Health Insurance in Virginia

Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.

Company Information

  • Company Providing Plan:Kaiser Permanente
  • Address:2101 East Jefferson Street
    Rockville, MD 20852
  • Telephone :301-816-2424
  • Website:www.kp.org
2017
Number of Enrollees: 180,972
PMPM: $381
Number of Physicians: 21,796
NCQA Accreditation: Excellent

*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

Commonwealth of Virginia


Cities

Commonwealth of Virginia

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

Administrative Data

2017 2016 2015 2014 2013
Number of Enrollees 180,972 180,359 171,883 138,673 114,001
PMPM $381 $350 $362 $388 $385
*Medical Cost Ratio 93% 89% 89% 89% 91%
*Administrative Ratio 9% 10% 11% 11% 9%
*Profit/Loss Ratio -2% 1% -0% -0% -1%
Number of Physicians 21,796 20,507 19,970 19,950 19,358

*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 $826,114,677 $761,639,141 $733,571,440 $610,846,468 $529,390,905
*Income ($85,020,295) $16,827,995 ($5,078,117) ($12,335,831) ($19,378,215)
*Net Worth $160,228,051 $198,655,393 $209,174,462 $147,191,831 $176,010,947

*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 93.61% 92.73% 92.45% 95.43%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 96.17% 95.57% 95.61% 97.46%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 96.99% 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 93.06% 92.81% 92.73% 95.55%
2015 93.26% 92.25% 92.83% 95.45%
2014 92.48% 93.10% 92.91% 95.39%
2013 92.69% 93.27% 93.13% 95.56%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 2016 95.87% 95.78% 95.78% 97.61%
2015 96.18% 95.61% 95.90% 97.55%
2014 95.84% 96.03% 95.85% 97.54%
2013 95.83% 95.97% 95.93% 97.60%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 2016 96.73% 97.30% 97.19% 98.61%
2015 96.74% 96.84% 97.32% 96.73%
2014 96.32% 97.56% 97.50% 98.68%
2013 96.23% 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 54.22% 36.14% 36.11% 42.01%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 55.34% 40.06% 39.91% 52.54%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 54.18% 36.00% 35.97% 41.96%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 24.19% 13.36% 12.65% 17.26%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 40.78% 14.40% 14.95% 23.85%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 23.56% 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 51.22% 35.69% 32.93% 40.24%
2015 42.12% 33.04% 33.42% 41.07%
2014 33.16% 32.51% 35.63% 44.19%
2013 32.20% 35.00% 39.01% 50.93%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2016 46.88% 40.15% 40.47% 51.96%
2015 41.59% 37.03% 39.62% 50.00%
2014 34.44% 37.09% 40.79% 52.00%
2013 31.79% 39.67% 41.13% 53.51%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2016 51.36% 35.55% 32.64% 40.33%
2015 42.14% 32.96% 33.20% 40.93%
2014 33.10% 32.16% 35.21% 43.92%
2013 32.23% 34.74% 38.83% 51.61%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 2016 22.28% 12.51% 11.46% 16.72%
2015 15.09% 11.61% 12.46% 19.23%
2014 4.76% 10.64% 13.66% 19.19%
2013 9.80% 12.12% 14.64% 21.16%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2016 21.88% 11.28% 15.68% 23.73%
2015 13.27% 12.06% 15.42% 22.12%
2014 3.33% 13.00% 17.24% 25.29%
2013 13.29% 18.05% 18.23% 27.05%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2016 22.30% 12.57% 11.32% 16.09%
2015 15.17% 11.57% 12.34% 18.67%
2014 4.82% 10.33% 13.45% 18.68%
2013 9.58% 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 97.32% 87.01% N/A N/A
Prenatal and Postpartum Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Timeliness of Prenatal Care 2016 97.76% 86.52% N/A N/A
2015 95.60% 86.91% N/A N/A
2014 97.50% 85.85% N/A N/A
2013 96.60% 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 71.44% 76.58% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 5-11 69.73% 66.50% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 12-18 65.36% 68.06% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 19-50 68.94% 75.34% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 51-64 76.11% 84.54% N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Total 44.64% 54.32% 50.48% 57.69%
Medication Management for People With Asthma at least 75% Compliance - Ages 5-11 42.83% 42.35% 40.22% 52.99%
Medication Management for People With Asthma at least 75% Compliance - Ages 12-18 33.43% 41.76% 37.80% 47.11%
Medication Management for People With Asthma at least 75% Compliance - Ages 19-50 42.14% 52.86% 48.60% 57.87%
Medication Management for People With Asthma at least 75% Compliance - Ages 51-64 50.53% 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 68.03% 73.20% N/A N/A
2015 66.83% 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 67.07% 67.58% N/A N/A
2015 63.93% 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 55.42% 65.72% N/A N/A
2015 56.60% 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 65.28% 71.77% N/A N/A
2015 64.68% 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 72.40% 79.36% N/A N/A
2015 71.67% 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 42.16% 51.17% 48.54% 56.96%
2015 42.10% 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 35.10% 39.03% 37.58% 48.84%
2015 32.55% 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 27.55% 35.03% 35.83% 46.97%
2015 26.10% 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 38.68% 50.18% 46.16% 55.80%
2015 40.75% 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 49.16% 59.39% 57.47% 65.75%
2015 48.84% 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 86.00% 84.01% 79.04% 85.85%
Controller/Total Asthma Medication Ratio - Ages 5-11 87.64% 86.06% 86.90% 93.55%
Controller/Total Asthma Medication Ratio - Ages 12-18 80.83% 84.80% 76.69% 85.94%
Controller/Total Asthma Medication Ratio - Ages 19-50 83.44% 78.94% 74.23% 81.70%
Controller/Total Asthma Medication Ratio - Ages 51-64 89.47% 89.17% 82.83% 89.28%
Asthma Medication Ratio Year Plan State Avg. Natl. Avg. 90th Pctl.
Controller/Total Asthma Medication Ratio - Total 2016 81.11% 80.60% 78.29% 85.46%
2015 80.01% 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 86.62% 91.67% 86.40% 93.97%
2015 92.34% 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 76.90% 81.12% 78.30% 86.34%
2015 81.06% 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 77.32% 75.24% 73.51% 81.08%
2015 73.62% 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 83.78% 83.27% 81.70% 88.64%
2015 82.83% 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 70.23% 41.27% 41.13% 50.83%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 76.64% 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 65.26% 41.91% 38.93% 48.61%
2015 66.10% 41.43% 38.13% 50.00%
2014 59.51% 39.00% 38.01% 46.81%
2013 26.49% 35.14% 40.10% 51.06%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 2016 69.14% 46.92% 45.82% 56.86%
2015 67.84% 49.06% 46.18% 58.06%
2014 62.61% 46.49% 45.70% 57.75%
2013 25.95% 41.32% 46.66% 58.62%
Info
Cardiovascular Disease Management 2017 Plan State Avg Nat Avg 90th Pctl.
Controlling High Blood Pressure 91.82% 56.61% 59.90% 74.82%
Persistence of Beta-Blockers 96.59% 85.80% 85.18% 93.41%
Cardiovascular Disease Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Controlling High Blood Pressure 2016 90.34% 56.91% 60.31% 74.43%
2015 91.19% 58.35% 58.69% 73.89%
2014 90.82% 59.30% 62.63% 75.63%
2013 85.90% 60.92% 63.30% 74.65%
Persistence of Beta-Blockers 2016 93.94% 90.70% 83.61% 90.83%
2015 88.00% 88.70% 84.68% 91.00%
2014 91.05% 84.03% 83.50% 91.43%
2013 77.60% 83.43% 83.39% 91.72%
Info
Common Childhood Illnesses 2017 Plan State Avg Nat Avg 90th Pctl.
Appropriate Testing for Children With Pharyngitis 92.50% 92.01% 87.45% 94.64%
Common Childhood Illnesses Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Testing for Children With Pharyngitis 2016 93.86% 91.84% 84.50% 93.75%
2015 95.48% 91.35% 83.12% 93.11%
2014 97.75% 90.30% 83.29% 91.40%
2013 95.76% 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 90.02% 82.98% N/A N/A
Immunizations Year Plan State Avg. Natl. Avg. 90th Pctl.
Immunizations for Adolescents - Meningococcal 2016 90.27% 79.09% N/A N/A
2015 0.93% 66.99% N/A N/A
2014 0.93% 66.20% N/A N/A
2013 0.86% 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 73.31% 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 74.16% 70.18% 66.56% 74.77%
2015 71.96% 68.89% 65.82% 74.06%
2014 70.80% 69.67% 65.88% 75.35%
2013 65.11% 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 87.62% 71.85% 72.81% 80.91%
Chlamydia Screening in Women-all Age groups 70.17% 51.46% 50.16% 66.08%
Preventive Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Breast Cancer Screening 2016 87.98% 71.80% 72.90% 80.63%
2015 88.23% 72.07% 73.08% 81.53%
2014 89.63% 72.22% 73.52% 81.91%
2013 88.84% 72.82% 73.71% 80.78%
Chlamydia Screening in Women-all Age groups 2016 69.30% 49.79% 48.98% 63.50%
2015 65.76% 47.89% 52.32% 64.06%
2014 66.77% 48.07% 51.65% 63.48%
2013 71.05% 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.
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 0.09 0.12 86.39 93.13
Medical Cost Ratio 0.93 0.83 93.13 96.59
Number of Enrollees 180,972 133,992 92 97
Number of Physicians 21,796 81,926 87 95
Premium Per Member Per Month $381 $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 0.10 0.15 N/A N/A
2015 0.11 0.14 N/A N/A
2014 0.11 0.14 N/A N/A
2013 0.09 0.14 N/A N/A
Medical Cost Ratio 2016 0.89 0.83 N/A N/A
2015 0.89 0.82 N/A N/A
2014 0.89 0.81 N/A N/A
2013 0.91 0.83 N/A N/A
Number of Enrollees 2016 180,359 136,796 N/A N/A
2015 171,883 124,097 N/A N/A
2014 138,673 115,428 N/A N/A
2013 114,001 98,253 N/A N/A
Number of Physicians 2016 20,507 73,426 N/A N/A
2015 19,970 90,027 N/A N/A
2014 19,950 63,157 N/A N/A
2013 19,358 64,207 N/A N/A
Premium Per Member Per Month 2016 $350 $370 N/A N/A
2015 $362 $375 N/A N/A
2014 $388 $412 N/A N/A
2013 $385 $544 N/A N/A
Profit/Loss Ratio 2016 0.01 0.03 N/A N/A
2015 -0.00 0.04 N/A N/A
2014 -0.00 0.06 N/A N/A
2013 -0.01 0.03 N/A N/A
Info
Board Certification Rates for Providers 2017 Plan State Avg Nat Avg 90th Pctl.
Board Certification for Geriatricians 100.00% 71.38% N/A N/A
Board Certification for Pediatricians 94.00% 85.50% N/A N/A
Board Certification Rate for Family Medicine Physicians 95.00% 81.38% N/A N/A
Board Certification Rate for Internal Medicine Physicians 96.00% 81.00% N/A N/A
Board Certification Rate for OB/GYN Providers 88.00% 83.00% N/A N/A
Board Certification Rate for Other Specialists 95.00% 81.88% N/A N/A
Board Certification Rates for Providers Year Plan State Avg. Natl. Avg. 90th Pctl.
Board Certification for Geriatricians 2016 91.18% 73.44% N/A N/A
2015 96.88% 71.06% N/A N/A
2014 96.67% 74.73% 64.82% 87.50%
2013 96.83% 71.19% 63.29% 83.33%
Board Certification for Pediatricians 2016 97.18% 87.02% N/A N/A
2015 96.96% 88.14% N/A N/A
2014 97.14% 88.13% 83.89% 91.52%
2013 92.19% 86.01% 81.01% 90.29%
Board Certification Rate for Family Medicine Physicians 2016 95.31% 80.32% N/A N/A
2015 97.21% 82.53% N/A N/A
2014 95.20% 82.93% 77.41% 89.90%
2013 90.14% 81.36% 76.60% 88.80%
Board Certification Rate for Internal Medicine Physicians 2016 95.66% 81.15% N/A N/A
2015 96.66% 82.59% N/A N/A
2014 94.89% 83.98% 79.07% 88.73%
2013 83.85% 80.80% 78.18% 87.44%
Board Certification Rate for OB/GYN Providers 2016 90.16% 83.36% N/A N/A
2015 90.45% 83.51% N/A N/A
2014 90.51% 83.71% 79.30% 88.80%
2013 82.77% 80.44% 76.89% 87.80%
Board Certification Rate for Other Specialists 2016 95.46% 83.25% N/A N/A
2015 96.25% 82.88% N/A N/A
2014 94.40% 84.44% 78.09% 89.67%
2013 87.59% 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 38 35 N/A N/A
Years in Business Year Plan State Avg. Natl. Avg. 90th Pctl.
Years in Business 2016 37 34 N/A N/A
2015 36 33 N/A N/A
2014 35 32 N/A N/A
2013 34 31 N/A N/A
Member Satisfaction
Info
Member Satisfaction 2017 Plan State Avg Nat Avg 90th Pctl.
How Well Doctors Communicate 91.69% 88.46% N/A N/A
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 78.89% 94.34% 95.10% 96.91%
Member Satisfaction Year Plan State Avg. Natl. Avg. 90th Pctl.
How Well Doctors Communicate 2016 91.95% 87.23% N/A N/A
2015 94.31% 87.33% N/A N/A
2014 92.75% 88.88% N/A N/A
2013 94.62% 87.29% N/A N/A
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 2016 82.97% 94.88% 95.39% 97.21%
2015 86.64% 94.63% 95.20% 97.10%
2014 85.79% 94.87% 95.26% 97.16%
2013 86.05% 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 76.95% 50.55% 36.07% 48.57%
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 72.22% 58.14% 54.52% 68.67%
Use of Multiple Concurrent Antipsychotics in Children and Adolescents - Ages 1-17 0.50% 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 75.00% 34.87% 35.80% 45.93%
2015 49.55% 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 73.08% 61.93% 58.30% 75.00%
2015 58.78% 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 0.51% 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 0.05% 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 0.13% 1.10% 1.84% 0.62%
2015 0.00% 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 0.56 0.77 0.76 0.90
Average number of antibiotic prescriptions per member per year - Ages 0-9 0.52 0.87 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 0.31 0.57 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 0.51 0.67 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 0.58 0.75 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 0.66 0.88 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 0.76 1.00 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 0.77 1.12 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 0.91 1.12 N/A N/A
Days suppplied per antibiotic prescription - Total 10.95 10.02 9.88 10.83
Days suppplied per antibiotic prescription - Ages 0-9 10.53 10.05 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 15.16 12.69 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 11.12 9.84 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 10.47 9.59 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 10.51 9.86 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 10.98 9.85 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 11.39 10.60 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 11.08 9.87 N/A N/A
Prescriptions of concern - Total 0.24 0.35 0.36 0.45
Prescriptions of concern - Ages 0-9 0.19 0.35 N/A N/A
Prescriptions of concern - Ages 10-17 0.11 0.22 N/A N/A
Prescriptions of concern - Ages 18-34 0.20 0.28 N/A N/A
Prescriptions of concern - Ages 35-49 0.25 0.37 N/A N/A
Prescriptions of concern - Ages 50-64 0.31 0.44 N/A N/A
Prescriptions of concern - Ages 65-74 0.35 0.50 N/A N/A
Prescriptions of concern - Ages 75-85 0.36 0.54 N/A N/A
Prescriptions of concern - Ages 85 plus 0.38 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 0.56 0.79 0.76 0.90
2015 0.58 0.80 0.81 0.97
2014 0.60 0.75 0.79 0.96
2013 0.62 0.83 0.81 0.98
Average number of antibiotic prescriptions per member per year - Ages 0-9 2016 0.56 0.97 N/A N/A
2015 0.60 0.94 N/A N/A
2014 0.59 0.84 N/A N/A
2013 0.63 0.93 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 2016 0.31 0.60 N/A N/A
2015 0.32 0.60 N/A N/A
2014 0.33 0.56 N/A N/A
2013 0.34 0.62 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 2016 0.52 0.69 N/A N/A
2015 0.53 0.70 N/A N/A
2014 0.56 0.67 N/A N/A
2013 0.58 0.74 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 2016 0.60 0.77 N/A N/A
2015 0.61 0.80 N/A N/A
2014 0.65 0.76 N/A N/A
2013 0.66 0.83 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 2016 0.65 0.87 N/A N/A
2015 0.67 0.90 N/A N/A
2014 0.69 0.84 N/A N/A
2013 0.70 0.92 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 2016 0.70 0.99 N/A N/A
2015 0.71 1.07 N/A N/A
2014 0.66 0.96 N/A N/A
2013 0.72 1.05 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 2016 0.70 1.23 N/A N/A
2015 0.76 1.08 N/A N/A
2014 0.73 1.09 N/A N/A
2013 0.74 1.11 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 2016 0.80 0.73 N/A N/A
2015 0.79 1.67 N/A N/A
2014 0.70 1.37 N/A N/A
2013 0.81 1.67 N/A N/A
Days suppplied per antibiotic prescription - Total 2016 10.94 10.09 9.88 10.83
2015 11.06 10.26 10.12 11.03
2014 11.15 10.44 10.32 11.18
2013 10.90 10.44 10.45 11.35
Days suppplied per antibiotic prescription - Ages 0-9 2016 10.34 10.04 N/A N/A
2015 10.43 9.99 N/A N/A
2014 10.24 10.01 N/A N/A
2013 10.14 10.00 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 2016 15.77 12.80 N/A N/A
2015 16.14 13.32 N/A N/A
2014 16.28 13.65 N/A N/A
2013 15.92 13.72 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 2016 11.23 10.07 N/A N/A
2015 11.45 10.33 N/A N/A
2014 11.61 10.65 N/A N/A
2013 11.18 10.61 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 2016 10.41 9.62 N/A N/A
2015 10.46 9.83 N/A N/A
2014 10.44 9.95 N/A N/A
2013 10.29 9.93 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 2016 10.41 9.82 N/A N/A
2015 10.46 9.90 N/A N/A
2014 10.51 10.04 N/A N/A
2013 10.46 10.07 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 2016 10.97 9.93 N/A N/A
2015 11.19 10.18 N/A N/A
2014 12.31 10.43 N/A N/A
2013 10.95 10.23 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 2016 11.23 10.59 N/A N/A
2015 10.93 9.93 N/A N/A
2014 11.00 10.54 N/A N/A
2013 10.10 10.32 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 2016 10.64 9.43 N/A N/A
2015 11.60 9.54 N/A N/A
2014 13.46 10.65 N/A N/A
2013 13.37 8.73 N/A N/A
Prescriptions of concern - Total 2016 0.25 0.38 0.36 0.45
2015 0.27 0.40 0.41 0.52
2014 0.28 0.37 0.39 0.49
2013 0.30 0.42 0.41 0.52
Prescriptions of concern - Ages 0-9 2016 0.21 0.43 N/A N/A
2015 0.23 0.41 N/A N/A
2014 0.22 0.38 N/A N/A
2013 0.26 0.44 N/A N/A
Prescriptions of concern - Ages 10-17 2016 0.12 0.24 N/A N/A
2015 0.16 0.25 N/A N/A
2014 0.12 0.22 N/A N/A
2013 0.13 0.25 N/A N/A
Prescriptions of concern - Ages 18-34 2016 0.21 0.31 N/A N/A
2015 0.22 0.32 N/A N/A
2014 0.23 0.30 N/A N/A
2013 0.24 0.34 N/A N/A
Prescriptions of concern - Ages 35-49 2016 0.28 0.40 N/A N/A
2015 0.29 0.42 N/A N/A
2014 0.32 0.41 N/A N/A
2013 0.33 0.45 N/A N/A
Prescriptions of concern - Ages 50-64 2016 0.33 0.46 N/A N/A
2015 0.35 0.49 N/A N/A
2014 0.37 0.45 N/A N/A
2013 0.38 0.50 N/A N/A
Prescriptions of concern - Ages 65-74 2016 0.33 0.51 N/A N/A
2015 0.36 0.57 N/A N/A
2014 0.38 0.51 N/A N/A
2013 0.40 0.56 N/A N/A
Prescriptions of concern - Ages 75-85 2016 0.34 0.65 N/A N/A
2015 0.39 0.59 N/A N/A
2014 0.38 0.51 N/A N/A
2013 0.42 0.57 N/A N/A
Prescriptions of concern - Ages 85 plus 2016 0.39 0.34 N/A N/A
2015 0.38 0.82 N/A N/A
2014 0.37 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 87.50% 85.55% N/A N/A
Adolescent Well-Care Visits 61.27% 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 89.81% 82.77% N/A N/A
2015 84.05% 83.06% N/A N/A
2014 82.79% 81.95% N/A N/A
2013 78.47% 82.08% N/A N/A
Adolescent Well-Care Visits 2016 54.78% 82.50% 78.30% 90.11%
2015 52.68% 80.48% 77.75% 89.74%
2014 51.73% 80.03% 77.37% 88.75%
2013 49.36% 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 0.00% 0.01% N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 0.51% 0.00% N/A N/A
Mental Health Utilization - Outpatient - Ages 65 plus 0.28% 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 4.77% 5.26% N/A N/A
2015 5.24% 5.07% N/A N/A
2014 4.80% 5.47% N/A N/A
2013 4.50% 5.15% N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 2016 5.88% 14.81% N/A N/A
2015 6.07% 10.33% N/A N/A
2014 6.06% 10.70% N/A N/A
2013 6.33% 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.