Health Insurance in Virginia

UnitedHealthcare Plan of the River Valley, Inc.

Company Information

  • Company Providing Plan:United Healthcare Plan of the River Valley, Inc.
  • Address:9800 Health Care Lane, MN006-W500
    Minnetonka, MN 55343
  • Telephone :309-736-4600
  • Website:www.uhcrivervalley.com
2017
Number of Enrollees: *3,120
PMPM: *$445
Number of Physicians: *126,348
NCQA Accreditation: Accredited

*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

Bedford, Bland, Botetourt, Buchanan, Carroll, Craig, Dickenson, Floyd, Franklin, Giles, Grayson, Henry, Lee, Montgomery, Pulaski, Roanoke, Rockbridge, Russell, Scott, Smyth, Tazewell, Washington, Wise, Wythe


Cities

Bedford, Bristol, Buena Vista, Galax, Lexington, Martinsville, Norton, Radford, Roanoke, Salem

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

Administrative Data

2017 2016 2015 2014 2013
*Number of Enrollees 3,120 2,075 12,735 12,570 14,682
PMPM $445 $458 $722 $726 $628
*Medical Cost Ratio 84% 81% 78% 77% 83%
*Administrative Ratio 13% 16% 16% 14% 12%
*Profit/Loss Ratio 2% 5% 5% 9% 5%
*Number of Physicians 126,348 104,855 96,584 75,990 124,482

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

Financial Data

2017 2016 2015 2014 2013
Premiums Earned $12,975,673 $13,908,052 $111,592,310 $120,037,173 $113,355,300
*Income $66,112,321 $125,998,557 $62,453,637 $236,985,815 $152,048,836
*Net Worth $446,288,192 $434,309,068 $423,305,536 $600,328,649 $513,401,130

*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 2017 Plan State Avg Nat Avg 90th Pctl.
Adult Access (Age 20-44) To Preventive/Ambulatory Health Services N/A 92.73% 92.45% 95.43%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services N/A 95.57% 95.61% 97.46%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services N/A 97.82% 97.07% 98.47%
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 2016 91.42% 92.81% 92.73% 95.55%
2015 91.83% 92.25% 92.83% 95.45%
2014 91.41% 93.10% 92.91% 95.39%
2013 91.77% 93.27% 93.13% 95.56%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 2016 95.07% 95.78% 95.78% 97.61%
2015 94.70% 95.61% 95.90% 97.55%
2014 95.05% 96.03% 95.85% 97.54%
2013 95.13% 95.97% 95.93% 97.60%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 2016 97.65% 97.30% 97.19% 98.61%
2015 97.44% 96.84% 97.32% 96.73%
2014 97.32% 97.56% 97.50% 98.68%
2013 96.91% 97.45% 97.36% 98.63%
Info
Alcohol and Other Drug Dependence Treatment 2017 Plan State Avg Nat Avg 90th Pctl.
Initiation of Alcohol and Other Drug Dependence Treatment - Total N/A 36.14% 36.11% 42.01%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 N/A 40.06% 39.91% 52.54%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus N/A 36.00% 35.97% 41.96%
Engagement of Alcohol and Other Drug Dependence Treatment - Total N/A 13.36% 12.65% 17.26%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 N/A 14.40% 14.95% 23.85%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus N/A 13.40% 12.55% 17.38%
Alcohol and Other Drug Dependence Treatment Year Plan State Avg. Natl. Avg. 90th Pctl.
Initiation of Alcohol and Other Drug Dependence Treatment - Total 2016 34.10% 35.69% 32.93% 40.24%
2015 35.21% 33.04% 33.42% 41.07%
2014 34.07% 32.51% 35.63% 44.19%
2013 38.40% 35.00% 39.01% 50.93%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2016 54.55% 40.15% 40.47% 51.96%
2015 N/A 37.03% 39.62% 50.00%
2014 N/A 37.09% 40.79% 52.00%
2013 47.37% 39.67% 41.13% 53.51%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2016 33.57% 35.55% 32.64% 40.33%
2015 34.50% 32.96% 33.20% 40.93%
2014 33.50% 32.16% 35.21% 43.92%
2013 37.97% 34.74% 38.83% 51.61%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 2016 13.50% 12.51% 11.46% 16.72%
2015 15.83% 11.61% 12.46% 19.23%
2014 13.72% 10.64% 13.66% 19.19%
2013 16.69% 12.12% 14.64% 21.16%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2016 9.09% 11.28% 15.68% 23.73%
2015 N/A 12.06% 15.42% 22.12%
2014 N/A 13.00% 17.24% 25.29%
2013 13.16% 18.05% 18.23% 27.05%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2016 13.62% 12.57% 11.32% 16.09%
2015 15.28% 11.57% 12.34% 18.67%
2014 13.04% 10.33% 13.45% 18.68%
2013 16.86% 11.84% 14.47% 21.31%
Info
Child Access to Primary Care Practitioners 2017 Plan State Avg Nat Avg 90th Pctl.
Child Access to Primary Care Practitioners Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Prenatal and Postpartum Care 2017 Plan State Avg Nat Avg 90th Pctl.
Timeliness of Prenatal Care N/A 87.01% N/A N/A
Prenatal and Postpartum Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Timeliness of Prenatal Care 2016 67.84% 86.52% N/A N/A
2015 81.19% 86.91% N/A N/A
2014 82.57% 85.85% N/A N/A
2013 96.35% 91.58% N/A N/A
Effectiveness of Care
Info
Asthma Medication Management 2017 Plan State Avg Nat Avg 90th Pctl.
Medication Management for People With Asthma at least 50% Compliance - Total N/A 76.58% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 5-11 N/A 66.50% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 12-18 N/A 68.06% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 19-50 N/A 75.34% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 51-64 N/A 84.54% N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Total N/A 54.32% 50.48% 57.69%
Medication Management for People With Asthma at least 75% Compliance - Ages 5-11 N/A 42.35% 40.22% 52.99%
Medication Management for People With Asthma at least 75% Compliance - Ages 12-18 N/A 41.76% 37.80% 47.11%
Medication Management for People With Asthma at least 75% Compliance - Ages 19-50 N/A 52.86% 48.60% 57.87%
Medication Management for People With Asthma at least 75% Compliance - Ages 51-64 N/A 64.50% 59.65% 67.58%
Asthma Medication Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Medication Management for People With Asthma at least 50% Compliance - Total 2016 70.38% 73.20% N/A N/A
2015 67.11% 71.52% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 5-11 2016 68.18% 67.58% N/A N/A
2015 63.33% 64.34% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 12-18 2016 67.74% 65.72% N/A N/A
2015 69.70% 60.17% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 19-50 2016 67.77% 71.77% N/A N/A
2015 58.11% 68.82% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 51-64 2016 72.41% 79.36% N/A N/A
2015 72.93% 78.55% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Total 2016 46.18% 51.17% 48.54% 56.96%
2015 44.30% 48.01% 46.20% 55.00%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Ages 5-11 2016 31.82% 39.03% 37.58% 48.84%
2015 30.00% 36.59% 37.85% 49.09%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Ages 12-18 2016 41.94% 35.03% 35.83% 46.97%
2015 51.52% 35.39% 34.97% 45.26%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Ages 19-50 2016 44.63% 50.18% 46.16% 55.80%
2015 39.86% 45.56% 43.39% 53.13%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Ages 51-64 2016 49.14% 59.39% 57.47% 65.75%
2015 45.86% 58.44% 55.49% 65.28%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Info
Asthma Medication Ratio 2017 Plan State Avg Nat Avg 90th Pctl.
Controller/Total Asthma Medication Ratio - Total N/A 84.01% 79.04% 85.85%
Controller/Total Asthma Medication Ratio - Ages 5-11 N/A 86.06% 86.90% 93.55%
Controller/Total Asthma Medication Ratio - Ages 12-18 N/A 84.80% 76.69% 85.94%
Controller/Total Asthma Medication Ratio - Ages 19-50 N/A 78.94% 74.23% 81.70%
Controller/Total Asthma Medication Ratio - Ages 51-64 N/A 89.17% 82.83% 89.28%
Asthma Medication Ratio Year Plan State Avg. Natl. Avg. 90th Pctl.
Controller/Total Asthma Medication Ratio - Total 2016 75.86% 80.60% 78.29% 85.46%
2015 79.04% 81.09% 77.99% 83.76%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Controller/Total Asthma Medication Ratio - Ages 5-11 2016 82.61% 91.67% 86.40% 93.97%
2015 87.10% 88.49% 86.99% 92.47%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Controller/Total Asthma Medication Ratio - Ages 12-18 2016 78.79% 81.12% 78.30% 86.34%
2015 75.00% 78.19% 77.09% 84.67%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Controller/Total Asthma Medication Ratio - Ages 19-50 2016 67.39% 75.24% 73.51% 81.08%
2015 71.26% 75.16% 72.38% 80.79%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Controller/Total Asthma Medication Ratio - Ages 51-64 2016 81.25% 83.27% 81.70% 88.64%
2015 85.52% 85.39% 81.87% 88.89%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Info
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication 2017 Plan State Avg Nat Avg 90th Pctl.
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Initiation N/A 41.27% 41.13% 50.83%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation N/A 55.09% 47.07% 58.44%
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 2016 37.33% 41.91% 38.93% 48.61%
2015 40.59% 41.43% 38.13% 50.00%
2014 32.45% 39.00% 38.01% 46.81%
2013 42.49% 35.14% 40.10% 51.06%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 2016 52.63% 46.92% 45.82% 56.86%
2015 47.83% 49.06% 46.18% 58.06%
2014 N/A 46.49% 45.70% 57.75%
2013 52.63% 41.32% 46.66% 58.62%
Info
Cardiovascular Disease Management 2017 Plan State Avg Nat Avg 90th Pctl.
Controlling High Blood Pressure N/A 56.61% 59.90% 74.82%
Persistence of Beta-Blockers N/A 85.80% 85.18% 93.41%
Cardiovascular Disease Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Controlling High Blood Pressure 2016 63.73% 56.91% 60.31% 74.43%
2015 66.29% 58.35% 58.69% 73.89%
2014 55.33% 59.30% 62.63% 75.63%
2013 65.08% 60.92% 63.30% 74.65%
Persistence of Beta-Blockers 2016 97.50% 90.70% 83.61% 90.83%
2015 86.84% 88.70% 84.68% 91.00%
2014 74.07% 84.03% 83.50% 91.43%
2013 81.82% 83.43% 83.39% 91.72%
Info
Common Childhood Illnesses 2017 Plan State Avg Nat Avg 90th Pctl.
Common Childhood Illnesses Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Diabetes Care and Management 2017 Plan State Avg Nat Avg 90th Pctl.
Diabetes Care and Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Drug Therapy in Rheumatoid Arthritis 2017 Plan State Avg Nat Avg 90th Pctl.
Drug Therapy in Rheumatoid Arthritis Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Immunizations 2017 Plan State Avg Nat Avg 90th Pctl.
Immunizations for Adolescents - Combination N/A 82.98% N/A N/A
Immunizations Year Plan State Avg. Natl. Avg. 90th Pctl.
Immunizations for Adolescents - Combination 2016 68.98% 79.09% N/A N/A
2015 52.59% 66.99% N/A N/A
2014 56.94% 66.20% N/A N/A
2013 40.12% 51.54% N/A N/A
Info
Mental Health: Care and Follow-up 2017 Plan State Avg Nat Avg 90th Pctl.
Mental Health: Care and Follow-up Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Persistent Medications 2017 Plan State Avg Nat Avg 90th Pctl.
Persistent Medications Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Pharmacotherapy of COPD Exacerbation 2017 Plan State Avg Nat Avg 90th Pctl.
Pharmacotherapy of COPD Exacerbation Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Preventive Care 2017 Plan State Avg Nat Avg 90th Pctl.
Breast Cancer Screening N/A 71.85% 72.81% 80.91%
Chlamydia Screening in Women-all Age groups N/A 51.46% 50.16% 66.08%
Preventive Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Breast Cancer Screening 2016 69.07% 71.80% 72.90% 80.63%
2015 67.84% 72.07% 73.08% 81.53%
2014 68.36% 72.22% 73.52% 81.91%
2013 70.11% 72.82% 73.71% 80.78%
Chlamydia Screening in Women-all Age groups 2016 37.20% 49.79% 48.98% 63.50%
2015 37.26% 47.89% 52.32% 64.06%
2014 37.55% 48.07% 51.65% 63.48%
2013 30.71% 47.46% 46.20% 59.63%
Info
Spirometry Testing 2017 Plan State Avg Nat Avg 90th Pctl.
Spirometry Testing Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Weight Assessment and Counseling 2017 Plan State Avg Nat Avg 90th Pctl.
Counseling for Physical Activity for Children/Adolescents - Total N/A 59.44% N/A N/A
Weight Assessment and Counseling Year Plan State Avg. Natl. Avg. 90th Pctl.
Counseling for Physical Activity for Children/Adolescents - Total 2016 40.97% 54.14% N/A N/A
2015 49.65% 54.38% N/A N/A
2014 53.94% 58.06% N/A N/A
2013 45.37% 52.85% N/A N/A
Health Plan Stability/Descriptive
Info
Administrative Data 2017 Plan State Avg Nat Avg 90th Pctl.
Administrative Ratio 0.13 0.12 86.39 93.13
Medical Cost Ratio 0.84 0.83 93.13 96.59
Number of Enrollees 3,120 133,992 92 97
Number of Physicians 126,348 81,926 87 95
Premium Per Member Per Month $445 $370 N/A N/A
Profit/Loss Ratio 0.02 0.05 79.44 89.14
Administrative Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Administrative Ratio 2016 0.16 0.15 N/A N/A
2015 0.16 0.14 N/A N/A
2014 0.14 0.14 N/A N/A
2013 0.12 0.14 N/A N/A
Medical Cost Ratio 2016 0.81 0.83 N/A N/A
2015 0.78 0.82 N/A N/A
2014 0.77 0.81 N/A N/A
2013 0.83 0.83 N/A N/A
Number of Enrollees 2016 2,075 136,796 N/A N/A
2015 12,735 124,097 N/A N/A
2014 12,570 115,428 N/A N/A
2013 14,682 98,253 N/A N/A
Number of Physicians 2016 104,855 73,426 N/A N/A
2015 96,584 90,027 N/A N/A
2014 75,990 63,157 N/A N/A
2013 124,482 64,207 N/A N/A
Premium Per Member Per Month 2016 $458 $370 N/A N/A
2015 $722 $375 N/A N/A
2014 $726 $412 N/A N/A
2013 $628 $544 N/A N/A
Profit/Loss Ratio 2016 0.05 0.03 N/A N/A
2015 0.05 0.04 N/A N/A
2014 0.09 0.06 N/A N/A
2013 0.05 0.03 N/A N/A
Info
Board Certification Rates for Providers 2017 Plan State Avg Nat Avg 90th Pctl.
Board Certification for Geriatricians N/A 71.38% N/A N/A
Board Certification for Pediatricians N/A 85.50% N/A N/A
Board Certification Rate for Family Medicine Physicians N/A 81.38% N/A N/A
Board Certification Rate for Internal Medicine Physicians N/A 81.00% N/A N/A
Board Certification Rate for OB/GYN Providers N/A 83.00% N/A N/A
Board Certification Rate for Other Specialists N/A 81.88% N/A N/A
Board Certification Rates for Providers Year Plan State Avg. Natl. Avg. 90th Pctl.
Board Certification for Geriatricians 2016 61.66% 73.44% N/A N/A
2015 59.38% 71.06% N/A N/A
2014 69.52% 74.73% 64.82% 87.50%
2013 71.43% 71.19% 63.29% 83.33%
Board Certification for Pediatricians 2016 82.04% 87.02% N/A N/A
2015 79.18% 88.14% N/A N/A
2014 79.05% 88.13% 83.89% 91.52%
2013 86.89% 86.01% 81.01% 90.29%
Board Certification Rate for Family Medicine Physicians 2016 71.70% 80.32% N/A N/A
2015 69.20% 82.53% N/A N/A
2014 69.44% 82.93% 77.41% 89.90%
2013 78.57% 81.36% 76.60% 88.80%
Board Certification Rate for Internal Medicine Physicians 2016 75.84% 81.15% N/A N/A
2015 75.67% 82.59% N/A N/A
2014 78.40% 83.98% 79.07% 88.73%
2013 81.11% 80.80% 78.18% 87.44%
Board Certification Rate for OB/GYN Providers 2016 84.47% 83.36% N/A N/A
2015 82.90% 83.51% N/A N/A
2014 84.58% 83.71% 79.30% 88.80%
2013 87.85% 80.44% 76.89% 87.80%
Board Certification Rate for Other Specialists 2016 81.29% 83.25% N/A N/A
2015 79.56% 82.88% N/A N/A
2014 79.78% 84.44% 78.09% 89.67%
2013 85.01% 79.95% 74.88% 88.36%
Info
Financial Data 2017 Plan State Avg Nat Avg 90th Pctl.
Financial Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Years in Business 2017 Plan State Avg Nat Avg 90th Pctl.
Years in Business 32 35 N/A N/A
Years in Business Year Plan State Avg. Natl. Avg. 90th Pctl.
Years in Business 2016 31 34 N/A N/A
2015 30 33 N/A N/A
2014 29 32 N/A N/A
2013 28 31 N/A N/A
Member Satisfaction
Info
Member Satisfaction 2017 Plan State Avg Nat Avg 90th Pctl.
Getting Needed Care N/A 88.46% N/A N/A
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) N/A 94.34% 95.10% 96.91%
Member Satisfaction Year Plan State Avg. Natl. Avg. 90th Pctl.
Getting Needed Care 2016 87.93% 87.23% N/A N/A
2015 88.03% 87.33% N/A N/A
2014 89.86% 88.88% N/A N/A
2013 91.54% 87.29% N/A N/A
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 2016 83.69% 94.88% 95.39% 97.21%
2015 82.03% 94.63% 95.20% 97.10%
2014 85.96% 94.87% 95.26% 97.16%
2013 81.25% 93.94% 94.94% 96.97%
Overuse/Appropriateness
Info
Antipsychotics 2017 Plan State Avg Nat Avg 90th Pctl.
Metabolic Monitoring for Children and Adolescents on Antipsychotics - Ages 1-17 N/A 50.55% 36.07% 48.57%
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 N/A 58.14% 54.52% 68.67%
Use of Multiple Concurrent Antipsychotics in Children and Adolescents - Ages 1-17 N/A 2.39% N/A N/A
Antipsychotics Year Plan State Avg. Natl. Avg. 90th Pctl.
Metabolic Monitoring for Children and Adolescents on Antipsychotics - Ages 1-17 2016 19.35% 34.87% 35.80% 45.93%
2015 37.50% 37.02% 33.94% 45.45%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 2016 78.57% 61.93% 58.30% 75.00%
2015 N/A 61.38% 54.40% 70.49%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Use of Multiple Concurrent Antipsychotics in Children and Adolescents - Ages 1-17 2016 3.85% 2.06% N/A N/A
2015 0.00% 1.70% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Info
Cervical Cancer Screening in Adolescent Females 2017 Plan State Avg Nat Avg 90th Pctl.
Cervical Cancer Screening in Adolescent Females Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Lower Back Pain 2017 Plan State Avg Nat Avg 90th Pctl.
Lower Back Pain Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Respiratory 2017 Plan State Avg Nat Avg 90th Pctl.
Respiratory Year Plan State Avg. Natl. Avg. 90th Pctl.
Utilization
Info
Antibiotic Utilization 2017 Plan State Avg Nat Avg 90th Pctl.
Average number of antibiotic prescriptions per member per year - Total N/A 0.77 0.76 0.90
Average number of antibiotic prescriptions per member per year - Ages 0-9 N/A 0.87 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 N/A 0.57 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 N/A 0.67 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 N/A 0.75 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 N/A 0.88 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 N/A 1.00 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 N/A 1.12 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus N/A 1.12 N/A N/A
Days suppplied per antibiotic prescription - Total N/A 10.02 9.88 10.83
Days suppplied per antibiotic prescription - Ages 0-9 N/A 10.05 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 N/A 12.69 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 N/A 9.84 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 N/A 9.59 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 N/A 9.86 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 N/A 9.85 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 N/A 10.60 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus N/A 9.87 N/A N/A
Prescriptions of concern - Total N/A 0.35 0.36 0.45
Prescriptions of concern - Ages 0-9 N/A 0.35 N/A N/A
Prescriptions of concern - Ages 10-17 N/A 0.22 N/A N/A
Prescriptions of concern - Ages 18-34 N/A 0.28 N/A N/A
Prescriptions of concern - Ages 35-49 N/A 0.37 N/A N/A
Prescriptions of concern - Ages 50-64 N/A 0.44 N/A N/A
Prescriptions of concern - Ages 65-74 N/A 0.50 N/A N/A
Prescriptions of concern - Ages 75-85 N/A 0.54 N/A N/A
Prescriptions of concern - Ages 85 plus N/A 0.48 N/A N/A
Antibiotic Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Average number of antibiotic prescriptions per member per year - Total 2016 0.84 0.79 0.76 0.90
2015 0.89 0.80 0.81 0.97
2014 0.89 0.75 0.79 0.96
2013 0.95 0.83 0.81 0.98
Average number of antibiotic prescriptions per member per year - Ages 0-9 2016 1.16 0.97 N/A N/A
2015 1.18 0.94 N/A N/A
2014 1.13 0.84 N/A N/A
2013 1.24 0.93 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 2016 0.70 0.60 N/A N/A
2015 0.72 0.60 N/A N/A
2014 0.76 0.56 N/A N/A
2013 0.84 0.62 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 2016 0.71 0.69 N/A N/A
2015 0.74 0.70 N/A N/A
2014 0.76 0.67 N/A N/A
2013 0.82 0.74 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 2016 0.79 0.77 N/A N/A
2015 0.85 0.80 N/A N/A
2014 0.88 0.76 N/A N/A
2013 0.92 0.83 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 2016 0.94 0.87 N/A N/A
2015 0.97 0.90 N/A N/A
2014 0.94 0.84 N/A N/A
2013 1.01 0.92 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 2016 1.02 0.99 N/A N/A
2015 1.08 1.07 N/A N/A
2014 1.09 0.96 N/A N/A
2013 1.14 1.05 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 2016 1.17 1.23 N/A N/A
2015 1.49 1.08 N/A N/A
2014 1.58 1.09 N/A N/A
2013 1.52 1.11 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 2016 0.18 0.73 N/A N/A
2015 0.79 1.67 N/A N/A
2014 1.22 1.37 N/A N/A
2013 1.25 1.67 N/A N/A
Days suppplied per antibiotic prescription - Total 2016 10.41 10.09 9.88 10.83
2015 10.24 10.26 10.12 11.03
2014 10.41 10.44 10.32 11.18
2013 10.49 10.44 10.45 11.35
Days suppplied per antibiotic prescription - Ages 0-9 2016 9.61 10.04 N/A N/A
2015 9.65 9.99 N/A N/A
2014 9.52 10.01 N/A N/A
2013 9.32 10.00 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 2016 12.61 12.80 N/A N/A
2015 12.53 13.32 N/A N/A
2014 12.83 13.65 N/A N/A
2013 13.10 13.72 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 2016 10.77 10.07 N/A N/A
2015 10.29 10.33 N/A N/A
2014 10.70 10.65 N/A N/A
2013 10.74 10.61 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 2016 10.15 9.62 N/A N/A
2015 10.00 9.83 N/A N/A
2014 10.00 9.95 N/A N/A
2013 10.15 9.93 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 2016 10.12 9.82 N/A N/A
2015 10.00 9.90 N/A N/A
2014 10.12 10.04 N/A N/A
2013 10.26 10.07 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 2016 10.11 9.93 N/A N/A
2015 10.48 10.18 N/A N/A
2014 10.54 10.43 N/A N/A
2013 10.78 10.23 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 2016 10.95 10.59 N/A N/A
2015 10.21 9.93 N/A N/A
2014 11.15 10.54 N/A N/A
2013 10.88 10.32 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 2016 5.00 9.43 N/A N/A
2015 6.23 9.54 N/A N/A
2014 10.78 10.65 N/A N/A
2013 7.76 8.73 N/A N/A
Prescriptions of concern - Total 2016 0.42 0.38 0.36 0.45
2015 0.46 0.40 0.41 0.52
2014 0.46 0.37 0.39 0.49
2013 0.49 0.42 0.41 0.52
Prescriptions of concern - Ages 0-9 2016 0.54 0.43 N/A N/A
2015 0.56 0.41 N/A N/A
2014 0.56 0.38 N/A N/A
2013 0.65 0.44 N/A N/A
Prescriptions of concern - Ages 10-17 2016 0.29 0.24 N/A N/A
2015 0.31 0.25 N/A N/A
2014 0.32 0.22 N/A N/A
2013 0.37 0.25 N/A N/A
Prescriptions of concern - Ages 18-34 2016 0.33 0.31 N/A N/A
2015 0.36 0.32 N/A N/A
2014 0.37 0.30 N/A N/A
2013 0.39 0.34 N/A N/A
Prescriptions of concern - Ages 35-49 2016 0.42 0.40 N/A N/A
2015 0.48 0.42 N/A N/A
2014 0.50 0.41 N/A N/A
2013 0.51 0.45 N/A N/A
Prescriptions of concern - Ages 50-64 2016 0.51 0.46 N/A N/A
2015 0.54 0.49 N/A N/A
2014 0.51 0.45 N/A N/A
2013 0.54 0.50 N/A N/A
Prescriptions of concern - Ages 65-74 2016 0.49 0.51 N/A N/A
2015 0.57 0.57 N/A N/A
2014 0.56 0.51 N/A N/A
2013 0.59 0.56 N/A N/A
Prescriptions of concern - Ages 75-85 2016 0.54 0.65 N/A N/A
2015 0.65 0.59 N/A N/A
2014 0.72 0.51 N/A N/A
2013 0.70 0.57 N/A N/A
Prescriptions of concern - Ages 85 plus 2016 0.09 0.34 N/A N/A
2015 0.42 0.82 N/A N/A
2014 0.59 0.55 N/A N/A
2013 0.70 1.15 N/A N/A
Info
Child and Adolescent Well Child Visits 2017 Plan State Avg Nat Avg 90th Pctl.
Well Child Visits in the First 15 Months of Life N/A 85.55% N/A N/A
Well Child Visits in the 3rd - 6th Years N/A 83.18% 79.11% 91.03%
Adolescent Well-Care Visits N/A 53.24% 50.46% 70.44%
Child and Adolescent Well Child Visits Year Plan State Avg. Natl. Avg. 90th Pctl.
Well Child Visits in the First 15 Months of Life 2016 72.28% 82.77% N/A N/A
2015 74.35% 83.06% N/A N/A
2014 71.80% 81.95% N/A N/A
2013 74.16% 82.08% N/A N/A
Well Child Visits in the 3rd - 6th Years 2016 73.02% 82.50% 78.30% 90.11%
2015 69.09% 80.48% 77.75% 89.74%
2014 71.82% 80.03% 77.37% 88.75%
2013 69.91% 78.43% 75.89% 88.25%
Adolescent Well-Care Visits 2016 37.77% 50.35% 49.68% 67.70%
2015 37.89% 49.34% 48.26% 64.50%
2014 38.15% 48.09% 47.51% 64.76%
2013 39.85% 46.84% 46.27% 63.82%
Info
Mental Health Utilization 2017 Plan State Avg Nat Avg 90th Pctl.
Mental Health Utilization - ED - Ages 0-12 N/A 0.01% N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 N/A 0.00% N/A N/A
Mental Health Utilization - Outpatient - Ages 65 plus N/A 6.30% N/A N/A
Mental Health Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Mental Health Utilization - ED - Ages 0-12 2016 6.22% 5.26% N/A N/A
2015 5.59% 5.07% N/A N/A
2014 5.67% 5.47% N/A N/A
2013 5.87% 5.15% N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 2016 6.15% 14.81% N/A N/A
2015 5.86% 10.33% N/A N/A
2014 5.98% 10.70% N/A N/A
2013 5.91% 10.29% N/A N/A
Mental Health Utilization - Outpatient - Ages 65 plus 2016 N/A 6.56% N/A N/A
2015 N/A 6.62% N/A N/A
2014 N/A 7.64% N/A N/A
2013 N/A 6.80% N/A N/A
Info
Plan All-Cause Readmissions 2017 Plan State Avg Nat Avg 90th Pctl.
Plan All-Cause Readmissions Year Plan State Avg. Natl. Avg. 90th Pctl.