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
2017
Number of Enrollees: 50,391
PMPM: $430
Number of Physicians: *426,906
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

2017 2016 2015 2014 2013
Number of Enrollees 50,391 37,605 34,836 12,362 29,163
PMPM $430 $378 $386 $346 $321
*Medical Cost Ratio 81% 82% 78% 81% 84%
*Administrative Ratio 15% 16% 15% 13% 13%
*Profit/Loss Ratio 5% 3% 7% 6% 4%
*Number of Physicians 426,906 370,968 407,130 377,078 345,738

*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 $341,947,599 $174,415,257 $77,438,195 $85,755,116 $121,382,668
*Income $129,475,325 $83,382,290 $113,752,294 $117,023,153 $101,022,703
*Net Worth $525,277,678 $458,205,847 $421,403,811 $446,755,219 $329,348,905

*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 92.23% 92.73% 92.45% 95.43%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 96.03% 95.57% 95.61% 97.46%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 97.35% 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 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%
2013 92.30% 93.27% 93.13% 95.56%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 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%
2013 95.61% 95.97% 95.93% 97.60%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 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%
2013 96.88% 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 36.49% 36.14% 36.11% 42.01%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 36.54% 40.06% 39.91% 52.54%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 36.49% 36.00% 35.97% 41.96%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 13.57% 13.36% 12.65% 17.26%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 13.46% 14.40% 14.95% 23.85%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 13.57% 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 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%
2013 49.47% 35.00% 39.01% 50.93%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 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%
2013 42.31% 39.67% 41.13% 53.51%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 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%
2013 49.74% 34.74% 38.83% 51.61%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 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%
2013 13.43% 12.12% 14.64% 21.16%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 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%
2013 28.85% 18.05% 18.23% 27.05%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 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%
2013 12.84% 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.
Prenatal and Postpartum Care Year Plan State Avg. Natl. Avg. 90th Pctl.
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 77.91% 76.58% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 5-11 73.63% 66.50% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 12-18 70.30% 68.06% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 19-50 76.33% 75.34% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 51-64 85.43% 84.54% N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Total 56.37% 54.32% 50.48% 57.69%
Medication Management for People With Asthma at least 75% Compliance - Ages 5-11 48.97% 42.35% 40.22% 52.99%
Medication Management for People With Asthma at least 75% Compliance - Ages 12-18 43.07% 41.76% 37.80% 47.11%
Medication Management for People With Asthma at least 75% Compliance - Ages 19-50 57.65% 52.86% 48.60% 57.87%
Medication Management for People With Asthma at least 75% Compliance - Ages 51-64 64.47% 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 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
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 5-11 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
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 12-18 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
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 19-50 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
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 51-64 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
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Total 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
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Ages 5-11 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
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Ages 12-18 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
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Ages 19-50 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
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Ages 51-64 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
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 81.88% 84.01% 79.04% 85.85%
Controller/Total Asthma Medication Ratio - Ages 5-11 85.00% 86.06% 86.90% 93.55%
Controller/Total Asthma Medication Ratio - Ages 12-18 77.36% 84.80% 76.69% 85.94%
Controller/Total Asthma Medication Ratio - Ages 19-50 77.97% 78.94% 74.23% 81.70%
Controller/Total Asthma Medication Ratio - Ages 51-64 86.96% 89.17% 82.83% 89.28%
Asthma Medication Ratio Year Plan State Avg. Natl. Avg. 90th Pctl.
Controller/Total Asthma Medication Ratio - Total 2016 83.93% 80.60% 78.29% 85.46%
2015 81.01% 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 90.24% 91.67% 86.40% 93.97%
2015 84.66% 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 79.92% 81.12% 78.30% 86.34%
2015 74.47% 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 80.85% 75.24% 73.51% 81.08%
2015 79.37% 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 86.59% 83.27% 81.70% 88.64%
2015 84.34% 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 33.90% 41.27% 41.13% 50.83%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 40.85% 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 37.42% 41.91% 38.93% 48.61%
2015 38.71% 41.43% 38.13% 50.00%
2014 41.71% 39.00% 38.01% 46.81%
2013 38.04% 35.14% 40.10% 51.06%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 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%
2013 42.70% 41.32% 46.66% 58.62%
Info
Cardiovascular Disease Management 2017 Plan State Avg Nat Avg 90th Pctl.
Controlling High Blood Pressure 40.39% 56.61% 59.90% 74.82%
Persistence of Beta-Blockers 90.85% 85.80% 85.18% 93.41%
Cardiovascular Disease Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Controlling High Blood Pressure 2016 49.02% 56.91% 60.31% 74.43%
2015 52.68% 58.35% 58.69% 73.89%
2014 52.93% 59.30% 62.63% 75.63%
2013 53.77% 60.92% 63.30% 74.65%
Persistence of Beta-Blockers 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%
2013 88.50% 83.43% 83.39% 91.72%
Info
Common Childhood Illnesses 2017 Plan State Avg Nat Avg 90th Pctl.
Appropriate Testing for Children With Pharyngitis 91.53% 92.01% 87.45% 94.64%
Common Childhood Illnesses Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Testing for Children With Pharyngitis 2016 90.44% 91.84% 84.50% 93.75%
2015 91.43% 91.35% 83.12% 93.11%
2014 90.37% 90.30% 83.29% 91.40%
2013 88.28% 89.15% 81.45% 91.30%
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 - Meningococcal 79.81% 82.98% N/A N/A
Immunizations Year Plan State Avg. Natl. Avg. 90th Pctl.
Immunizations for Adolescents - Meningococcal 2016 81.51% 79.09% N/A N/A
2015 0.73% 66.99% N/A N/A
2014 0.63% 66.20% N/A N/A
2013 0.58% 51.54% N/A N/A
Info
Mental Health: Care and Follow-up 2017 Plan State Avg Nat Avg 90th Pctl.
Antidepressant Medication Management-Acute Phase Treatment 73.35% 70.90% 67.11% 75.76%
Mental Health: Care and Follow-up Year Plan State Avg. Natl. Avg. 90th Pctl.
Antidepressant Medication Management-Acute Phase Treatment 2016 73.73% 70.18% 66.56% 74.77%
2015 69.69% 68.89% 65.82% 74.06%
2014 73.33% 69.67% 65.88% 75.35%
2013 73.26% 67.58% 63.60% 73.26%
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 69.17% 71.85% 72.81% 80.91%
Chlamydia Screening in Women-all Age groups 52.43% 51.46% 50.16% 66.08%
Colorectal Cancer Screening 66.49% 66.54% 62.43% 74.72%
Preventive Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Breast Cancer Screening 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%
2013 69.36% 72.82% 73.71% 80.78%
Chlamydia Screening in Women-all Age groups 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%
2013 50.01% 47.46% 46.20% 59.63%
Colorectal Cancer Screening 2016 62.23% 64.54% 61.71% 74.09%
2015 65.80% 64.46% 62.32% 73.84%
2014 70.21% 67.87% 64.06% 74.86%
2013 65.15% 63.90% 62.85% 72.75%
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.
Weight Assessment and Counseling Year Plan State Avg. Natl. Avg. 90th Pctl.
Health Plan Stability/Descriptive
Info
Administrative Data 2017 Plan State Avg Nat Avg 90th Pctl.
Administrative Ratio 0.15 0.12 86.39 93.13
Medical Cost Ratio 0.81 0.83 93.13 96.59
Number of Enrollees 50,391 133,992 92 97
Number of Physicians 426,906 81,926 87 95
Premium Per Member Per Month $430 $370 N/A N/A
Profit/Loss Ratio 0.05 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 0.15 0.14 N/A N/A
2014 0.13 0.14 N/A N/A
2013 0.13 0.14 N/A N/A
Medical Cost Ratio 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
2013 0.84 0.83 N/A N/A
Number of Enrollees 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
2013 29,163 98,253 N/A N/A
Number of Physicians 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
2013 345,738 64,207 N/A N/A
Premium Per Member Per Month 2016 $378 $370 N/A N/A
2015 $386 $375 N/A N/A
2014 $346 $412 N/A N/A
2013 $321 $544 N/A N/A
Profit/Loss Ratio 2016 0.03 0.03 N/A N/A
2015 0.07 0.04 N/A N/A
2014 0.06 0.06 N/A N/A
2013 0.04 0.03 N/A N/A
Info
Board Certification Rates for Providers 2017 Plan State Avg Nat Avg 90th Pctl.
Board Certification for Geriatricians 58.00% 71.38% N/A N/A
Board Certification for Pediatricians 83.00% 85.50% N/A N/A
Board Certification Rate for Family Medicine Physicians 79.00% 81.38% N/A N/A
Board Certification Rate for Internal Medicine Physicians 74.00% 81.00% N/A N/A
Board Certification Rate for OB/GYN Providers 75.00% 83.00% N/A N/A
Board Certification Rate for Other Specialists 70.00% 81.88% N/A N/A
Board Certification Rates for Providers Year Plan State Avg. Natl. Avg. 90th Pctl.
Board Certification for Geriatricians 2016 65.41% 73.44% N/A N/A
2015 61.21% 71.06% N/A N/A
2014 64.03% 74.73% 64.82% 87.50%
2013 64.29% 71.19% 63.29% 83.33%
Board Certification for Pediatricians 2016 88.37% 87.02% N/A N/A
2015 88.81% 88.14% N/A N/A
2014 88.72% 88.13% 83.89% 91.52%
2013 84.86% 86.01% 81.01% 90.29%
Board Certification Rate for Family Medicine Physicians 2016 83.07% 80.32% N/A N/A
2015 83.88% 82.53% N/A N/A
2014 84.91% 82.93% 77.41% 89.90%
2013 82.57% 81.36% 76.60% 88.80%
Board Certification Rate for Internal Medicine Physicians 2016 77.14% 81.15% N/A N/A
2015 78.10% 82.59% N/A N/A
2014 78.37% 83.98% 79.07% 88.73%
2013 76.77% 80.80% 78.18% 87.44%
Board Certification Rate for OB/GYN Providers 2016 78.53% 83.36% N/A N/A
2015 78.29% 83.51% N/A N/A
2014 77.61% 83.71% 79.30% 88.80%
2013 74.90% 80.44% 76.89% 87.80%
Board Certification Rate for Other Specialists 2016 73.68% 83.25% N/A N/A
2015 74.57% 82.88% N/A N/A
2014 75.69% 84.44% 78.09% 89.67%
2013 71.73% 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 39 35 N/A N/A
Years in Business Year Plan State Avg. Natl. Avg. 90th Pctl.
Years in Business 2016 38 34 N/A N/A
2015 37 33 N/A N/A
2014 36 32 N/A N/A
2013 35 31 N/A N/A
Member Satisfaction
Info
Member Satisfaction 2017 Plan State Avg Nat Avg 90th Pctl.
How Well Doctors Communicate 97.17% 88.46% N/A N/A
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 82.48% 94.34% 95.10% 96.91%
Member Satisfaction Year Plan State Avg. Natl. Avg. 90th Pctl.
How Well Doctors Communicate 2016 95.15% 87.23% N/A N/A
2015 93.79% 87.33% N/A N/A
2014 95.67% 88.88% N/A N/A
2013 93.01% 87.29% N/A N/A
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 2016 76.69% 94.88% 95.39% 97.21%
2015 69.73% 94.63% 95.20% 97.10%
2014 74.37% 94.87% 95.26% 97.16%
2013 72.10% 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 38.13% 50.55% 36.07% 48.57%
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 45.83% 58.14% 54.52% 68.67%
Use of Multiple Concurrent Antipsychotics in Children and Adolescents - Ages 1-17 1.74% 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 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
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 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
2013 N/A N/A N/A N/A
Use of Multiple Concurrent Antipsychotics in Children and Adolescents - Ages 1-17 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
2013 N/A N/A N/A N/A
Info
Cervical Cancer Screening in Adolescent Females 2017 Plan State Avg Nat Avg 90th Pctl.
Non-Recommended Cervical Cancer Screening in Adolescent Females 0.82% 0.82% 1.47% 0.50%
Cervical Cancer Screening in Adolescent Females Year Plan State Avg. Natl. Avg. 90th Pctl.
Non-Recommended Cervical Cancer Screening in Adolescent Females 2016 1.22% 1.10% 1.84% 0.62%
2015 0.02% 0.02% 2.40% 0.93%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
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 0.80 0.77 0.76 0.90
Average number of antibiotic prescriptions per member per year - Ages 0-9 0.85 0.87 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 0.55 0.57 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 0.70 0.67 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 0.81 0.75 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 0.91 0.88 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 1.03 1.00 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 1.04 1.12 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 1.18 1.12 N/A N/A
Days suppplied per antibiotic prescription - Total 9.56 10.02 9.88 10.83
Days suppplied per antibiotic prescription - Ages 0-9 9.69 10.05 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 12.09 12.69 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 9.39 9.84 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 9.32 9.59 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 9.23 9.86 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 9.22 9.85 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 9.77 10.60 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 9.82 9.87 N/A N/A
Prescriptions of concern - Total 0.38 0.35 0.36 0.45
Prescriptions of concern - Ages 0-9 0.35 0.35 N/A N/A
Prescriptions of concern - Ages 10-17 0.22 0.22 N/A N/A
Prescriptions of concern - Ages 18-34 0.30 0.28 N/A N/A
Prescriptions of concern - Ages 35-49 0.39 0.37 N/A N/A
Prescriptions of concern - Ages 50-64 0.47 0.44 N/A N/A
Prescriptions of concern - Ages 65-74 0.52 0.50 N/A N/A
Prescriptions of concern - Ages 75-85 0.51 0.54 N/A N/A
Prescriptions of concern - Ages 85 plus 0.64 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 0.79 0.79 0.76 0.90
2015 0.80 0.80 0.81 0.97
2014 0.78 0.75 0.79 0.96
2013 0.80 0.83 0.81 0.98
Average number of antibiotic prescriptions per member per year - Ages 0-9 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
2013 0.85 0.93 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 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
2013 0.54 0.62 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 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
2013 0.71 0.74 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 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
2013 0.83 0.83 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 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
2013 0.91 0.92 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 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
2013 1.02 1.05 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 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
2013 1.13 1.11 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 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
2013 0.98 1.67 N/A N/A
Days suppplied per antibiotic prescription - Total 2016 9.69 10.09 9.88 10.83
2015 9.92 10.26 10.12 11.03
2014 10.10 10.44 10.32 11.18
2013 10.34 10.44 10.45 11.35
Days suppplied per antibiotic prescription - Ages 0-9 2016 9.63 10.04 N/A N/A
2015 9.71 9.99 N/A N/A
2014 9.73 10.01 N/A N/A
2013 9.90 10.00 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 2016 12.35 12.80 N/A N/A
2015 12.82 13.32 N/A N/A
2014 13.63 13.65 N/A N/A
2013 13.83 13.72 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 2016 9.57 10.07 N/A N/A
2015 10.34 10.33 N/A N/A
2014 10.59 10.65 N/A N/A
2013 10.69 10.61 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 2016 9.37 9.62 N/A N/A
2015 9.46 9.83 N/A N/A
2014 9.60 9.95 N/A N/A
2013 9.86 9.93 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 2016 9.35 9.82 N/A N/A
2015 9.34 9.90 N/A N/A
2014 9.44 10.04 N/A N/A
2013 9.73 10.07 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 2016 9.63 9.93 N/A N/A
2015 9.82 10.18 N/A N/A
2014 9.81 10.43 N/A N/A
2013 10.18 10.23 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 2016 10.46 10.59 N/A N/A
2015 10.03 9.93 N/A N/A
2014 9.82 10.54 N/A N/A
2013 9.91 10.32 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 2016 9.32 9.43 N/A N/A
2015 10.81 9.54 N/A N/A
2014 10.72 10.65 N/A N/A
2013 10.82 8.73 N/A N/A
Prescriptions of concern - Total 2016 0.39 0.38 0.36 0.45
2015 0.39 0.40 0.41 0.52
2014 0.39 0.37 0.39 0.49
2013 0.40 0.42 0.41 0.52
Prescriptions of concern - Ages 0-9 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
2013 0.40 0.44 N/A N/A
Prescriptions of concern - Ages 10-17 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
2013 0.22 0.25 N/A N/A
Prescriptions of concern - Ages 18-34 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
2013 0.32 0.34 N/A N/A
Prescriptions of concern - Ages 35-49 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
2013 0.45 0.45 N/A N/A
Prescriptions of concern - Ages 50-64 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
2013 0.50 0.50 N/A N/A
Prescriptions of concern - Ages 65-74 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
2013 0.57 0.56 N/A N/A
Prescriptions of concern - Ages 75-85 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
2013 0.60 0.57 N/A N/A
Prescriptions of concern - Ages 85 plus 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
2013 0.48 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 3rd - 6th Years 83.59% 85.55% N/A N/A
Adolescent Well-Care Visits 52.94% 83.18% 79.11% 91.03%
Child and Adolescent Well Child Visits Year Plan State Avg. Natl. Avg. 90th Pctl.
Well Child Visits in the 3rd - 6th Years 2016 82.32% 82.77% N/A N/A
2015 78.22% 83.06% N/A N/A
2014 80.73% 81.95% N/A N/A
2013 79.94% 82.08% N/A N/A
Adolescent Well-Care Visits 2016 51.10% 82.50% 78.30% 90.11%
2015 48.90% 80.48% 77.75% 89.74%
2014 49.48% 80.03% 77.37% 88.75%
2013 49.10% 78.43% 75.89% 88.25%
Info
Mental Health Utilization 2017 Plan State Avg Nat Avg 90th Pctl.
Mental Health Utilization - ED - Ages 0-12 0.01% 0.01% N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 6.45% 0.00% N/A N/A
Mental Health Utilization - Outpatient - Ages 65 plus 2.43% 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 4.32% 5.26% N/A N/A
2015 4.58% 5.07% N/A N/A
2014 6.96% 5.47% N/A N/A
2013 6.70% 5.15% N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 2016 6.08% 14.81% N/A N/A
2015 6.27% 10.33% N/A N/A
2014 9.21% 10.70% N/A N/A
2013 8.80% 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.