Compare Clinical Performance for HMO and PPO Plans Nationwide

What do the stars mean?

California’s health plans’ quality scores are compared to results of health plans throughout the United States. A set of standard patient experience measures are used to compare the average performance among health plans in California to the health plan national average and to the best performing plans in the country. The 90th percentile results are scores that are better than 90 percent of the plan results nationwide. These scores largely are based on patient care provided in 2024. The California plans’ scores are the average across all California health plans. The nationwide results are from health plans located throughout the United States and were calculated giving equal weight to each plan’s score regardless of its number of enrollees.

What Is the Source?

The National Committee for Quality Assurance (NCQA) collects and reports on CAHPS measures as part of its nationwide health plan accreditation program. These health plan scores include PPO plans as well as several managed healthcare insurance products which are commonly called HMO and POS (Point of Service) health plans. This comparison of California health plans to national scores uses data that was reported in the NCQA 2025 Quality Compass®.
Scores for the CAHPS® topics are based on the percentage of members who gave high scores or the most positive answers ("always" or "usually" for most questions) to the survey question. For most questions, answers are scored using one of four possible choices ranging from the member “always” had a positive experience to the member “never” had a positive experience.

 

California Average:

California Health Plans

National Average:

Health Plans Nationwide

National 90th Percentile:

Top Health Plans Nationwide
Doctor Advises Patient to Quit Smoking NA 80% 80%
Testing for Cause of Back Pain 77% 74% 82%
Treating Bronchitis - Getting the Right Care 43% 44% 58%
Asthma Medicine for patients / Teens 73% 82% 86%
Asthma Medicine for Children 80% 83% 92%
Treating Lung Disease - Bronchodilator Medicine 85% 82% 91%
Treating Lung Disease – Corticosteroid Medicine 75% 76% 87%
Immunizations for Early Teens 38% 33% 49%
Ongoing Care for Attention Deficit Hyperactivity Disorder 52% 49% 61%
Starting Care for Attention Deficit Hyperactivity Disorder 46% 44% 54%
Checking if Teen’s Weight Could Cause Health Problems 75% 70% 90%
Checking if Children’s Weight Could Cause Health Problems 78% 71% 90%
Teen's Well-Care Visits – 12-17 57% 63% 79%
Teen's Well-Care Visits – 18-21 31% 37% 54%
Children's Well-Care Visits – 3-11 65% 71% 85%
Child and Teen Well-Care Visits – Total 54% 60% 75%
Immunizations for Children 49% 47% 63%
Treating Children with Throat Infections 83% 89% 94%
Controlling Blood Pressure for People with Diabetes 70% 67% 81%
Controlling Blood Sugar for People with Diabetes 64% 64% 74%
Eye Exam for People with Diabetes 53% 51% 64%
Kidney Health Evaluation for People with Diabetes – 18-64 60% 52% 62%
Kidney Health Evaluation for People with Diabetes – 65-75 64% 55% 67%
Kidney Health Evaluation for People with Diabetes – 76-85 57% 49% 68%
Kidney Health Evaluation for People with Diabetes – Total 61% 52% 62%
Prescribing Statins to People with Diabetes 69% 65% 70%
Controlling High Blood Pressure 63% 64% 77%
Heart Attack Medicine 70% 72% 81%
Prescribing Statins to People with Heart Disease 81% 82% 87%
Alcohol and Drug Dependence Treatment – Ongoing Phase 14% 14% 19%
Alcohol and Drug Dependence Treatment - Beginning Phase 39% 37% 44%
Antidepressant Medicine – First Three Months of Treatment 77% 78% 85%
Antidepressant Medicine – Six Months' Continuation of Treatment 60% 62% 72%
Follow-up Visit Within 30 Days After Mental Illness Hospital Stay 68% 71% 83%
Follow-up Visit Within 7 Days After Mental Illness Hospital Stay 48% 50% 65%
Immunizations for Pregnant People – Combination 37% 33% 50%
Immunizations for Pregnant People – Influenza 41% 37% 53%
Immunizations for Pregnant People – Tdap 70% 70% 83%
Visits After Giving Birth 81% 83% 95%
Visits During Pregnancy 80% 80% 94%
Preventing Hospital Readmission After Discharge NA NA NA
Breast Cancer Screening 75% 75% 81%
Cervical Cancer Screening 75% 73% 81%
Chlamydia Screening 53% 47% 64%
Colorectal Cancer Screening 59% 59% 70%
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