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 Adults / 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%
Prescribing Statins to People with Diabetes	69%	65%	70%
Kidney Health Evaluation for People with Diabetes – Total	61%	52%	62%
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%
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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