also have higher deductibles.

The report was based on quality data from more than 1,000 health plans that cover 118 million Americans. Among HMOs, which the committee has graded for the longest, there have been clear improvements over time, the report said. For example, the rate of HMO patients with diabetes receiving blood-glucose screening has increased by 15 percentage points to 90% since 1999.

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