Health Insurance in Virginia

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CAREFIRST BLUECHOICE, INC.

Company Information

  • Company Providing Plan:Carefirst Inc Group
  • Address:10455 MILL RUN CIRCLE
    OWINGS MILLS MD 21117
  • Telephone :410-581-3000
  • Website:WWW.CAREFIRST.COM
2021
Number of Enrollees: *93,769
PMPM: *$479
Number of Physicians: 61,218
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

VIRGINIA: THE CITIES OF ALEXANDRIA AND FAIRFAX; THE TOWN OF VIENNA; ARLINGTON COUNTY AND THE AREAS OF FAIRFAX AND PRINCE WILLIAMS COUNTIES IN VIRGINIA LYING EAST OF ROUTE 123

Cities

Alexandria, Fairfax, Town of Vienna

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

Administrative Data

2021 2020 2019 2018 2017
*Number of Enrollees 93,769 83,967 81,960 79,558 84,851
PMPM $479 $468 $455 $455 $404
*Medical Cost Ratio 87% 75% 74% 77% 82%
*Administrative Ratio 19% 22% 20% 21% 21%
*Profit/Loss Ratio -6% 4% 7% 3% -2%
Number of Physicians 61,218 12,049 10,545 10,336 10,155

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

Financial Data

2021 2020 2019 2018 2017
Premiums Earned $514,053,745 $467,505,591 $437,755,166 $449,713,753 $399,660,112
*Income ($160,669,763) $97,593,666 $183,552,553 $63,916,927 ($27,820,788)
*Net Worth $728,884,056 $918,540,455 $916,778,984 $721,055,178 $672,613,635

*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 2021 Plan State Avg Nat Avg 90th Pctl.
Adult Access (Age 20-44) To Preventive/Ambulatory Health Services 96.29% 94.34% 93.47% 96.29%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 97.59% 96.22% 96.12% 97.63%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 98.31% 96.96% 96.96% 98.35%
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 2020 95.57% 93.90% 92.88% 95.71%
2019 95.17% 92.78% 92.66% 95.76%
2018 95.11% 92.43% 92.33% 95.45%
2017 95.04% 92.73% 92.45% 95.43%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 2020 97.25% 96.11% 95.86% 97.54%
2019 97.08% 95.78% 95.87% 97.69%
2018 97.00% 95.50% 95.64% 97.49%
2017 96.97% 95.57% 95.61% 97.46%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 2020 97.89% 96.79% 96.95% 98.30%
2019 97.84% 97.13% 97.14% 98.42%
2018 97.78% 97.15% 97.17% 98.45%
2017 97.79% 97.82% 97.07% 98.47%
Info
Alcohol and Other Drug Dependence Treatment 2021 Plan State Avg Nat Avg 90th Pctl.
Initiation of Alcohol and Other Drug Dependence Treatment - Total 35.37% 38.29% 34.72% 43.21%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 44.57% 45.84% 41.60% 52.08%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 35.18% 38.22% 34.53% 43.21%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 15.15% 14.66% 11.91% 15.33%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 21.74% 16.85% 15.29% 22.05%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 15.01% 14.60% 11.85% 15.56%
Alcohol and Other Drug Dependence Treatment Year Plan State Avg. Natl. Avg. 90th Pctl.
Initiation of Alcohol and Other Drug Dependence Treatment - Total 2020 37.93% 40.49% 36.39% 45.24%
2019 34.75% 39.13% 35.63% 41.36%
2018 35.60% 37.53% 35.68% 42.36%
2017 37.24% 36.14% 36.11% 42.01%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2020 34.17% 35.48% 44.95% 59.06%
2019 37.32% 36.19% 42.41% 54.29%
2018 40.69% 49.35% 40.21% 51.02%
2017 42.07% 40.06% 39.91% 52.54%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2020 38.03% 40.55% 36.18% 45.12%
2019 34.66% 39.20% 35.47% 40.96%
2018 35.45% 37.34% 35.51% 42.35%
2017 37.06% 36.00% 35.97% 41.96%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 2020 17.48% 15.16% 12.46% 17.48%
2019 14.89% 13.47% 12.31% 16.44%
2018 15.62% 14.69% 12.58% 17.04%
2017 15.46% 13.36% 12.65% 17.26%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2020 17.50% 14.80% 17.76% 27.27%
2019 17.61% 10.34% 16.48% 27.14%
2018 17.93% 18.18% 16.91% 25.00%
2017 17.68% 14.40% 14.95% 23.85%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2020 17.48% 15.15% 12.33% 17.48%
2019 14.80% 13.52% 12.20% 16.41%
2018 15.55% 14.58% 12.47% 16.97%
2017 15.38% 13.40% 12.55% 17.38%
Info
Prenatal and Postpartum Care 2021 Plan State Avg Nat Avg 90th Pctl.
Postpartum Care 74.32% 80.79% 81.70% 93.89%
Timeliness of Prenatal Care 83.45% 86.12% 83.24% 94.16%
Prenatal and Postpartum Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Postpartum Care 2020 77.86% 74.05% 78.11% 92.47%
2019 78.83% 78.66% 80.52% 91.97%
2018 70.32% 75.10% 75.89% 88.80%
2017 74.45% 73.45% 75.05% 88.13%
Timeliness of Prenatal Care 2020 85.89% 79.76% 81.82% 93.92%
2019 84.18% 86.76% 85.57% 95.33%
2018 90.27% 88.15% 84.75% 94.17%
2017 91.48% 86.37% 84.34% 94.89%
Behavioral Health
Info
Adherence to Antipsychotic Medications for Individuals with Schizophrenia 2021 Plan State Avg Nat Avg 90th Pctl.
Adherence to Antipsychotic Medications for Individuals With Schizophrenia 67.90% 67.45% 68.64% 79.03%
Adherence to Antipsychotic Medications for Individuals with Schizophrenia Year Plan State Avg. Natl. Avg. 90th Pctl.
Adherence to Antipsychotic Medications for Individuals With Schizophrenia 2020 74.46% 70.63% 69.41% 79.41%
2019 N/A N/A N/A N/A
2018 N/A N/A N/A N/A
2017 N/A N/A N/A N/A
Info
Antidepressant Medication Management 2021 Plan State Avg Nat Avg 90th Pctl.
Antidepressant Medication Management - Effective Acute Phase Treatment 81.67% 79.35% 76.18% 83.11%
Antidepressant Medication Management - Effective Continuation Phase Treatment 64.79% 61.51% 59.75% 67.55%
Antidepressant Medication Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Antidepressant Medication Management - Effective Acute Phase Treatment 2020 79.33% 77.14% 73.70% 81.07%
2019 77.09% 73.53% 71.19% 78.79%
2018 78.67% 71.96% 68.64% 77.59%
2017 77.04% 71.12% 67.11% 75.76%
Antidepressant Medication Management - Effective Continuation Phase Treatment 2020 63.58% 59.69% 57.32% 64.22%
2019 60.60% 55.44% 54.90% 62.18%
2018 64.17% 54.22% 53.01% 60.39%
2017 61.67% 54.87% 51.53% 60.24%
Info
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication 2021 Plan State Avg Nat Avg 90th Pctl.
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Initiation 40.68% 41.24% 36.60% 48.10%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 49.65% 45.63% 45.94% 60.34%
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 2020 43.63% 45.87% 41.24% 50.34%
2019 38.29% 42.67% 40.66% 51.30%
2018 40.81% 42.91% 39.85% 50.42%
2017 42.56% 41.27% 41.13% 50.83%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 2020 51.00% 56.56% 48.67% 59.32%
2019 46.09% 50.69% 47.95% 58.82%
2018 44.53% 40.32% 48.73% 60.57%
2017 48.75% 55.09% 47.07% 58.44%
Info
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence 2021 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 10.30% 12.52% 12.71% 21.05%
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence within 30 days after hospital discharge 14.40% 16.65% 17.10% 27.59%
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 2020 11.90% 14.52% 13.45% 21.43%
2019 9.50% 8.56% 11.48% 18.26%
2018 10.02% 9.96% 10.81% 17.07%
2017 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 2020 16.39% 19.84% 18.03% 26.07%
2019 13.50% 14.74% 15.35% 24.56%
2018 13.36% 13.52% 14.98% 23.11%
2017 N/A N/A N/A N/A
Info
Follow-Up After Emergency Department Visit for Mental Illness 2021 Plan State Avg Nat Avg 90th Pctl.
Follow-Up After Emergency Department Visit for Mental Illness within 7 days after hospital discharge 55.67% 44.60% 50.67% 70.54%
Follow-Up After Emergency Department Visit for Mental Illness within 30 days after hospital discharge 70.45% 61.91% 64.91% 82.58%
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 2020 50.96% 48.22% 47.90% 68.29%
2019 54.50% 45.64% 48.70% 70.67%
2018 51.76% 38.46% 46.62% 66.57%
2017 N/A N/A N/A N/A
Follow-Up After Emergency Department Visit for Mental Illness within 30 days after hospital discharge 2020 66.27% 59.38% 62.36% 78.77%
2019 69.61% 60.35% 62.59% 77.75%
2018 66.37% 53.38% 60.75% 77.57%
2017 N/A N/A N/A N/A
Info
Follow-up After Hospitalization For Mental Illness 2021 Plan State Avg Nat Avg 90th Pctl.
Follow-up After Hospitalization For Mental Illness within 7 days after hospital discharge 53.78% 49.75% 48.70% 63.60%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 76.33% 73.29% 71.44% 82.61%
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 2020 56.60% 49.46% 49.62% 63.68%
2019 51.67% 49.77% 45.66% 58.20%
2018 55.04% 48.09% 44.98% 60.38%
2017 55.31% 52.18% 46.63% 62.81%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 2020 76.53% 72.67% 70.00% 79.46%
2019 74.87% 72.38% 67.81% 80.65%
2018 73.95% 69.84% 66.68% 80.29%
2017 74.08% 69.80% 68.66% 82.58%
Effectiveness of Care
Info
Asthma Medication Ratio 2021 Plan State Avg Nat Avg 90th Pctl.
Asthma Medication Ratio - Ages 5-11 91.93% 92.78% 89.65% 96.23%
Asthma Medication Ratio - Ages 12-18 88.25% 85.93% 83.38% 90.21%
Asthma Medication Ratio - Ages 19-50 83.51% 82.29% 78.35% 87.18%
Asthma Medication Ratio - Ages 51-64 88.44% 86.60% 83.59% 90.22%
Asthma Medication Ratio - Total 86.21% 85.07% 81.23% 87.41%
Asthma Medication Ratio Year Plan State Avg. Natl. Avg. 90th Pctl.
Asthma Medication Ratio - Ages 5-11 2020 92.10% 93.70% 89.98% 95.00%
2019 90.33% 86.54% 85.94% 93.20%
2018 86.27% 85.26% 87.15% 93.97%
2017 85.67% 86.06% 86.90% 93.55%
Asthma Medication Ratio - Ages 12-18 2020 82.92% 84.76% 81.90% 89.30%
2019 76.95% 84.88% 77.43% 86.25%
2018 77.49% 84.71% 78.77% 84.72%
2017 78.01% 84.80% 76.69% 85.94%
Asthma Medication Ratio - Ages 19-50 2020 82.13% 78.90% 75.62% 84.47%
2019 79.97% 80.50% 74.07% 81.27%
2018 79.34% 82.69% 75.11% 82.84%
2017 76.64% 78.94% 74.23% 81.70%
Asthma Medication Ratio - Ages 51-64 2020 86.30% 85.69% 82.47% 89.38%
2019 85.36% 86.85% 81.27% 88.51%
2018 84.52% 86.11% 82.81% 89.49%
2017 84.18% 89.17% 82.83% 89.28%
Asthma Medication Ratio - Total 2020 84.54% 83.04% 79.76% 85.85%
2019 82.72% 83.92% 78.10% 84.69%
2018 81.66% 84.32% 79.34% 85.18%
2017 80.35% 84.01% 79.04% 85.85%
Info
Cardiovascular Disease Management 2021 Plan State Avg Nat Avg 90th Pctl.
Controlling High Blood Pressure 59.44% 60.64% 59.95% 73.24%
Persistence of Beta-Blockers 87.71% 88.98% 86.08% 93.62%
Cardiovascular Disease Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Controlling High Blood Pressure 2020 61.56% 43.15% 53.49% 69.10%
2019 56.05% 60.96% 61.02% 74.21%
2018 56.20% 60.55% N/A N/A
2017 N/A N/A N/A N/A
Persistence of Beta-Blockers 2020 86.23% 87.06% 87.38% 94.19%
2019 88.08% 88.62% 85.16% 92.47%
2018 85.76% 83.54% 82.37% 89.29%
2017 86.02% 85.80% 85.18% 93.41%
Info
Cervical Cancer Screening 2021 Plan State Avg Nat Avg 90th Pctl.
Cervical Cancer Screening 76.01% 76.66% 75.48% 81.94%
Cervical Cancer Screening Year Plan State Avg. Natl. Avg. 90th Pctl.
Cervical Cancer Screening 2020 77.78% 75.44% 75.50% 81.71%
2019 79.32% 78.50% 77.40% 83.91%
2018 79.32% 77.90% 76.08% 83.21%
2017 N/A N/A N/A N/A
Info
Common Childhood Illnesses 2021 Plan State Avg Nat Avg 90th Pctl.
Appropriate Testing for Children With Pharyngitis 86.68% 82.09% 79.49% 89.15%
Common Childhood Illnesses Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Testing for Children With Pharyngitis 2020 91.11% 90.05% 84.77% 92.62%
2019 91.63% 90.44% 86.62% 93.98%
2018 93.29% 92.74% 87.97% 94.94%
2017 93.25% 92.30% 87.45% 94.64%
Info
Diabetes Care and Management 2021 Plan State Avg Nat Avg 90th Pctl.
Comprehensive Diabetes Care-Blood Pressure Control (<140/90 mm Hg) 62.29% 59.77% 62.09% 75.43%
Comprehensive Diabetes Care-HbA1c control (<8.0%) 63.26% 61.24% 59.64% 67.11%
Comprehensive Diabetes Care-Rate of Eye Exams 49.39% 57.17% 52.65% 64.30%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 26.03% 28.15% 29.94% 21.90%
Comprehensive Diabetes Care-Testing for HbA1c 91.00% 91.18% 90.81% 93.92%
Diabetes Care and Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Comprehensive Diabetes Care-Blood Pressure Control (<140/90 mm Hg) 2020 58.19% 44.59% 55.85% 73.48%
2019 63.75% 62.53% 63.23% 77.86%
2018 58.39% 63.70% 62.59% 77.37%
2017 61.31% 63.40% 60.82% 76.41%
Comprehensive Diabetes Care-HbA1c control (<8.0%) 2020 57.46% 55.20% 55.37% 65.50%
2019 61.07% 63.81% 58.07% 66.33%
2018 57.12% 62.46% 57.79% 66.33%
2017 65.69% 62.51% 57.48% 67.15%
Comprehensive Diabetes Care-Rate of Eye Exams 2020 47.19% 53.44% 50.27% 64.23%
2019 54.01% 58.32% 55.45% 69.32%
2018 54.56% 56.58% 54.40% 69.68%
2017 49.88% 56.95% 54.06% 70.69%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 2020 33.74% 36.05% 34.87% 23.45%
2019 32.36% 26.09% 30.80% 20.82%
2018 32.12% 27.18% 30.85% 20.62%
2017 23.60% 27.63% 31.91% 21.41%
Comprehensive Diabetes Care-Testing for HbA1c 2020 83.86% 86.71% 87.74% 91.73%
2019 89.29% 92.45% 91.60% 94.71%
2018 89.60% 92.11% 91.29% 94.71%
2017 92.21% 91.52% 90.96% 94.18%
Info
Immunizations 2021 Plan State Avg Nat Avg 90th Pctl.
Childhood Immunization for Multiple Diseases (Combo 10) 66.12% 66.38% 60.60% 73.21%
Childhood Immunization for Multiple Diseases Including Pneumovax 79.51% 82.74% 78.15% 88.27%
Flu Vaccinations for Adults Ages 18-64 58.44% 59.29% 55.31% 65.85%
Immunizations for Adolescents - Combination 2 36.25% 39.82% 34.09% 44.04%
Immunizations for Adolescents - HPV 37.47% 41.73% 35.37% 46.00%
Immunizations for Adolescents - Meningococcal 91.00% 86.88% 85.91% 93.19%
Immunizations for Adolescents - Tdap 90.75% 93.05% 90.13% 95.38%
Immunizations Year Plan State Avg. Natl. Avg. 90th Pctl.
Childhood Immunization for Multiple Diseases (Combo 10) 2020 N/A N/A N/A N/A
2019 N/A N/A N/A N/A
2018 N/A N/A N/A N/A
2017 N/A N/A N/A N/A
Childhood Immunization for Multiple Diseases Including Pneumovax 2020 82.81% 74.94% 75.84% 87.36%
2019 76.29% 81.30% 78.32% 87.99%
2018 83.70% 79.46% 77.50% 86.62%
2017 75.91% 80.09% 77.67% 87.61%
Flu Vaccinations for Adults Ages 18-64 2020 58.45% 57.13% 57.41% 67.88%
2019 58.60% 59.38% 55.06% 65.24%
2018 49.40% 53.06% 51.93% 61.07%
2017 51.23% 55.21% 49.33% 59.27%
Immunizations for Adolescents - Combination 2 2020 31.87% 35.09% 31.84% 39.17%
2019 29.44% 33.16% 29.59% 40.63%
2018 83.21% 79.55% 82.25% 91.52%
2017 85.89% 80.48% 80.23% 89.54%
Immunizations for Adolescents - HPV 2020 34.06% 37.80% 33.38% 42.34%
2019 30.90% 35.43% 31.21% 42.46%
2018 30.41% 32.22% 28.05% 37.23%
2017 26.03% 28.29% 23.98% 32.36%
Immunizations for Adolescents - Meningococcal 2020 89.54% 80.71% 85.83% 93.12%
2019 88.32% 81.83% 85.01% 92.59%
2018 84.91% 80.66% 83.69% 92.94%
2017 87.35% 82.05% 81.75% 90.27%
Immunizations for Adolescents - Tdap 2020 93.19% 92.47% 90.62% 95.13%
2019 94.16% 92.23% 90.47% 95.13%
2018 90.27% 91.16% 89.95% 95.62%
2017 91.24% 91.65% 88.91% 94.65%
Info
Pharmacotherapy of COPD Exacerbation 2021 Plan State Avg Nat Avg 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 81.88% 86.14% 81.56% 89.58%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 79.38% 80.22% 74.79% 84.78%
Pharmacotherapy of COPD Exacerbation Year Plan State Avg. Natl. Avg. 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 2020 81.99% 86.03% 81.34% 88.51%
2019 84.73% 83.91% 80.32% 88.97%
2018 86.62% 85.49% 78.92% 87.88%
2017 83.17% 80.88% 79.87% 87.50%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 2020 77.02% 75.06% 74.31% 85.07%
2019 77.09% 81.14% 76.90% 87.69%
2018 78.03% 76.41% 74.76% 83.55%
2017 74.26% 78.84% 76.26% 84.38%
Info
Preventive Care 2021 Plan State Avg Nat Avg 90th Pctl.
Breast Cancer Screening 74.19% 72.93% 72.44% 79.62%
Chlamydia Screening in Women-all Age groups 50.85% 51.90% 48.47% 62.71%
Colorectal Cancer Screening 66.75% 63.99% 64.90% 76.16%
Preventive Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Breast Cancer Screening 2020 72.72% 72.56% 72.44% 79.39%
2019 74.45% 72.92% 74.81% 81.58%
2018 73.66% 72.13% 73.73% 81.17%
2017 72.56% 71.85% 72.81% 80.91%
Chlamydia Screening in Women-all Age groups 2020 50.75% 49.80% 48.49% 63.85%
2019 55.20% 54.77% 51.86% 67.02%
2018 54.26% 52.91% 51.41% 67.76%
2017 52.90% 51.46% 50.16% 66.08%
Colorectal Cancer Screening 2020 62.80% 60.99% 63.64% 74.42%
2019 66.85% 68.10% 66.15% 77.91%
2018 66.67% 64.94% 64.37% 76.52%
2017 61.56% 65.16% 62.43% 74.72%
Info
Spirometry Testing 2021 Plan State Avg Nat Avg 90th Pctl.
Use of Spirometry Testing in the Assessment and diagnosis of COPD 40.23% 34.87% 36.29% 45.50%
Spirometry Testing Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Spirometry Testing in the Assessment and diagnosis of COPD 2020 40.66% 37.53% 37.16% 43.86%
2019 42.44% 39.81% 42.11% 52.78%
2018 43.31% 44.14% 41.48% 50.95%
2017 44.36% 43.12% 41.90% 50.52%
Info
Statin Therapy 2021 Plan State Avg Nat Avg 90th Pctl.
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 21-75 years (Male) 87.65% 86.25% 84.99% 90.85%
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 40–75 years (Female) 75.61% 74.86% 76.91% 83.87%
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - Total 84.40% 83.06% 82.86% 88.32%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 21-75 years (Male) 81.62% 78.10% 80.36% 87.04%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 40–75 years (Female) 80.48% 77.02% 76.97% 85.47%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - Total 81.34% 77.77% 79.53% 86.44%
Statin Therapy for Patients with Diabetes - Received Therapy 65.54% 66.92% 66.45% 72.23%
Statin Therapy for Patients with Diabetes - Statin Adherence 80% 76.20% 74.32% 73.74% 81.61%
Statin Therapy Year Plan State Avg. Natl. Avg. 90th Pctl.
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 21-75 years (Male) 2020 84.92% 85.75% 84.86% 89.67%
2019 86.22% 85.53% 84.83% 90.71%
2018 84.98% 84.45% 83.64% 89.14%
2017 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 40–75 years (Female) 2020 75.09% 77.46% 75.69% 81.94%
2019 71.56% 75.96% 74.89% 81.82%
2018 69.38% 76.45% 73.26% 81.82%
2017 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - Total 2020 82.35% 83.41% 82.46% 87.85%
2019 82.30% 82.97% 82.41% 88.24%
2018 80.82% 82.21% 81.23% 87.21%
2017 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 21-75 years (Male) 2020 83.54% 81.24% 81.04% 86.60%
2019 80.37% 78.19% 78.73% 85.40%
2018 81.29% 75.19% 77.14% 82.88%
2017 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 40–75 years (Female) 2020 79.95% 78.29% 77.58% 86.55%
2019 76.52% 75.98% 73.50% 82.09%
2018 77.50% 72.78% 72.12% 81.10%
2017 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - Total 2020 82.68% 80.47% 80.55% 86.26%
2019 79.47% 77.63% 77.38% 84.14%
2018 80.42% 74.49% 75.95% 82.83%
2017 N/A N/A N/A N/A
Statin Therapy for Patients with Diabetes - Received Therapy 2020 64.27% 66.42% 65.49% 71.27%
2019 63.16% 65.53% 64.43% 70.97%
2018 62.17% 63.94% 62.57% 70.05%
2017 N/A N/A N/A N/A
Statin Therapy for Patients with Diabetes - Statin Adherence 80% 2020 77.21% 73.48% 74.69% 82.04%
2019 74.65% 71.84% 71.74% 79.50%
2018 74.65% 68.88% 69.52% 78.00%
2017 N/A N/A N/A N/A
Info
Weight Assessment and Counseling 2021 Plan State Avg Nat Avg 90th Pctl.
Children/Adolescents BMI Assessment - Total 73.44% 77.31% 75.21% 89.14%
Children/Adolescents BMI Assessment - Ages 3-11 71.55% 78.77% 76.73% 90.56%
Children/Adolescents BMI Assessment - Ages 12-17 76.32% 75.37% 73.29% 87.42%
Counseling for Nutrition for Children/Adolescents - Total 73.44% 74.98% 69.95% 83.70%
Counseling for Nutrition for Children/Adolescents - Ages 3-11 73.71% 77.08% 72.50% 86.18%
Counseling for Nutrition for Children/Adolescents - Ages 12-17 73.03% 72.13% 66.75% 82.14%
Counseling for Physical Activity for Children/Adolescents - Total 69.53% 71.34% 66.55% 80.86%
Counseling for Physical Activity for Children/Adolescents - Ages 3-11 66.81% 69.93% 66.24% 81.08%
Counseling for Physical Activity for Children/Adolescents - Ages 12-17 73.68% 73.30% 66.87% 83.09%
Weight Assessment and Counseling Year Plan State Avg. Natl. Avg. 90th Pctl.
Children/Adolescents BMI Assessment - Total 2020 67.78% 61.27% 70.64% 88.81%
2019 75.91% 74.97% 74.90% 90.00%
2018 75.91% 73.74% 72.87% 90.00%
2017 65.94% 70.41% 70.59% 88.08%
Children/Adolescents BMI Assessment - Ages 3-11 2020 70.70% 64.54% 72.11% 88.89%
2019 77.35% 78.68% 76.00% 90.91%
2018 77.35% 76.94% 74.00% 90.91%
2017 66.92% 71.37% 71.84% 88.89%
Children/Adolescents BMI Assessment - Ages 12-17 2020 63.45% 57.19% 68.80% 87.79%
2019 74.01% 70.46% 73.46% 89.29%
2018 74.01% 69.73% 71.39% 88.97%
2017 64.24% 68.96% 68.94% 87.82%
Counseling for Nutrition for Children/Adolescents - Total 2020 65.28% 56.08% 65.06% 82.43%
2019 75.18% 72.58% 68.74% 85.24%
2018 75.18% 71.79% 67.72% 85.06%
2017 63.99% 69.47% 65.50% 83.21%
Counseling for Nutrition for Children/Adolescents - Ages 3-11 2020 70.70% 59.21% 67.32% 84.32%
2019 79.06% 77.02% 71.33% 86.49%
2018 79.06% 75.91% 69.85% 86.21%
2017 65.38% 71.63% 68.20% 84.82%
Counseling for Nutrition for Children/Adolescents - Ages 12-17 2020 57.24% 52.10% 62.24% 79.49%
2019 70.06% 66.89% 65.44% 84.29%
2018 70.06% 66.37% 64.92% 84.29%
2017 61.59% 66.54% 61.92% 80.26%
Counseling for Physical Activity for Children/Adolescents - Total 2020 63.61% 52.21% 60.81% 80.29%
2019 68.37% 66.86% 64.24% 82.78%
2018 68.37% 66.42% 63.08% 81.32%
2017 58.15% 64.30% 59.96% 77.32%
Counseling for Physical Activity for Children/Adolescents - Ages 3-11 2020 66.51% 52.27% 60.31% 81.14%
2019 65.38% 66.12% 63.39% 82.53%
2018 65.38% 65.48% 61.70% 80.92%
2017 56.15% 62.31% 58.84% 75.00%
Counseling for Physical Activity for Children/Adolescents - Ages 12-17 2020 59.31% 51.96% 61.40% 79.85%
2019 72.32% 67.67% 65.38% 84.68%
2018 72.32% 67.51% 64.79% 84.03%
2017 61.59% 66.86% 61.40% 79.89%
Health Plan Stability/Descriptive
Info
Administrative Data 2021 Plan State Avg Nat Avg 90th Pctl.
Administrative Ratio 0.19 0.12 N/A N/A
Medical Cost Ratio 0.87 0.85 N/A N/A
Number of Enrollees 93,769 189,570 N/A N/A
Number of Physicians 61,218 144,761 N/A N/A
Premium Per Member Per Month $479 $582 N/A N/A
Profit/Loss Ratio -0.06 0.04 N/A N/A
Administrative Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Administrative Ratio 2020 0.22 0.13 N/A N/A
2019 0.20 0.12 N/A N/A
2018 0.21 0.14 86.19 92.68
2017 0.21 0.12 86.39 93.13
Medical Cost Ratio 2020 0.75 0.81 N/A N/A
2019 0.74 0.84 N/A N/A
2018 0.77 0.83 92.60 95.85
2017 0.82 0.83 93.13 96.59
Number of Enrollees 2020 83,967 157,206 N/A N/A
2019 81,960 136,748 N/A N/A
2018 79,558 129,656 92 96
2017 84,851 133,992 92 97
Number of Physicians 2020 12,049 118,547 N/A N/A
2019 10,545 105,314 N/A N/A
2018 10,336 86,806 87 95
2017 10,155 81,926 87 95
Premium Per Member Per Month 2020 $468 $529 N/A N/A
2019 $455 $511 N/A N/A
2018 $455 $517 N/A N/A
2017 $404 $370 N/A N/A
Profit/Loss Ratio 2020 0.04 0.06 N/A N/A
2019 0.07 0.04 N/A N/A
2018 0.03 0.04 N/A N/A
2017 -0.02 0.05 N/A N/A
Info
Financial Data 2021 Plan State Avg Nat Avg 90th Pctl.
Income $-160,669,763 $84,171,275 N/A N/A
Net Worth $728,884,056 $444,659,972 N/A N/A
Premiums Earned $514,053,745 $1,315,605,350 N/A N/A
Financial Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Income 2020 $97,593,666 $108,797,768 N/A N/A
2019 $183,552,553 $81,234,487 N/A N/A
2018 $63,916,927 $44,046,244 N/A N/A
2017 $-27,820,788 $34,422,501 N/A N/A
Net Worth 2020 $918,540,455 $381,868,187 N/A N/A
2019 $916,778,984 $340,553,480 N/A N/A
2018 $721,055,178 $279,558,644 N/A N/A
2017 $672,613,635 $263,890,874 N/A N/A
Premiums Earned 2020 $467,505,591 $1,079,933,473 N/A N/A
2019 $437,755,166 $936,529,722 N/A N/A
2018 $449,713,753 $815,577,345 N/A N/A
2017 $399,660,112 $645,600,589 N/A N/A
Info
Years in Business 2021 Plan State Avg Nat Avg 90th Pctl.
Years in Business 35 39 N/A N/A
Years in Business Year Plan State Avg. Natl. Avg. 90th Pctl.
Years in Business 2020 34 38 N/A N/A
2019 33 37 N/A N/A
2018 32 36 N/A N/A
2017 31 35 N/A N/A
Member Satisfaction
Info
Member Satisfaction 2021 Plan State Avg Nat Avg 90th Pctl.
Getting Care Quickly N/A 83.79% 83.12% 89.04%
Getting Needed Care 86.39% 85.63% 84.05% 89.10%
How Well Doctors Communicate 93.77% 94.61% 95.28% 97.41%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 68.45% 66.71% 67.27% 78.31%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 83.47% 83.98% 84.85% 88.79%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 83.58% 78.88% 77.89% 84.07%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 79.43% 83.94% 85.47% 90.41%
Member Satisfaction Year Plan State Avg. Natl. Avg. 90th Pctl.
Getting Care Quickly 2020 90.72% 85.38% 86.32% 91.51%
2019 90.57% 87.14% 86.32% 90.57%
2018 84.64% 85.27% 85.23% 89.89%
2017 89.38% 87.22% 85.34% 89.83%
Getting Needed Care 2020 88.67% 87.88% 88.01% 92.51%
2019 89.16% 87.88% 87.38% 91.22%
2018 87.75% 85.53% 86.33% 90.45%
2017 89.05% 87.44% 86.71% 90.37%
How Well Doctors Communicate 2020 96.99% 95.93% 95.93% 97.98%
2019 95.73% 94.99% 95.85% 97.38%
2018 93.21% 94.70% 95.31% 97.22%
2017 94.93% 94.74% 95.10% 96.91%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 2020 73.13% 65.21% 69.04% 80.59%
2019 74.89% 69.24% 67.91% 78.57%
2018 69.03% 64.78% 64.53% 76.79%
2017 68.08% 61.26% 62.44% 75.00%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 2020 88.97% 86.67% 87.14% 91.18%
2019 87.07% 88.18% 86.27% 90.20%
2018 85.71% 84.82% 84.41% 88.57%
2017 83.96% 83.86% 84.62% 88.77%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 2020 85.64% 79.32% 80.71% 87.04%
2019 83.92% 79.81% 80.27% 86.36%
2018 76.09% 76.02% 78.17% 83.95%
2017 76.92% 76.98% 77.27% 82.99%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 2020 88.83% 85.69% 86.56% 91.30%
2019 87.25% 87.91% 87.34% 90.94%
2018 80.97% 84.08% 85.14% 89.78%
2017 81.70% 83.95% 84.60% 89.86%
Overuse/Appropriateness
Info
Antipsychotics 2021 Plan State Avg Nat Avg 90th Pctl.
Metabolic Monitoring for Children and Adolescents on Antipsychotics - Ages 1-17 37.06% 45.59% 35.85% 48.30%
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 63.77% 60.14% 63.65% 75.31%
Antipsychotics Year Plan State Avg. Natl. Avg. 90th Pctl.
Metabolic Monitoring for Children and Adolescents on Antipsychotics - Ages 1-17 2020 32.89% 38.77% 31.82% 42.98%
2019 38.22% 42.62% 37.50% 49.28%
2018 39.90% 44.74% 36.17% 47.41%
2017 40.15% 50.55% 36.07% 48.57%
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 2020 60.32% 60.42% 62.97% 76.39%
2019 72.20% 63.47% 61.05% 78.36%
2018 62.41% 57.96% 56.00% 70.54%
2017 49.80% 58.14% 54.52% 68.67%
Info
Cervical Cancer Screening in Adolescent Females 2021 Plan State Avg Nat Avg 90th Pctl.
Non-Recommended Cervical Cancer Screening in Adolescent Females 0.59% 0.37% 0.59% 0.10%
Cervical Cancer Screening in Adolescent Females Year Plan State Avg. Natl. Avg. 90th Pctl.
Non-Recommended Cervical Cancer Screening in Adolescent Females 2020 0.68% 0.46% 0.67% 0.19%
2019 0.90% 0.58% 0.85% 0.24%
2018 1.31% 0.71% 1.05% 0.33%
2017 1.59% 0.94% 1.47% 0.50%
Info
Lower Back Pain 2021 Plan State Avg Nat Avg 90th Pctl.
Use of Imaging for Low Back Pain 74.39% 75.38% 77.23% 84.21%
Lower Back Pain Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Imaging for Low Back Pain 2020 76.01% 77.22% 78.53% 85.60%
2019 74.74% 77.01% 76.69% 83.47%
2018 72.94% 74.77% 75.11% 82.95%
2017 72.73% 73.85% 75.16% 82.29%
Info
Respiratory 2021 Plan State Avg Nat Avg 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 96.49% 95.68% 94.48% 98.12%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 42.35% 44.79% 46.61% 61.68%
Respiratory Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 2020 93.12% 93.12% 91.57% 95.67%
2019 92.25% 91.87% 90.76% 95.51%
2018 92.27% 92.50% 91.22% 95.48%
2017 91.29% 90.92% 89.19% 94.59%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 2020 39.45% 41.88% 43.24% 59.45%
2019 37.58% 38.42% 39.91% 54.09%
2018 31.66% 33.60% 33.16% 48.28%
2017 28.10% 30.67% 30.99% 49.52%
Info
Use of Opiods 2021 Plan State Avg Nat Avg 90th Pctl.
Use of Opioids at High Dosage 10.23% 6.26% 5.24% 1.88%
Use of Opioids From Multiple Providers - Multiple Pharmacies 2.64% 1.32% 1.59% 0.33%
Use of Opioids From Multiple Providers - Multiple Prescribers 16.62% 16.64% 13.69% 8.71%
Use of Opioids From Multiple Providers - Multiple Prescribers and Multiple Pharmacies 1.46% 0.70% 0.77% 0.00%
Use of Opiods Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Opioids at High Dosage 2020 11.64% 6.49% 5.76% 1.88%
2019 10.26% 6.96% 6.08% 1.88%
2018 9.02% 5.32% 4.54% 1.87%
2017 N/A N/A N/A N/A
Use of Opioids From Multiple Providers - Multiple Pharmacies 2020 2.68% 2.27% 1.67% 0.62%
2019 4.30% 3.75% 2.79% 0.69%
2018 9.14% 5.21% 3.80% 1.40%
2017 N/A N/A N/A N/A
Use of Opioids From Multiple Providers - Multiple Prescribers 2020 17.55% 16.62% 13.32% 8.20%
2019 19.81% 17.64% 14.51% 9.79%
2018 26.52% 18.32% 15.02% 9.64%
2017 N/A N/A N/A N/A
Use of Opioids From Multiple Providers - Multiple Prescribers and Multiple Pharmacies 2020 1.36% 1.22% 0.76% 0.08%
2019 2.44% 1.70% 1.24% 0.00%
2018 5.93% 2.68% 1.76% 0.47%
2017 N/A N/A N/A N/A
Risk Adjusted Utilization
Info
Acute Hospital Utilization Rate 2021 Plan State Avg Nat Avg 90th Pctl.
Acute Hospital Utilization - Medicine 24.80% 23.22% 0.78% 0.58%
Acute Hospital Utilization - Surgery 11.11% 11.64% N/A N/A
Acute Hospital Utilization - Total Acute 35.91% 34.86% 1.02% 0.79%
Acute Hospital Utilization Rate Year Plan State Avg. Natl. Avg. 90th Pctl.
Acute Hospital Utilization - Medicine 2020 17.25% 21.48% 0.72% 0.53%
2019 18.34% 26.50% 0.89% 0.68%
2018 N/A N/A N/A N/A
2017 N/A N/A N/A N/A
Acute Hospital Utilization - Surgery 2020 11.54% 11.94% N/A N/A
2019 14.37% 15.92% N/A N/A
2018 N/A N/A N/A N/A
2017 N/A N/A N/A N/A
Acute Hospital Utilization - Total Acute 2020 28.80% 33.42% 0.97% 0.78%
2019 32.71% 42.42% 1.09% 0.92%
2018 N/A N/A N/A N/A
2017 N/A N/A N/A N/A
Info
Emergency Department Utilization 2021 Plan State Avg Nat Avg 90th Pctl.
Emergency Department Utilization 144.22% 138.89% 0.90% 0.72%
Emergency Department Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Emergency Department Utilization 2020 126.05% 124.84% N/A N/A
2019 190.48% 187.39% 1.04% 0.82%
2018 N/A N/A N/A N/A
2017 N/A N/A N/A N/A
Info
Plan All-Cause Readmissions 2021 Plan State Avg Nat Avg 90th Pctl.
Plan All-Cause Readmissions Ages 18-64 (Total) 4.98% 4.93% 0.60% 0.48%
Plan All-Cause Readmissions Ages 18-44 4.55% 4.20% N/A N/A
Plan All-Cause Readmissions Ages 45-54 4.85% 4.67% N/A N/A
Plan All-Cause Readmissions Ages 55-64 5.49% 5.63% N/A N/A
Plan All-Cause Readmissions Year Plan State Avg. Natl. Avg. 90th Pctl.
Plan All-Cause Readmissions Ages 18-64 (Total) 2020 4.42% 4.88% 0.58% 0.47%
2019 3.82% 4.32% 0.51% 0.37%
2018 11.69% 11.17% N/A N/A
2017 11.13% 12.19% N/A N/A
Plan All-Cause Readmissions Ages 18-44 2020 4.24% 4.26% N/A N/A
2019 3.32% 4.54% N/A N/A
2018 12.20% 11.41% N/A N/A
2017 11.92% 12.99% N/A N/A
Plan All-Cause Readmissions Ages 45-54 2020 4.19% 4.46% N/A N/A
2019 4.12% 4.35% N/A N/A
2018 11.07% 10.56% N/A N/A
2017 10.59% 11.71% N/A N/A
Plan All-Cause Readmissions Ages 55-64 2020 4.76% 5.69% N/A N/A
2019 4.03% 4.26% N/A N/A
2018 11.67% 11.21% N/A N/A
2017 10.78% 11.93% N/A N/A
Utilization
Info
Antibiotic Utilization 2021 Plan State Avg Nat Avg 90th Pctl.
Average number of antibiotic prescriptions per member per year - Total 0.59 0.55 0.57 0.73
Average number of antibiotic prescriptions per member per year - Ages 0-9 0.40 0.39 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 0.36 0.31 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 0.56 0.52 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 0.60 0.57 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 0.74 0.67 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 0.85 0.75 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 0.99 0.82 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 1.36 1.42 N/A N/A
Days suppplied per antibiotic prescription - Total 10.390 10.197 10.210 11.220
Days suppplied per antibiotic prescription - Ages 0-9 10.580 10.540 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 14.840 14.793 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 10.020 9.754 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 9.980 9.787 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 10.120 10.114 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 10.300 10.241 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 10.520 8.940 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 11.220 11.142 N/A N/A
Prescriptions of concern - Total 0.230 0.209 0.230 0.340
Prescriptions of concern - Ages 0-9 0.14 0.14 N/A N/A
Prescriptions of concern - Ages 10-17 0.11 0.10 N/A N/A
Prescriptions of concern - Ages 18-34 0.20 0.18 N/A N/A
Prescriptions of concern - Ages 35-49 0.24 0.22 N/A N/A
Prescriptions of concern - Ages 50-64 0.31 0.28 N/A N/A
Prescriptions of concern - Ages 65-74 0.35 0.29 N/A N/A
Prescriptions of concern - Ages 75-85 0.40 0.27 N/A N/A
Prescriptions of concern - Ages 85 plus 0.53 0.32 N/A N/A
Antibiotic Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Average number of antibiotic prescriptions per member per year - Total 2020 0.59 0.57 0.57 0.71
2019 0.79 0.75 0.74 0.90
2018 0.80 0.74 0.71 0.88
2017 0.82 0.77 0.76 0.90
Average number of antibiotic prescriptions per member per year - Ages 0-9 2020 0.41 0.41 N/A N/A
2019 0.86 0.85 N/A N/A
2018 0.87 0.81 N/A N/A
2017 0.93 0.87 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 2020 0.37 0.33 N/A N/A
2019 0.59 0.52 N/A N/A
2018 0.61 0.52 N/A N/A
2017 0.66 0.57 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 2020 0.55 0.53 N/A N/A
2019 0.71 0.66 N/A N/A
2018 0.71 0.65 N/A N/A
2017 0.72 0.67 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 2020 0.61 0.59 N/A N/A
2019 0.78 0.74 N/A N/A
2018 0.78 0.73 N/A N/A
2017 0.79 0.75 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 2020 0.76 0.70 N/A N/A
2019 0.93 0.85 N/A N/A
2018 0.94 0.84 N/A N/A
2017 0.95 0.88 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 2020 0.88 0.77 N/A N/A
2019 1.12 0.95 N/A N/A
2018 1.11 0.97 N/A N/A
2017 1.14 1.00 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 2020 1.02 0.80 N/A N/A
2019 1.19 1.15 N/A N/A
2018 1.15 1.21 N/A N/A
2017 1.25 1.12 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 2020 0.75 1.56 N/A N/A
2019 1.81 0.95 N/A N/A
2018 1.75 1.32 N/A N/A
2017 1.56 1.12 N/A N/A
Days suppplied per antibiotic prescription - Total 2020 10.460 10.133 10.310 11.480
2019 10.050 9.888 9.890 10.660
2018 10.120 9.950 9.910 10.890
2017 10.210 10.024 9.880 10.830
Days suppplied per antibiotic prescription - Ages 0-9 2020 10.480 10.550 N/A N/A
2019 10.050 10.025 N/A N/A
2018 9.970 9.979 N/A N/A
2017 10.000 10.050 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 2020 14.860 14.369 N/A N/A
2019 12.940 12.591 N/A N/A
2018 13.110 12.948 N/A N/A
2017 13.010 12.689 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 2020 10.080 9.729 N/A N/A
2019 9.900 9.695 N/A N/A
2018 10.010 9.731 N/A N/A
2017 10.070 9.836 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 2020 10.030 9.703 N/A N/A
2019 9.610 9.488 N/A N/A
2018 9.670 9.568 N/A N/A
2017 9.760 9.591 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 2020 10.230 10.027 N/A N/A
2019 9.820 9.756 N/A N/A
2018 9.870 9.769 N/A N/A
2017 10.000 9.856 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 2020 10.590 9.997 N/A N/A
2019 10.070 9.766 N/A N/A
2018 10.110 9.830 N/A N/A
2017 10.310 9.850 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 2020 10.680 10.119 N/A N/A
2019 10.400 9.645 N/A N/A
2018 10.200 9.428 N/A N/A
2017 10.430 10.604 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 2020 8.920 10.606 N/A N/A
2019 12.020 9.997 N/A N/A
2018 12.840 9.026 N/A N/A
2017 10.540 9.873 N/A N/A
Prescriptions of concern - Total 2020 0.240 0.227 0.240 0.320
2019 0.360 0.339 0.330 0.430
2018 0.370 0.338 0.330 0.430
2017 0.380 0.354 0.360 0.450
Prescriptions of concern - Ages 0-9 2020 0.15 0.15 N/A N/A
2019 0.33 0.34 N/A N/A
2018 0.34 0.32 N/A N/A
2017 0.37 0.35 N/A N/A
Prescriptions of concern - Ages 10-17 2020 0.12 0.11 N/A N/A
2019 0.23 0.20 N/A N/A
2018 0.23 0.20 N/A N/A
2017 0.26 0.22 N/A N/A
Prescriptions of concern - Ages 18-34 2020 0.21 0.20 N/A N/A
2019 0.30 0.28 N/A N/A
2018 0.31 0.28 N/A N/A
2017 0.31 0.28 N/A N/A
Prescriptions of concern - Ages 35-49 2020 0.26 0.25 N/A N/A
2019 0.38 0.35 N/A N/A
2018 0.38 0.35 N/A N/A
2017 0.40 0.37 N/A N/A
Prescriptions of concern - Ages 50-64 2020 0.34 0.31 N/A N/A
2019 0.46 0.41 N/A N/A
2018 0.48 0.42 N/A N/A
2017 0.49 0.44 N/A N/A
Prescriptions of concern - Ages 65-74 2020 0.39 0.33 N/A N/A
2019 0.54 0.44 N/A N/A
2018 0.54 0.48 N/A N/A
2017 0.56 0.50 N/A N/A
Prescriptions of concern - Ages 75-85 2020 0.44 0.34 N/A N/A
2019 0.60 0.51 N/A N/A
2018 0.56 0.62 N/A N/A
2017 0.61 0.54 N/A N/A
Prescriptions of concern - Ages 85 plus 2020 0.38 0.41 N/A N/A
2019 0.73 0.36 N/A N/A
2018 0.67 0.45 N/A N/A
2017 0.72 0.48 N/A N/A
Info
Mental Health Utilization 2021 Plan State Avg Nat Avg 90th Pctl.
Mental Health Utilization - Any Service - Total 13.24% 9.40% 9.48% 13.63%
Mental Health Utilization - Any Service - Ages 0-12 7.89% 6.00% N/A N/A
Mental Health Utilization - Any Service - Ages 13-17 21.01% 16.24% N/A N/A
Mental Health Utilization - Any Service - Ages 18-64 13.90% 9.76% N/A N/A
Mental Health Utilization - Any Service - Ages 65 plus 4.51% 3.11% N/A N/A
Mental Health Utilization - ED - Total 0.06% 0.05% 0.07% 0.17%
Mental Health Utilization - ED - Ages 0-12 0.03% 0.02% N/A N/A
Mental Health Utilization - ED - Ages 13-17 0.25% 0.21% N/A N/A
Mental Health Utilization - ED - Ages 18-64 0.05% 0.04% N/A N/A
Mental Health Utilization - ED - Ages 65 plus 0.01% 0.01% N/A N/A
Mental Health Utilization - Inpatient - Total 0.27% 0.24% 0.25% 0.33%
Mental Health Utilization - Inpatient - Ages 0-12 0.07% 0.08% N/A N/A
Mental Health Utilization - Inpatient - Ages 13-17 1.03% 0.88% N/A N/A
Mental Health Utilization - Inpatient - Ages 18-64 0.24% 0.22% N/A N/A
Mental Health Utilization - Inpatient - Ages 65 plus 0.11% 0.08% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Total 0.13% 0.08% 0.16% 0.31%
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 0-12 0.05% 0.03% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 13-17 0.65% 0.40% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 18-64 0.10% 0.07% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 65 plus 0.03% 0.01% N/A N/A
Mental Health Utilization - Outpatient - Total 6.65% 4.73% 5.70% 8.26%
Mental Health Utilization - Outpatient - Ages 0-12 4.79% 3.72% N/A N/A
Mental Health Utilization - Outpatient - Ages 13-17 12.79% 9.85% N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 6.61% 4.63% N/A N/A
Mental Health Utilization - Outpatient - Ages 65 plus 2.72% 1.73% N/A N/A
Mental Health Utilization - Telehealth - Total 9.74% 6.68% 6.01% 9.77%
Mental Health Utilization - Telehealth - Ages 0-12 5.27% 3.74% N/A N/A
Mental Health Utilization - Telehealth - Ages 13-17 14.95% 10.92% N/A N/A
Mental Health Utilization - Telehealth - Ages 18-64 10.40% 7.11% N/A N/A
Mental Health Utilization - Telehealth - Ages 65 plus 2.66% 1.96% N/A N/A
Mental Health Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Mental Health Utilization - Any Service - Total 2020 12.11% 9.13% 9.07% 12.95%
2019 11.77% 8.33% 8.86% 12.67%
2018 10.40% 7.63% 7.98% 11.76%
2017 N/A N/A N/A N/A
Mental Health Utilization - Any Service - Ages 0-12 2020 7.58% 6.25% N/A N/A
2019 7.75% 6.35% N/A N/A
2018 7.05% 6.12% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Any Service - Ages 13-17 2020 19.22% 15.31% N/A N/A
2019 19.28% 15.01% N/A N/A
2018 17.29% 13.96% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Any Service - Ages 18-64 2020 12.60% 9.40% N/A N/A
2019 12.12% 8.45% N/A N/A
2018 10.63% 7.62% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Any Service - Ages 65 plus 2020 4.83% 3.53% N/A N/A
2019 4.68% 3.17% N/A N/A
2018 4.67% 3.20% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - ED - Total 2020 0.04% 0.03% 0.06% 0.15%
2019 0.06% 0.04% 0.08% 0.17%
2018 0.17% 0.09% 0.10% 0.22%
2017 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 0-12 2020 0.02% 0.01% N/A N/A
2019 0.03% 0.02% N/A N/A
2018 0.08% 0.05% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 13-17 2020 0.15% 0.10% N/A N/A
2019 0.25% 0.17% N/A N/A
2018 0.57% 0.28% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 18-64 2020 0.04% 0.03% N/A N/A
2019 0.05% 0.03% N/A N/A
2018 0.16% 0.08% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 65 plus 2020 0.02% 0.01% N/A N/A
2019 0.02% 0.07% N/A N/A
2018 0.06% 0.02% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Total 2020 0.24% 0.22% 0.24% 0.31%
2019 0.28% 0.25% 0.27% 0.34%
2018 0.28% 0.27% 0.27% 0.34%
2017 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 0-12 2020 0.08% 0.07% N/A N/A
2019 0.10% 0.12% N/A N/A
2018 0.09% 0.12% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 13-17 2020 0.86% 0.79% N/A N/A
2019 0.99% 0.85% N/A N/A
2018 1.03% 0.95% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 18-64 2020 0.23% 0.20% N/A N/A
2019 0.26% 0.24% N/A N/A
2018 0.27% 0.26% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 65 plus 2020 0.07% 0.06% N/A N/A
2019 0.10% 0.11% N/A N/A
2018 0.05% 0.06% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Total 2020 0.12% 0.07% 0.15% 0.30%
2019 0.18% 0.11% 0.20% 0.40%
2018 0.16% 0.12% 0.19% 0.38%
2017 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 0-12 2020 0.04% 0.05% N/A N/A
2019 0.09% 0.10% N/A N/A
2018 0.08% 0.15% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 13-17 2020 0.52% 0.26% N/A N/A
2019 0.79% 0.35% N/A N/A
2018 0.72% 0.49% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 18-64 2020 0.11% 0.06% N/A N/A
2019 0.15% 0.09% N/A N/A
2018 0.14% 0.09% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 65 plus 2020 0.01% 0.01% N/A N/A
2019 0.04% 0.02% N/A N/A
2018 0.03% 0.02% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Total 2020 9.27% 7.22% 6.95% 9.99%
2019 11.66% 8.24% 8.73% 12.61%
2018 10.28% 7.53% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Ages 0-12 2020 5.99% 5.23% N/A N/A
2019 7.73% 6.32% N/A N/A
2018 7.03% 6.10% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Ages 13-17 2020 15.75% 12.84% N/A N/A
2019 19.10% 14.86% N/A N/A
2018 17.08% 13.80% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 2020 9.51% 7.35% N/A N/A
2019 12.00% 8.36% N/A N/A
2018 10.50% 7.51% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Ages 65 plus 2020 3.85% 2.62% N/A N/A
2019 4.63% 3.07% N/A N/A
2018 4.62% 3.16% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Total 2020 7.69% 4.92% 5.19% 8.37%
2019 0.31% 0.11% 0.11% 0.22%
2018 0.13% 0.10% 0.05% 0.11%
2017 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Ages 0-12 2020 4.57% 3.07% N/A N/A
2019 0.07% 0.04% N/A N/A
2018 0.02% 0.03% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Ages 13-17 2020 11.78% 8.30% N/A N/A
2019 0.45% 0.15% N/A N/A
2018 0.25% 0.19% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Ages 18-64 2020 8.10% 5.11% N/A N/A
2019 0.35% 0.12% N/A N/A
2018 0.15% 0.11% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Ages 65 plus 2020 2.64% 1.80% N/A N/A
2019 0.05% 0.02% N/A N/A
2018 0.03% 0.02% N/A N/A
2017 N/A N/A N/A N/A
2021 data updated on: 07/05/2023