Health Insurance in Virginia

Aetna Health Inc. (a Pennsylvania Corporation)

Company Information

  • Company Providing Plan:Aetna Health, Inc. (a Pennsylvania Corporation)
  • Address:1425 Union Meeting Road, U23S
    Blue Bell, PA 19422
  • Telephone :800-872-3862
  • Website:www.aetna.com
2018
Number of Enrollees: 22,748
PMPM: $645
Number of Physicians: *554,080
NCQA Accreditation: Commendable

*The data elements noted with an asterisk (*) contain regional-specific values whereas those not noted with an asterisk (*) contain Virginia specific values.


Coverage Areas

Counties

Accomack, Albemarle, Alleghany, Amelia, Amherst, Appomattox, Arlington, Augusta, Bath, Bedford, Bland, Botetourt, Brunswick, Buckingham, Campbell, Caroline, Carroll, Charles City, Charlotte, Chesterfield, Clark, Craig, Cumberland, Culpepper, Dinwiddie, Essex, Fairfax, Fauquier, Floyd, Fluvana, Franklin, Frederick, Giles, Gloucester, Goochland, Grayson, Greene, Greensville, Halifax, Hanover, Henrico, Henry, Highland, Isle of Wight, James City, King and Queen, King George, King William, Lancaster, Loudoun, Louisa, Lunenburg, Madison, Mathews, Mecklenberg, Middlesex, Montgomery, Nelson, New Kent, Northampton, Northumberland, Nottaway, Orange, Page, Patrick, Pittsylvania, Powhatan, Prince Edward, Prince George, Prince William, Pulaski, Rappahannock, Roanoke, Rockbridge, Rockingham, Russell, Shenandoah, Smyth, Spotsylvania, Stafford, Surry, Sussex, Tazewell, Warren, Westmoreland, Wise, Wythe, York


Cities

Alexandria, Buena Vista, Charlottesville, Chesapeake, Colonial Heights, Covington, Danville, Fairfax, Falls Church, Fredericksburg, Galax, Hampton, Harrisonburg, Hopewell, Lexington, Lynchburg, Manassas, Manassas Park, Martinsville, Newport News, Norton, Petersburg, Poquoson, Radford, Richmond, Roanoke, Salem, Staunton, Suffolk, Waynesboro, Williamsburg, Winchester

Information provided by HMOs to State Corporation Commission Bureau of Insurance.

Administrative Data

2018 2017 2016 2015 2014
Number of Enrollees 22,748 50,391 37,605 34,836 12,362
PMPM $645 $430 $378 $386 $346
*Medical Cost Ratio 80% 81% 82% 78% 81%
*Administrative Ratio 17% 15% 16% 15% 13%
*Profit/Loss Ratio 4% 5% 3% 7% 6%
*Number of Physicians 554,080 426,906 370,968 407,130 377,078

*The data elements noted with an asterisk (*) contain regional-specific values whereas those not noted with an asterisk (*) contain Virginia specific values.

Financial Data

2018 2017 2016 2015 2014
Premiums Earned $183,812,024 $341,947,599 $174,415,257 $77,438,195 $85,755,116
*Income $96,319,039 $129,475,325 $83,382,290 $113,752,294 $117,023,153
*Net Worth $489,511,836 $525,277,678 $458,205,847 $421,403,811 $446,755,219

*The data elements noted with an asterisk (*) contain regional-specific values whereas those not noted with an asterisk (*) contain Virginia specific values.

Performance

Access/Availability of Care
Info
Adult Access To Preventive/Ambulatory Health Services 2018 Plan State Avg Nat Avg 90th Pctl.
Adult Access (Age 20-44) To Preventive/Ambulatory Health Services 92.21% 92.43% 92.33% 95.45%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 96.16% 95.50% 95.64% 97.49%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 97.35% 97.15% 97.17% 98.45%
Adult Access To Preventive/Ambulatory Health Services Year Plan State Avg. Natl. Avg. 90th Pctl.
Adult Access (Age 20-44) To Preventive/Ambulatory Health Services 2017 92.23% 92.73% 92.45% 95.43%
2016 92.05% 92.81% 92.73% 95.55%
2015 92.62% 92.25% 92.83% 95.45%
2014 92.31% 93.10% 92.91% 95.39%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 2017 96.03% 95.57% 95.61% 97.46%
2016 95.97% 95.78% 95.78% 97.61%
2015 95.97% 95.61% 95.90% 97.55%
2014 95.95% 96.03% 95.85% 97.54%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 2017 97.35% 97.82% 97.07% 98.47%
2016 97.13% 97.30% 97.19% 98.61%
2015 97.11% 96.84% 97.32% 96.73%
2014 96.83% 97.56% 97.50% 98.68%
Info
Alcohol and Other Drug Dependence Treatment 2018 Plan State Avg Nat Avg 90th Pctl.
Initiation of Alcohol and Other Drug Dependence Treatment - Total 32.55% 37.53% 35.68% 42.36%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 50.00% 49.35% 40.21% 51.02%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 32.20% 37.34% 35.51% 42.35%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 12.99% 14.69% 12.58% 17.04%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 36.67% 18.18% 16.91% 25.00%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 12.52% 14.58% 12.47% 16.97%
Alcohol and Other Drug Dependence Treatment Year Plan State Avg. Natl. Avg. 90th Pctl.
Initiation of Alcohol and Other Drug Dependence Treatment - Total 2017 36.49% 36.14% 36.11% 42.01%
2016 33.37% 35.69% 32.93% 40.24%
2015 32.68% 33.04% 33.42% 41.07%
2014 36.19% 32.51% 35.63% 44.19%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2017 36.54% 40.06% 39.91% 52.54%
2016 33.33% 40.15% 40.47% 51.96%
2015 41.54% 37.03% 39.62% 50.00%
2014 47.54% 37.09% 40.79% 52.00%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2017 36.49% 36.00% 35.97% 41.96%
2016 33.37% 35.55% 32.64% 40.33%
2015 32.33% 32.96% 33.20% 40.93%
2014 35.71% 32.16% 35.21% 43.92%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 2017 13.57% 13.36% 12.65% 17.26%
2016 11.16% 12.51% 11.46% 16.72%
2015 11.29% 11.61% 12.46% 19.23%
2014 13.31% 10.64% 13.66% 19.19%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2017 13.46% 14.40% 14.95% 23.85%
2016 10.42% 11.28% 15.68% 23.73%
2015 13.85% 12.06% 15.42% 22.12%
2014 21.31% 13.00% 17.24% 25.29%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2017 13.57% 13.40% 12.55% 17.38%
2016 11.18% 12.57% 11.32% 16.09%
2015 11.19% 11.57% 12.34% 18.67%
2014 12.97% 10.33% 13.45% 18.68%
Info
Child Access to Primary Care Practitioners 2018 Plan State Avg Nat Avg 90th Pctl.
12-24 month old Child Access to Primary Care Practitioners 98.69% 98.57% 98.19% 99.60%
25 month to 6 year old Child Access to Primary Care Practitioners 95.13% 94.36% 93.13% 97.39%
7-11 year old Child Access to Primary Care Practitioners 95.29% 95.22% 93.87% 98.50%
12-19 year old Child Access to Primary Care Practitioners 91.78% 92.36% 91.48% 97.12%
Child Access to Primary Care Practitioners Year Plan State Avg. Natl. Avg. 90th Pctl.
12-24 month old Child Access to Primary Care Practitioners 2017 98.80% 98.09% 97.93% 99.50%
2016 98.70% 98.34% 98.09% 99.72%
2015 98.97% 98.78% 98.03% 99.48%
2014 98.34% 98.49% 97.87% 99.62%
25 month to 6 year old Child Access to Primary Care Practitioners 2017 94.59% 94.63% 92.58% 96.95%
2016 94.03% 94.33% 92.60% 96.46%
2015 93.21% 94.16% 92.67% 96.64%
2014 93.83% 93.85% 92.33% 96.52%
7-11 year old Child Access to Primary Care Practitioners 2017 94.73% 95.40% 93.43% 98.48%
2016 94.47% 94.38% 93.25% 98.25%
2015 94.41% 94.23% 93.23% 97.92%
2014 94.05% 93.78% 93.02% 97.87%
12-19 year old Child Access to Primary Care Practitioners 2017 90.72% 92.00% 91.08% 96.99%
2016 90.83% 91.45% 90.76% 96.39%
2015 90.08% 91.30% 90.66% 96.19%
2014 89.48% 90.84% 90.44% 96.28%
Info
Prenatal and Postpartum Care 2018 Plan State Avg Nat Avg 90th Pctl.
Postpartum Care 62.50% 75.10% 75.89% 88.80%
Timeliness of Prenatal Care 83.06% 88.15% 84.75% 94.17%
Prenatal and Postpartum Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Postpartum Care 2017 68.71% 73.45% 75.05% 88.13%
2016 71.68% 74.50% 73.95% 88.85%
2015 61.70% 73.91% 73.72% 87.50%
2014 71.96% 77.29% 77.64% 88.65%
Timeliness of Prenatal Care 2017 81.29% 86.37% 84.34% 94.89%
2016 88.27% 86.71% 85.57% 96.28%
2015 80.99% 86.80% 84.28% 94.56%
2014 89.72% 86.83% 88.00% 96.23%
Behavioral Health
Info
Antidepressant Medication Management 2018 Plan State Avg Nat Avg 90th Pctl.
Antidepressant Medication Management - Effective Acute Phase Treatment 74.81% 71.96% 68.64% 77.59%
Antidepressant Medication Management - Effective Continuation Phase Treatment 60.99% 54.22% 53.01% 60.39%
Antidepressant Medication Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Antidepressant Medication Management - Effective Acute Phase Treatment 2017 73.35% 71.12% 67.11% 75.76%
2016 73.73% 70.29% 66.56% 74.77%
2015 69.69% 67.61% 65.82% 74.06%
2014 73.33% 68.52% 65.88% 75.35%
Antidepressant Medication Management - Effective Continuation Phase Treatment 2017 58.79% 54.87% 51.53% 60.24%
2016 58.01% 53.51% 50.69% 58.60%
2015 56.22% 49.81% 50.15% 57.56%
2014 59.11% 50.31% 49.83% 59.11%
Info
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication 2018 Plan State Avg Nat Avg 90th Pctl.
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Initiation 36.42% 42.91% 39.85% 50.42%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 43.21% 40.32% 48.73% 60.57%
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication Year Plan State Avg. Natl. Avg. 90th Pctl.
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Initiation 2017 33.90% 41.27% 41.13% 50.83%
2016 37.42% 41.91% 38.93% 48.61%
2015 38.71% 41.43% 38.13% 50.00%
2014 41.71% 39.00% 38.01% 46.81%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 2017 40.85% 55.09% 47.07% 58.44%
2016 47.22% 46.92% 45.82% 56.86%
2015 54.02% 49.06% 46.18% 58.06%
2014 56.38% 46.49% 45.70% 57.75%
Info
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence 2018 Plan State Avg Nat Avg 90th Pctl.
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence within 7 days after hospital discharge 8.06% 9.96% 10.81% 17.07%
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence within 30 days after hospital discharge 11.37% 13.52% 14.98% 23.11%
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence Year Plan State Avg. Natl. Avg. 90th Pctl.
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence within 7 days after hospital discharge 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence within 30 days after hospital discharge 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Info
Follow-Up After Emergency Department Visit for Mental Illness 2018 Plan State Avg Nat Avg 90th Pctl.
Follow-Up After Emergency Department Visit for Mental Illness within 7 days after hospital discharge 37.73% 38.46% 46.62% 66.57%
Follow-Up After Emergency Department Visit for Mental Illness within 30 days after hospital discharge 52.01% 53.38% 60.75% 77.57%
Follow-Up After Emergency Department Visit for Mental Illness Year Plan State Avg. Natl. Avg. 90th Pctl.
Follow-Up After Emergency Department Visit for Mental Illness within 7 days after hospital discharge 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Follow-Up After Emergency Department Visit for Mental Illness within 30 days after hospital discharge 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Info
Follow-up After Hospitalization For Mental Illness 2018 Plan State Avg Nat Avg 90th Pctl.
Follow-up After Hospitalization For Mental Illness within 7 days after hospital discharge 39.52% 48.09% 44.98% 60.38%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 62.14% 69.84% 66.68% 80.29%
Follow-up After Hospitalization For Mental Illness Year Plan State Avg. Natl. Avg. 90th Pctl.
Follow-up After Hospitalization For Mental Illness within 7 days after hospital discharge 2017 46.78% 52.18% 46.63% 62.81%
2016 43.67% 52.99% 52.06% 67.31%
2015 46.44% 47.66% 50.57% 67.57%
2014 47.84% 51.82% 52.21% 70.33%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 2017 68.96% 69.80% 68.66% 82.58%
2016 63.97% 73.85% 71.36% 84.17%
2015 66.75% 71.58% 69.72% 83.80%
2014 63.87% 72.52% 70.72% 85.71%
Effectiveness of Care
Info
Asthma Medication Management 2018 Plan State Avg Nat Avg 90th Pctl.
Medication Management for People With Asthma at least 50% Compliance - Total 75.74% 77.42% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 5-11 65.42% 63.81% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 12-18 64.97% 71.44% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 19-50 78.15% 77.64% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 51-64 81.64% 83.35% N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Total 57.47% 55.48% 51.74% 59.67%
Medication Management for People With Asthma at least 75% Compliance - Ages 5-11 40.42% 37.21% 38.94% 47.83%
Medication Management for People With Asthma at least 75% Compliance - Ages 12-18 45.69% 46.61% 38.67% 47.44%
Medication Management for People With Asthma at least 75% Compliance - Ages 19-50 60.93% 55.33% 50.37% 60.00%
Medication Management for People With Asthma at least 75% Compliance - Ages 51-64 65.58% 64.47% 61.41% 69.42%
Asthma Medication Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Medication Management for People With Asthma at least 50% Compliance - Total 2017 77.91% 76.58% N/A N/A
2016 74.18% 73.20% N/A N/A
2015 75.57% 71.52% N/A N/A
2014 N/A N/A N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 5-11 2017 73.63% 66.50% N/A N/A
2016 71.87% 67.58% N/A N/A
2015 72.30% 64.34% N/A N/A
2014 N/A N/A N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 12-18 2017 70.30% 68.06% N/A N/A
2016 62.30% 65.72% N/A N/A
2015 65.60% 60.17% N/A N/A
2014 N/A N/A N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 19-50 2017 76.33% 75.34% N/A N/A
2016 75.15% 71.77% N/A N/A
2015 76.34% 68.82% N/A N/A
2014 N/A N/A N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 51-64 2017 85.43% 84.54% N/A N/A
2016 79.83% 79.36% N/A N/A
2015 80.37% 78.55% N/A N/A
2014 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Total 2017 56.37% 54.32% 50.48% 57.69%
2016 54.08% 51.17% 48.54% 56.96%
2015 54.58% 48.01% 46.20% 55.00%
2014 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Ages 5-11 2017 48.97% 42.35% 40.22% 52.99%
2016 48.01% 39.03% 37.58% 48.84%
2015 46.28% 36.59% 37.85% 49.09%
2014 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Ages 12-18 2017 43.07% 41.76% 37.80% 47.11%
2016 38.49% 35.03% 35.83% 46.97%
2015 41.74% 35.39% 34.97% 45.26%
2014 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Ages 19-50 2017 57.65% 52.86% 48.60% 57.87%
2016 56.54% 50.18% 46.16% 55.80%
2015 55.88% 45.56% 43.39% 53.13%
2014 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Ages 51-64 2017 64.47% 64.50% 59.65% 67.58%
2016 62.21% 59.39% 57.47% 65.75%
2015 63.61% 58.44% 55.49% 65.28%
2014 N/A N/A N/A N/A
Info
Cardiovascular Disease Management 2018 Plan State Avg Nat Avg 90th Pctl.
Controlling High Blood Pressure 41.61% 60.55% N/A N/A
Persistence of Beta-Blockers 88.79% 83.54% 82.37% 89.29%
Cardiovascular Disease Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Controlling High Blood Pressure 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Persistence of Beta-Blockers 2017 90.85% 85.80% 85.18% 93.41%
2016 90.97% 90.70% 83.61% 90.83%
2015 87.21% 88.70% 84.68% 91.00%
2014 88.46% 84.03% 83.50% 91.43%
Info
Common Childhood Illnesses 2018 Plan State Avg Nat Avg 90th Pctl.
Appropriate Testing for Children With Pharyngitis 92.97% 92.74% 87.97% 94.94%
Common Childhood Illnesses Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Testing for Children With Pharyngitis 2017 91.53% 92.30% 87.45% 94.64%
2016 90.44% 90.38% 84.50% 93.75%
2015 91.43% 90.13% 83.12% 93.11%
2014 90.37% 88.64% 83.29% 91.40%
Info
Diabetes Care and Management 2018 Plan State Avg Nat Avg 90th Pctl.
Comprehensive Diabetes Care-Blood Pressure Control (<140/90 mm Hg) 51.58% 63.70% 62.59% 77.37%
Comprehensive Diabetes Care-HbA1c control (<8.0%) 65.21% 62.46% 57.79% 66.33%
Comprehensive Diabetes Care-Medical Attention for Nephropathy 91.00% 90.73% 90.33% 93.43%
Comprehensive Diabetes Care-Rate of Eye Exams 60.10% 56.58% 54.40% 69.68%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 25.55% 27.18% 30.85% 20.62%
Comprehensive Diabetes Care-Testing for HbA1c 91.73% 92.11% 91.29% 94.71%
Diabetes Care and Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Comprehensive Diabetes Care-Blood Pressure Control (<140/90 mm Hg) 2017 47.45% 63.40% 60.82% 76.41%
2016 49.64% 60.88% 61.06% 78.35%
2015 50.36% 61.03% 58.80% 75.68%
2014 46.81% 63.33% 63.85% 76.00%
Comprehensive Diabetes Care-HbA1c control (<8.0%) 2017 55.96% 62.51% 57.48% 67.15%
2016 55.96% 58.36% 56.62% 66.39%
2015 54.01% 57.59% 55.81% 66.67%
2014 56.45% 59.12% 58.53% 68.61%
Comprehensive Diabetes Care-Medical Attention for Nephropathy 2017 89.29% 90.80% 90.38% 93.61%
2016 88.56% 90.56% 90.03% 92.71%
2015 92.46% 91.11% 90.10% 93.40%
2014 85.16% 86.26% 84.72% 89.60%
Comprehensive Diabetes Care-Rate of Eye Exams 2017 59.85% 56.95% 54.06% 70.69%
2016 59.85% 58.46% 52.96% 72.04%
2015 58.15% 57.15% 52.47% 70.44%
2014 61.31% 57.54% 54.98% 71.93%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 2017 34.55% 27.63% 31.91% 21.41%
2016 34.79% 30.47% 32.15% 20.98%
2015 35.28% 30.83% 33.90% 20.20%
2014 34.31% 31.37% 30.48% 19.33%
Comprehensive Diabetes Care-Testing for HbA1c 2017 86.13% 91.52% 90.96% 94.18%
2016 85.64% 90.38% 90.32% 94.83%
2015 90.75% 91.13% 90.54% 94.69%
2014 85.40% 89.01% 90.34% 94.86%
Info
Drug Therapy in Rheumatoid Arthritis 2018 Plan State Avg Nat Avg 90th Pctl.
Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis 85.57% 88.42% 87.69% 94.27%
Drug Therapy in Rheumatoid Arthritis Year Plan State Avg. Natl. Avg. 90th Pctl.
Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis 2017 83.82% 90.16% 88.62% 93.75%
2016 83.56% 89.05% 87.87% 93.92%
2015 82.46% 89.72% 87.84% 92.86%
2014 85.00% 88.05% 87.86% 93.59%
Info
Immunizations 2018 Plan State Avg Nat Avg 90th Pctl.
Childhood Immunization for Multiple Diseases Including Chicken Pox 77.22% 80.96% 79.32% 88.06%
Childhood Immunization for Multiple Diseases Including Pneumovax 77.22% 79.46% 77.50% 86.62%
Flu Vaccinations for Adults Ages 65 and Older 75.19% 53.53% 51.93% 61.07%
Immunizations for Adolescents - Combination 55.61% 79.55% 82.25% 91.52%
Immunizations for Adolescents - HPV 79.08% 32.22% 28.05% 37.23%
Immunizations for Adolescents - Meningococcal 27.49% 80.66% 83.69% 92.94%
Immunizations for Adolescents - Tdap 80.05% 91.16% 89.95% 95.62%
Immunizations Year Plan State Avg. Natl. Avg. 90th Pctl.
Childhood Immunization for Multiple Diseases Including Chicken Pox 2017 83.62% 73.55% 79.44% 89.14%
2016 80.89% 75.86% 78.93% 89.03%
2015 83.94% 74.15% 78.59% 88.08%
2014 77.86% 72.96% 80.18% 88.07%
Childhood Immunization for Multiple Diseases Including Pneumovax 2017 0.05% 80.09% 77.67% 87.61%
2016 0.03% 82.08% 77.04% 87.50%
2015 0.07% 79.45% 76.49% 87.10%
2014 0.06% 78.11% 78.13% 86.26%
Flu Vaccinations for Adults Ages 65 and Older 2017 82.15% 0.53% 49.33% 59.27%
2016 78.91% 47.13% 47.47% 58.70%
2015 80.05% 0.50% 47.85% 58.01%
2014 75.43% 0.52% 49.45% 59.73%
Immunizations for Adolescents - Combination 2017 0.50% 80.48% 80.23% 89.54%
2016 44.69% 77.95% 77.63% 88.81%
2015 0.46% 69.50% 74.25% 88.47%
2014 0.47% 67.04% 70.73% 87.34%
Immunizations for Adolescents - HPV 2017 78.83% 28.29% 23.98% 32.36%
2016 78.83% 77.95% 77.63% 88.81%
2015 66.40% 69.50% 74.25% 88.47%
2014 56.05% 67.04% 70.73% 87.34%
Immunizations for Adolescents - Meningococcal 2017 22.87% 82.05% 81.75% 90.27%
2016 78.83% 79.65% 79.20% 90.02%
2015 66.40% 0.72% 76.12% 89.29%
2014 56.05% 0.69% 72.59% 88.27%
Immunizations for Adolescents - Tdap 2017 79.81% 91.65% 88.91% 94.65%
2016 81.51% 91.29% 87.77% 95.38%
2015 0.73% 0.85% 86.03% 94.39%
2014 0.63% 0.85% 84.49% 95.15%
Info
Persistent Medications 2018 Plan State Avg Nat Avg 90th Pctl.
Annual Monitoring for Patients on Persistent Medications 83.89% 86.50% 84.47% 88.08%
Persistent Medications Year Plan State Avg. Natl. Avg. 90th Pctl.
Annual Monitoring for Patients on Persistent Medications 2017 81.26% 85.73% 83.71% 87.04%
2016 81.30% 84.90% 83.34% 87.04%
2015 81.38% 83.34% 82.94% 86.72%
2014 81.74% 83.28% 82.33% 86.25%
Info
Pharmacotherapy of COPD Exacerbation 2018 Plan State Avg Nat Avg 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 88.51% 85.49% 78.92% 87.88%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 75.86% 76.41% 74.76% 83.55%
Pharmacotherapy of COPD Exacerbation Year Plan State Avg. Natl. Avg. 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 2017 81.67% 80.88% 79.87% 87.50%
2016 79.17% 84.12% 76.30% 85.98%
2015 76.33% 78.48% 79.09% 87.10%
2014 81.03% 80.03% 80.14% 86.90%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 2017 75.42% 78.84% 76.26% 84.38%
2016 70.31% 79.54% 70.70% 81.82%
2015 70.41% 72.98% 75.30% 84.56%
2014 78.97% 75.53% 75.28% 83.54%
Info
Preventive Care 2018 Plan State Avg Nat Avg 90th Pctl.
Breast Cancer Screening 70.34% 72.13% 73.73% 81.17%
Chlamydia Screening in Women-all Age groups 53.31% 52.91% 51.41% 67.76%
Colorectal Cancer Screening 64.42% 64.94% 64.37% 76.52%
Preventive Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Breast Cancer Screening 2017 69.17% 71.85% 72.81% 80.91%
2016 67.74% 71.80% 72.90% 80.63%
2015 67.66% 72.07% 73.08% 81.53%
2014 68.57% 72.22% 73.52% 81.91%
Chlamydia Screening in Women-all Age groups 2017 52.43% 51.46% 50.16% 66.08%
2016 51.14% 49.79% 48.98% 63.50%
2015 49.47% 47.89% 52.32% 64.06%
2014 49.68% 48.07% 51.65% 63.48%
Colorectal Cancer Screening 2017 66.49% 65.16% 62.43% 74.72%
2016 62.23% 64.67% 61.71% 74.09%
2015 65.80% 63.31% 62.32% 73.84%
2014 70.21% 63.41% 64.06% 74.86%
Info
Spirometry Testing 2018 Plan State Avg Nat Avg 90th Pctl.
Use of Spirometry Testing in the Assessment and diagnosis of COPD 44.40% 44.14% 41.48% 50.95%
Spirometry Testing Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Spirometry Testing in the Assessment and diagnosis of COPD 2017 43.44% 43.12% 41.90% 50.52%
2016 47.78% 42.48% 42.55% 51.02%
2015 48.18% 46.31% 42.44% 51.66%
2014 48.58% 42.48% 42.16% 51.85%
Info
Statin Therapy 2018 Plan State Avg Nat Avg 90th Pctl.
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 21-75 years (Male) 81.38% 84.45% 83.64% 89.14%
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 40–75 years (Female) 69.59% 76.45% 73.26% 81.82%
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - Total 77.31% 82.21% 81.23% 87.21%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 21-75 years (Male) 82.35% 75.19% 77.14% 82.88%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 40–75 years (Female) 76.48% 72.78% 72.12% 81.10%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - Total 80.53% 74.49% 75.95% 82.83%
Statin Therapy for Patients with Diabetes - Received Therapy 63.50% 63.94% 62.57% 70.05%
Statin Therapy for Patients with Diabetes - Statin Adherence 80% 75.73% 68.88% 69.52% 78.00%
Statin Therapy Year Plan State Avg. Natl. Avg. 90th Pctl.
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 21-75 years (Male) 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 40–75 years (Female) 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - Total 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 21-75 years (Male) 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 40–75 years (Female) 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - Total 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Statin Therapy for Patients with Diabetes - Received Therapy 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Statin Therapy for Patients with Diabetes - Statin Adherence 80% 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Info
Weight Assessment and Counseling 2018 Plan State Avg Nat Avg 90th Pctl.
Adult BMI Assessment 54.59% 82.61% 81.07% 93.61%
Children/Adolescents BMI Assessment - Total 63.52% 73.74% 72.87% 90.00%
Children/Adolescents BMI Assessment - Ages 3-11 68.37% 76.94% 74.00% 90.91%
Children/Adolescents BMI Assessment - Ages 12-17 57.98% 69.73% 71.39% 88.97%
Counseling for Nutrition for Children/Adolescents - Total 62.53% 71.79% 67.72% 85.06%
Counseling for Nutrition for Children/Adolescents - Ages 3-11 65.12% 75.91% 69.85% 86.21%
Counseling for Nutrition for Children/Adolescents - Ages 12-17 59.57% 66.37% 64.92% 84.29%
Counseling for Physical Activity for Children/Adolescents - Total 57.57% 66.42% 63.08% 81.32%
Counseling for Physical Activity for Children/Adolescents - Ages 3-11 55.35% 65.48% 61.70% 80.92%
Counseling for Physical Activity for Children/Adolescents - Ages 12-17 60.11% 67.51% 64.79% 84.03%
Weight Assessment and Counseling Year Plan State Avg. Natl. Avg. 90th Pctl.
Adult BMI Assessment 2017 57.78% 79.49% 79.78% 93.20%
2016 68.16% 77.87% 76.17% 91.85%
2015 64.10% 75.90% 74.19% 91.76%
2014 65.16% 76.28% 75.36% 91.20%
Children/Adolescents BMI Assessment - Total 2017 65.51% 70.41% 70.59% 88.08%
2016 66.34% 69.07% 65.62% 88.08%
2015 54.55% 60.49% 60.37% 83.78%
2014 58.77% 61.63% 61.08% 85.37%
Children/Adolescents BMI Assessment - Ages 3-11 2017 66.09% 71.37% 71.84% 88.89%
2016 69.53% 70.86% 67.11% 88.19%
2015 56.36% 63.37% 61.61% 84.69%
2014 58.60% 60.91% 60.86% 86.64%
Children/Adolescents BMI Assessment - Ages 12-17 2017 64.71% 68.96% 68.94% 87.82%
2016 62.15% 66.72% 64.28% 87.29%
2015 52.41% 56.47% 58.77% 83.62%
2014 58.94% 62.60% 61.34% 85.47%
Counseling for Nutrition for Children/Adolescents - Total 2017 64.52% 69.47% 65.50% 83.21%
2016 69.02% 66.76% 61.76% 83.68%
2015 60.69% 63.88% 58.94% 80.79%
2014 61.61% 65.02% 60.64% 80.05%
Counseling for Nutrition for Children/Adolescents - Ages 3-11 2017 64.38% 71.63% 68.20% 84.82%
2016 71.67% 69.25% 64.59% 85.48%
2015 64.55% 67.34% 61.49% 82.89%
2014 67.44% 68.39% 63.58% 84.21%
Counseling for Nutrition for Children/Adolescents - Ages 12-17 2017 64.71% 66.54% 61.92% 80.26%
2016 65.54% 63.42% 58.79% 81.87%
2015 56.15% 59.10% 55.64% 77.85%
2014 55.56% 60.63% 56.75% 76.92%
Counseling for Physical Activity for Children/Adolescents - Total 2017 60.55% 64.30% 59.96% 77.32%
2016 59.02% 60.41% 55.96% 79.44%
2015 59.21% 59.53% 54.50% 78.85%
2014 59.66% 62.13% 57.09% 77.30%
Counseling for Physical Activity for Children/Adolescents - Ages 3-11 2017 57.51% 62.31% 58.84% 75.00%
2016 57.94% 58.91% 54.72% 76.52%
2015 63.18% 58.85% 53.14% 76.08%
2014 60.27% 60.95% 55.78% 76.72%
Counseling for Physical Activity for Children/Adolescents - Ages 12-17 2017 64.71% 66.86% 61.40% 79.89%
2016 60.45% 62.44% 58.47% 83.05%
2015 54.55% 60.35% 56.39% 80.86%
2014 58.95% 63.65% 58.73% 78.07%
Health Plan Stability/Descriptive
Info
Administrative Data 2018 Plan State Avg Nat Avg 90th Pctl.
Administrative Ratio 0.17 0.13 86.19 92.68
Medical Cost Ratio 0.80 0.83 92.60 95.85
Number of Enrollees 22,748 140,630 92 96
Number of Physicians 554,080 94,540 87 95
Premium Per Member Per Month $645 $499 N/A N/A
Administrative Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Administrative Ratio 2017 0.15 0.12 86.39 93.13
2016 0.16 0.15 N/A N/A
2015 0.15 0.14 N/A N/A
2014 0.13 0.14 N/A N/A
Medical Cost Ratio 2017 0.81 0.83 93.13 96.59
2016 0.82 0.83 N/A N/A
2015 0.78 0.82 N/A N/A
2014 0.81 0.81 N/A N/A
Number of Enrollees 2017 50,391 133,992 92 97
2016 37,605 136,796 N/A N/A
2015 34,836 124,097 N/A N/A
2014 12,362 115,428 N/A N/A
Number of Physicians 2017 426,906 81,926 87 95
2016 370,968 73,426 N/A N/A
2015 407,130 90,027 N/A N/A
2014 377,078 63,157 N/A N/A
Premium Per Member Per Month 2017 $430 $370 N/A N/A
2016 $378 $370 N/A N/A
2015 $386 $375 N/A N/A
2014 $346 $412 N/A N/A
Info
Board Certification Rates for Providers 2018 Plan State Avg Nat Avg 90th Pctl.
Board Certification for Geriatricians 56.28% 69.82% N/A N/A
Board Certification for Pediatricians 83.04% 86.24% N/A N/A
Board Certification Rate for Family Medicine Physicians 81.80% 83.01% N/A N/A
Board Certification Rate for Internal Medicine Physicians 73.44% 79.67% N/A N/A
Board Certification Rate for OB/GYN Providers 75.80% 84.25% N/A N/A
Board Certification Rate for Other Specialists 68.81% 81.57% N/A N/A
Board Certification Rates for Providers Year Plan State Avg. Natl. Avg. 90th Pctl.
Board Certification for Geriatricians 2017 58.00% 71.38% N/A N/A
2016 65.41% 73.44% N/A N/A
2015 61.21% 71.06% N/A N/A
2014 64.03% 74.73% N/A N/A
Board Certification for Pediatricians 2017 83.00% 85.50% N/A N/A
2016 88.37% 87.02% N/A N/A
2015 88.81% 88.14% N/A N/A
2014 88.72% 88.13% N/A N/A
Board Certification Rate for Family Medicine Physicians 2017 79.00% 81.38% N/A N/A
2016 83.07% 80.32% N/A N/A
2015 83.88% 82.53% N/A N/A
2014 84.91% 82.93% N/A N/A
Board Certification Rate for Internal Medicine Physicians 2017 74.00% 81.00% N/A N/A
2016 77.14% 81.15% N/A N/A
2015 78.10% 82.59% N/A N/A
2014 78.37% 83.98% N/A N/A
Board Certification Rate for OB/GYN Providers 2017 75.00% 83.00% N/A N/A
2016 78.53% 83.36% N/A N/A
2015 78.29% 83.51% N/A N/A
2014 77.61% 83.71% N/A N/A
Board Certification Rate for Other Specialists 2017 70.00% 81.88% N/A N/A
2016 73.68% 83.25% N/A N/A
2015 74.57% 82.88% N/A N/A
2014 75.69% 84.44% N/A N/A
Info
Financial Data 2018 Plan State Avg Nat Avg 90th Pctl.
Income $96,319,039 $47,837,732 N/A N/A
Net Worth $489,511,836 $303,649,748 N/A N/A
Premiums Earned $183,812,024 $879,518,893 N/A N/A
Financial Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Income 2017 $129,475,325 $34,422,501 N/A N/A
2016 $83,382,290 $38,212,136 N/A N/A
2015 $113,752,294 $19,029,685 N/A N/A
2014 $117,023,153 $50,732,622 N/A N/A
Net Worth 2017 $525,277,678 $263,890,874 N/A N/A
2016 $458,205,847 $267,217,323 N/A N/A
2015 $421,403,811 $237,291,717 N/A N/A
2014 $446,755,219 $250,764,247 N/A N/A
Premiums Earned 2017 $341,947,599 $645,600,589 N/A N/A
2016 $174,415,257 $644,862,921 N/A N/A
2015 $77,438,195 $552,705,214 N/A N/A
2014 $85,755,116 $470,221,984 N/A N/A
Info
Years in Business 2018 Plan State Avg Nat Avg 90th Pctl.
Years in Business 40 36 N/A N/A
Years in Business Year Plan State Avg. Natl. Avg. 90th Pctl.
Years in Business 2017 39 35 N/A N/A
2016 38 34 N/A N/A
2015 37 33 N/A N/A
2014 36 32 N/A N/A
Member Satisfaction
Info
Member Satisfaction 2018 Plan State Avg Nat Avg 90th Pctl.
Getting Care Quickly 88.81% 85.27% 85.23% 89.89%
Getting Needed Care 88.23% 85.53% 86.33% 90.45%
How Well Doctors Communicate 96.57% 94.70% 95.31% 97.22%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 74.12% 64.78% 64.53% 76.79%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 87.71% 84.82% 84.41% 88.57%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 79.20% 76.02% 78.17% 83.95%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 89.45% 84.08% 85.14% 89.78%
Member Satisfaction Year Plan State Avg. Natl. Avg. 90th Pctl.
Getting Care Quickly 2017 91.22% 87.22% 85.34% 89.83%
2016 82.72% 85.81% 85.14% 90.00%
2015 84.16% 85.61% 85.00% 89.71%
2014 88.17% 86.12% 85.79% 90.17%
Getting Needed Care 2017 91.67% 87.44% 86.71% 90.37%
2016 89.93% 86.38% 87.25% 91.54%
2015 86.79% 86.51% 86.79% 91.23%
2014 92.63% 88.34% 87.95% 92.13%
How Well Doctors Communicate 2017 97.17% 94.74% 95.10% 96.91%
2016 95.15% 95.22% 95.39% 97.21%
2015 93.79% 94.90% 95.20% 97.10%
2014 95.67% 95.30% 95.26% 97.16%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 2017 70.90% 61.26% 62.44% 75.00%
2016 68.07% 62.47% 62.27% 74.92%
2015 61.84% 62.71% 62.65% 74.57%
2014 64.05% 58.77% 64.71% 76.75%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 2017 89.08% 83.86% 84.62% 88.77%
2016 83.33% 83.44% 84.72% 88.74%
2015 85.79% 83.49% 83.85% 89.05%
2014 81.37% 85.38% 84.24% 88.27%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 2017 82.48% 76.98% 77.27% 82.99%
2016 76.69% 77.49% 77.19% 83.29%
2015 69.73% 76.25% 76.99% 82.76%
2014 74.37% 79.49% 78.26% 83.66%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 2017 83.98% 83.95% 84.60% 89.86%
2016 86.69% 84.65% 84.57% 88.37%
2015 80.88% 83.85% 84.24% 88.77%
2014 78.10% 84.37% 84.70% 88.96%
Overuse/Appropriateness
Info
Antipsychotics 2018 Plan State Avg Nat Avg 90th Pctl.
Metabolic Monitoring for Children and Adolescents on Antipsychotics - Ages 1-17 50.36% 44.74% 36.17% 47.41%
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 48.98% 57.96% 56.00% 70.54%
Use of Multiple Concurrent Antipsychotics in Children and Adolescents - Ages 1-17 2.86% 5.32% N/A N/A
Antipsychotics Year Plan State Avg. Natl. Avg. 90th Pctl.
Metabolic Monitoring for Children and Adolescents on Antipsychotics - Ages 1-17 2017 38.13% 50.55% 36.07% 48.57%
2016 33.78% 34.87% 35.80% 45.93%
2015 35.66% 37.02% 33.94% 45.45%
2014 N/A N/A N/A N/A
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 2017 45.83% 58.14% 54.52% 68.67%
2016 50.00% 61.93% 58.30% 75.00%
2015 62.12% 61.38% 54.40% 70.49%
2014 N/A N/A N/A N/A
Use of Multiple Concurrent Antipsychotics in Children and Adolescents - Ages 1-17 2017 1.74% 2.39% N/A N/A
2016 0.00% 2.06% N/A N/A
2015 3.77% 1.70% N/A N/A
2014 N/A N/A N/A N/A
Info
Cervical Cancer Screening in Adolescent Females 2018 Plan State Avg Nat Avg 90th Pctl.
Non-Recommended Cervical Cancer Screening in Adolescent Females 77.14% 77.90% 76.08% 83.21%
Cervical Cancer Screening in Adolescent Females Year Plan State Avg. Natl. Avg. 90th Pctl.
Non-Recommended Cervical Cancer Screening in Adolescent Females 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Info
Lower Back Pain 2018 Plan State Avg Nat Avg 90th Pctl.
Use of Imaging for Low Back Pain 71.32% 74.77% 75.11% 82.95%
Lower Back Pain Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Imaging for Low Back Pain 2017 69.90% 73.85% 75.16% 82.29%
2016 68.56% 73.58% 72.67% 80.11%
2015 69.59% 74.11% 74.57% 81.25%
2014 69.80% 72.44% 74.82% 81.95%
Info
Respiratory 2018 Plan State Avg Nat Avg 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 93.81% 92.50% 91.22% 95.48%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 28.31% 33.60% 33.16% 48.28%
Respiratory Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 2017 90.02% 90.92% 89.19% 94.59%
2016 92.02% 88.81% 88.51% 94.80%
2015 89.82% 87.71% 88.11% 94.26%
2014 88.67% 87.19% 87.39% 94.57%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 2017 27.67% 30.67% 30.99% 49.52%
2016 22.07% 27.03% 28.19% 41.72%
2015 20.62% 25.68% 26.11% 38.04%
2014 21.09% 25.67% 25.79% 36.11%
Info
Use of Opiods 2018 Plan State Avg Nat Avg 90th Pctl.
Use of Opioids at High Dosage 3.87% 5.32% 4.54% 1.87%
Use of Opioids From Multiple Providers - Multiple Pharmacies 6.65% 5.21% 3.80% 1.40%
Use of Opioids From Multiple Providers - Multiple Prescribers 18.33% 18.32% 15.02% 9.64%
Use of Opioids From Multiple Providers - Multiple Prescribers and Multiple Pharmacies 2.79% 2.68% 1.76% 0.47%
Use of Opiods Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Opioids at High Dosage 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Use of Opioids From Multiple Providers - Multiple Pharmacies 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Use of Opioids From Multiple Providers - Multiple Prescribers 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Use of Opioids From Multiple Providers - Multiple Prescribers and Multiple Pharmacies 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Utilization
Info
Antibiotic Utilization 2018 Plan State Avg Nat Avg 90th Pctl.
Average number of antibiotic prescriptions per member per year - Total 0.79 0.74 0.71 0.88
Average number of antibiotic prescriptions per member per year - Ages 0-9 0.82 0.81 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 0.50 0.52 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 0.70 0.65 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 0.79 0.73 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 0.91 0.84 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 0.99 0.97 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 1.07 1.21 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 1.06 1.32 N/A N/A
Days suppplied per antibiotic prescription - Total 9.460 9.950 9.910 10.890
Days suppplied per antibiotic prescription - Ages 0-9 9.850 9.979 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 12.530 12.948 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 9.380 9.731 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 9.140 9.568 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 9.070 9.769 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 8.930 9.830 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 9.410 9.428 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 9.200 9.026 N/A N/A
Prescriptions of concern - Total 0.370 0.338 0.330 0.430
Prescriptions of concern - Ages 0-9 0.33 0.32 N/A N/A
Prescriptions of concern - Ages 10-17 0.19 0.20 N/A N/A
Prescriptions of concern - Ages 18-34 0.30 0.28 N/A N/A
Prescriptions of concern - Ages 35-49 0.38 0.35 N/A N/A
Prescriptions of concern - Ages 50-64 0.46 0.42 N/A N/A
Prescriptions of concern - Ages 65-74 0.52 0.48 N/A N/A
Prescriptions of concern - Ages 75-85 0.53 0.62 N/A N/A
Prescriptions of concern - Ages 85 plus 0.57 0.45 N/A N/A
Antibiotic Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Average number of antibiotic prescriptions per member per year - Total 2017 0.80 0.77 0.76 0.90
2016 0.79 0.79 0.76 0.90
2015 0.80 0.80 0.81 0.97
2014 0.78 0.75 0.79 0.96
Average number of antibiotic prescriptions per member per year - Ages 0-9 2017 0.85 0.87 N/A N/A
2016 0.92 0.97 N/A N/A
2015 0.84 0.94 N/A N/A
2014 0.79 0.84 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 2017 0.55 0.57 N/A N/A
2016 0.55 0.60 N/A N/A
2015 0.53 0.60 N/A N/A
2014 0.52 0.56 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 2017 0.70 0.67 N/A N/A
2016 0.68 0.69 N/A N/A
2015 0.70 0.70 N/A N/A
2014 0.68 0.67 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 2017 0.81 0.75 N/A N/A
2016 0.80 0.77 N/A N/A
2015 0.82 0.80 N/A N/A
2014 0.82 0.76 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 2017 0.91 0.88 N/A N/A
2016 0.89 0.87 N/A N/A
2015 0.91 0.90 N/A N/A
2014 0.90 0.84 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 2017 1.03 1.00 N/A N/A
2016 1.00 0.99 N/A N/A
2015 1.03 1.07 N/A N/A
2014 1.02 0.96 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 2017 1.04 1.12 N/A N/A
2016 0.99 1.23 N/A N/A
2015 1.11 1.08 N/A N/A
2014 1.05 1.09 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 2017 1.18 1.12 N/A N/A
2016 0.91 0.73 N/A N/A
2015 0.98 1.67 N/A N/A
2014 1.07 1.37 N/A N/A
Days suppplied per antibiotic prescription - Total 2017 9.560 10.024 9.880 10.830
2016 9.690 10.090 9.880 10.830
2015 9.919 10.259 10.120 11.030
2014 10.099 10.444 10.320 11.180
Days suppplied per antibiotic prescription - Ages 0-9 2017 9.690 10.050 N/A N/A
2016 9.630 10.041 N/A N/A
2015 9.708 9.987 N/A N/A
2014 9.729 10.008 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 2017 12.090 12.689 N/A N/A
2016 12.350 12.799 N/A N/A
2015 12.823 13.321 N/A N/A
2014 13.626 13.648 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 2017 9.390 9.836 N/A N/A
2016 9.570 10.074 N/A N/A
2015 10.340 10.334 N/A N/A
2014 10.588 10.650 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 2017 9.320 9.591 N/A N/A
2016 9.370 9.620 N/A N/A
2015 9.463 9.825 N/A N/A
2014 9.600 9.954 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 2017 9.230 9.856 N/A N/A
2016 9.350 9.816 N/A N/A
2015 9.337 9.898 N/A N/A
2014 9.437 10.043 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 2017 9.220 9.850 N/A N/A
2016 9.630 9.929 N/A N/A
2015 9.815 10.178 N/A N/A
2014 9.808 10.427 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 2017 9.770 10.604 N/A N/A
2016 10.460 10.594 N/A N/A
2015 10.034 9.934 N/A N/A
2014 9.817 10.543 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 2017 9.820 9.873 N/A N/A
2016 9.320 9.431 N/A N/A
2015 10.814 9.538 N/A N/A
2014 10.716 10.648 N/A N/A
Prescriptions of concern - Total 2017 0.380 0.354 0.360 0.450
2016 0.390 0.383 0.360 0.450
2015 0.393 0.401 0.410 0.520
2014 0.385 0.374 0.390 0.490
Prescriptions of concern - Ages 0-9 2017 0.35 0.35 N/A N/A
2016 0.40 0.43 N/A N/A
2015 0.37 0.41 N/A N/A
2014 0.36 0.38 N/A N/A
Prescriptions of concern - Ages 10-17 2017 0.22 0.22 N/A N/A
2016 0.22 0.24 N/A N/A
2015 0.22 0.25 N/A N/A
2014 0.20 0.22 N/A N/A
Prescriptions of concern - Ages 18-34 2017 0.30 0.28 N/A N/A
2016 0.31 0.31 N/A N/A
2015 0.30 0.32 N/A N/A
2014 0.30 0.30 N/A N/A
Prescriptions of concern - Ages 35-49 2017 0.39 0.37 N/A N/A
2016 0.41 0.40 N/A N/A
2015 0.43 0.42 N/A N/A
2014 0.43 0.41 N/A N/A
Prescriptions of concern - Ages 50-64 2017 0.47 0.44 N/A N/A
2016 0.47 0.46 N/A N/A
2015 0.49 0.49 N/A N/A
2014 0.48 0.45 N/A N/A
Prescriptions of concern - Ages 65-74 2017 0.52 0.50 N/A N/A
2016 0.52 0.51 N/A N/A
2015 0.55 0.57 N/A N/A
2014 0.55 0.51 N/A N/A
Prescriptions of concern - Ages 75-85 2017 0.51 0.54 N/A N/A
2016 0.52 0.65 N/A N/A
2015 0.58 0.59 N/A N/A
2014 0.56 0.51 N/A N/A
Prescriptions of concern - Ages 85 plus 2017 0.64 0.48 N/A N/A
2016 0.44 0.34 N/A N/A
2015 0.49 0.82 N/A N/A
2014 0.57 0.55 N/A N/A
Info
Child and Adolescent Well Child Visits 2018 Plan State Avg Nat Avg 90th Pctl.
Well Child Visits in the First 15 Months of Life 88.09% 85.93% 81.33% 90.72%
Well Child Visits in the 3rd - 6th Years 86.10% 83.85% 80.95% 91.86%
Adolescent Well-Care Visits 54.92% 53.54% 52.57% 71.93%
Child and Adolescent Well Child Visits Year Plan State Avg. Natl. Avg. 90th Pctl.
Well Child Visits in the First 15 Months of Life 2017 85.84% 85.68% 80.53% 90.78%
2016 86.98% 83.40% 80.76% 90.36%
2015 85.39% 84.01% 79.35% 89.12%
2014 73.87% 82.63% 79.12% 89.64%
Well Child Visits in the 3rd - 6th Years 2017 83.59% 83.18% 79.11% 91.03%
2016 82.32% 82.50% 78.30% 90.11%
2015 78.22% 80.48% 77.75% 89.74%
2014 80.73% 80.03% 77.37% 88.75%
Adolescent Well-Care Visits 2017 52.94% 53.24% 50.46% 70.44%
2016 51.10% 50.35% 49.68% 67.70%
2015 48.90% 49.34% 48.26% 64.50%
2014 49.48% 48.09% 47.51% 64.76%
Info
Mental Health Utilization 2018 Plan State Avg Nat Avg 90th Pctl.
Mental Health Utilization - Any service - Total 6.89% 7.63% 7.98% 11.76%
Mental Health Utilization - Any service - Ages 0-12 5.24% 6.12% N/A N/A
Mental Health Utilization - Any service - Ages 13-17 11.44% 13.96% N/A N/A
Mental Health Utilization - Any service - Ages 18-64 7.18% 7.62% N/A N/A
Mental Health Utilization - Any service - Ages 65 plus 2.53% 3.20% N/A N/A
Mental Health Utilization - ED - Total 0.10% 0.09% 0.10% 0.22%
Mental Health Utilization - ED - Ages 0-12 0.07% 0.05% N/A N/A
Mental Health Utilization - ED - Ages 13-17 0.32% 0.28% N/A N/A
Mental Health Utilization - ED - Ages 18-64 0.09% 0.08% N/A N/A
Mental Health Utilization - ED - Ages 65 plus 0.01% 0.02% N/A N/A
Mental Health Utilization - Inpatient - Total 0.29% 0.27% 0.27% 0.34%
Mental Health Utilization - Inpatient - Ages 0-12 0.14% 0.12% N/A N/A
Mental Health Utilization - Inpatient - Ages 13-17 0.83% 0.95% N/A N/A
Mental Health Utilization - Inpatient - Ages 18-64 0.27% 0.26% N/A N/A
Mental Health Utilization - Inpatient - Ages 65 plus 0.15% 0.06% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Total 0.10% 0.12% 0.19% 0.38%
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 0-12 0.08% 0.15% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 13-17 0.45% 0.49% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 18-64 0.08% 0.09% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 65 plus 0.03% 0.02% N/A N/A
Mental Health Utilization - Outpatient - Total 6.79% 7.53% N/A N/A
Mental Health Utilization - Outpatient - Ages 0-12 5.22% 6.10% N/A N/A
Mental Health Utilization - Outpatient - Ages 13-17 11.26% 13.80% N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 7.08% 7.51% N/A N/A
Mental Health Utilization - Outpatient - Ages 65 plus 2.42% 3.16% N/A N/A
Mental Health Utilization - Telehealth - Total 0.07% 0.10% 0.05% 0.11%
Mental Health Utilization - Telehealth - Ages 0-12 0.01% 0.03% N/A N/A
Mental Health Utilization - Telehealth - Ages 13-17 0.08% 0.19% N/A N/A
Mental Health Utilization - Telehealth - Ages 18-64 0.08% 0.11% N/A N/A
Mental Health Utilization - Telehealth - Ages 65 plus 0.02% 0.02% N/A N/A
Mental Health Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Mental Health Utilization - Any service - Total 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Any service - Ages 0-12 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Any service - Ages 13-17 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Any service - Ages 18-64 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Any service - Ages 65 plus 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - ED - Total 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 0-12 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 13-17 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 18-64 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 65 plus 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Total 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 0-12 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 13-17 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 18-64 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 65 plus 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Total 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 0-12 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 13-17 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 18-64 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 65 plus 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Total 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Ages 0-12