| HMO | POS | PPO | Total | |
|---|---|---|---|---|
| Administration | ||||
| Claims processing (if yes to claims processing function) | 50.9% | 32.4%* | 12.5%** | 40.4% |
| Staffing/network (if yes to provider network function) | 71.7 | 84.3** | 16.6** | 66.4 |
| Administrative reporting | 91.9 | 90.9 | 22.8** | 80.5 |
| Member services phone response | 87.6 | 85.8 | 15.3** | 75.6 |
| Any administrative | 93.2 | 90.9 | 24.5** | 81.6 |
| Quality Related | ||||
| Quality assurance system | 73.3 | 87.4** | 15.8** | 67.6 |
| HEDIS behavioral health measures | 66.9 | 78.9* | 12.6* | 61.2 |
| Patient satisfaction | 85.4 | 78.8 | 14.3** | 72.4 |
| Provider satisfaction | 81.1 | 74.9 | 8.3** | 67.8 |
| Any quality related | 92.6 | 90.6 | 18.0** | 80.1 |
| Enrollee Focused | ||||
| Disenrollment | 33.0 | 5.3* | 2.5* | 21.3 |
| Complaints and appeals | 87.6 | 82.2 | 94.9 | 87.4 |
| Any enrollee focused | 87.6 | 82.2 | 94.9 | 87.4 |
| Total (any performance standards) | 93.2 | 90.9 | 100.0 | 93.7 |
1 The answer category "don't know" was under 2.0%
with the exception of claims processing in HMOs (14.6%); claims processing in
total (8.3%), POS plans (7.2%), and total (3.8%); provider satisfaction in PPOs
(2.6%); and disenrollment in HMOs (3.6%).
* Different from HMO value at p <0.05 level.
** Different from HMO value at p0.01 level.
Note: HEDIS = Health Plan Employer Data and Information Set.
Source: Garnick et al., 2001.