And although HMOs have traditionally led in healthcare quality, the data showed that PPOs have made significant jumps in performance in many areas, O'Kane said. For instance, commercial HMOs and PPOs had nearly identical scores—92.9% and 93%, respectively—on a measure of use of appropriate medications for asthma patients. PPOs also are making headway on other measures, including those related to cholesterol management, diabetes care and patient satisfaction, she added.
“PPOs are starting to catch up to HMOs in terms of quality and that's a very positive thing,” said Dr. John Bennett, president and CEO of CDPHP, a health plan based in Albany, N.Y.
The report also showed areas that need more attention, including measures of care related to waste and misuse. Both HMOs and PPOs showed room for improvement on avoidance of unnecessary antibiotics for acute bronchitis and on use of imaging for lower back pain.
That comparison data is useful, O'Kane said, but a sizable number of health plans are still choosing not to submit their data openly. In some states, insurers are required by law to report quality data. The NCQA can use this data for benchmarking, but the insurers' names are not attached. “When we compare those results to plans that voluntarily report their data, there is a big gap,” she explained.
For instance, on a measure of effective cholesterol management for heart patients, the average performance score was 51% for commercial HMOs that don't publicly report their data, compared with an average of nearly 61% for those that do.
“A lot of plans have not seen this as a major priority,” said Dr. Michael Sherman, senior vice president and chief medical officer of Harvard Pilgrim Health Care, a health benefits company based in Wellesley, Mass. “Medicare payment reform and the push for more transparency are changing that.”
And as health plans look forward and recognize those upcoming changes, they're looking more closely at ways to restructure payment models and engage patients, said Dr. Duane Davis, vice president and CMO at Geisinger Health Plan, Danville, Pa.
Sherman described those changes as “an opportunity for plans like ours to leverage our capabilities in population management, medical informatics, disease management and predictive modeling in order to help improve care” to stay relevant. “Those plans that choose not to will be an endangered species.”