Health Insurance in Virginia

Innovation Health Plan, Inc.

Company Information

  • Company Providing Plan:Inova and Aetna
  • Address:151 Farmington Avenue, RT21
    Hartford, CT 06156
  • Telephone :703-914-2925
  • Website:www.innovation-health.com
2018
Number of Enrollees: 14,892
PMPM: $423
Number of Physicians: 84,706
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

Amelia, Arlington, Buckingham, Caroline, Charlotte, Charles City, Chesterfield, Cumberland, Dinwiddie, Fairfax, Fauquier, Goochland, Hanover, Henrico, King George, King William, Loudoun, Louisa, Lunenburg, New Kent, Nottoway, Powhatan, Prince Edward, Prince George, Prince William, Spotsylvania, Stafford, Surrey, Sussex, Westmoreland


Cities

Alexandria, Colonial Heights, Fairfax, Falls Church, Fredericksburg, Hopewell, Manassas, Manassas Park, Petersburg, Richmond

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

Administrative Data

2018 2017 2016 2015 2014
Number of Enrollees 14,892 21,040 27,510 22,874 18,580
PMPM $423 $352 $313 $318 $335
Medical Cost Ratio 79% 82% 88% 73% 73%
Administrative Ratio 16% 17% 19% 19% 23%
Profit/Loss Ratio 5% 1% -7% 7% 2%
Number of Physicians 84,706 79,982 72,651 65,263 50,861

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

Financial Data

2018 2017 2016 2015 2014
Premiums Earned $96,247,408 $104,799,970 $95,876,576 $79,978,908 $42,248,104
Income $3,296,121 $277,269 ($4,890,121) $3,438,659 $1,088,809
Net Worth $26,914,092 $22,523,667 $18,427,637 $17,645,367 $12,139,629

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

Performance

  • Performance Information for Innovation Health Plan, Inc. is available beginning in 2017.
Access/Availability of Care
Info
Adult Access To Preventive/Ambulatory Health Services 2018 Plan State Avg Nat Avg 90th Pctl.
Adult Access (Age 20-44) To Preventive/Ambulatory Health Services 90.40% 92.43% 92.33% 95.45%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 93.57% 95.50% 95.64% 97.49%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 96.15% 97.15% 97.17% 98.45%
Adult Access To Preventive/Ambulatory Health Services Year Plan State Avg. Natl. Avg. 90th Pctl.
Adult Access (Age 20-44) To Preventive/Ambulatory Health Services 2017 90.18% 92.73% 92.45% 95.43%
2016 N/A 92.81% 92.73% 95.55%
2015 N/A 92.25% 92.83% 95.45%
2014 N/A 93.10% 92.91% 95.39%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 2017 92.91% 95.57% 95.61% 97.46%
2016 N/A 95.78% 95.78% 97.61%
2015 N/A 95.61% 95.90% 97.55%
2014 N/A 96.03% 95.85% 97.54%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 2017 99.54% 97.82% 97.07% 98.47%
2016 N/A 97.30% 97.19% 98.61%
2015 N/A 96.84% 97.32% 96.73%
2014 N/A 97.56% 97.50% 98.68%
Info
Alcohol and Other Drug Dependence Treatment 2018 Plan State Avg Nat Avg 90th Pctl.
Initiation of Alcohol and Other Drug Dependence Treatment - Total 32.84% 37.53% 35.68% 42.36%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 20.00% 49.35% 40.21% 51.02%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 33.33% 37.34% 35.51% 42.35%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 8.96% 14.69% 12.58% 17.04%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 0.00% 18.18% 16.91% 25.00%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 9.30% 14.58% 12.47% 16.97%
Alcohol and Other Drug Dependence Treatment Year Plan State Avg. Natl. Avg. 90th Pctl.
Initiation of Alcohol and Other Drug Dependence Treatment - Total 2017 28.33% 36.14% 36.11% 42.01%
2016 N/A 35.69% 32.93% 40.24%
2015 N/A 33.04% 33.42% 41.07%
2014 N/A 32.51% 35.63% 44.19%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2017 44.44% 40.06% 39.91% 52.54%
2016 N/A 40.15% 40.47% 51.96%
2015 N/A 37.03% 39.62% 50.00%
2014 N/A 37.09% 40.79% 52.00%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2017 27.49% 36.00% 35.97% 41.96%
2016 N/A 35.55% 32.64% 40.33%
2015 N/A 32.96% 33.20% 40.93%
2014 N/A 32.16% 35.21% 43.92%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 2017 11.11% 13.36% 12.65% 17.26%
2016 N/A 12.51% 11.46% 16.72%
2015 N/A 11.61% 12.46% 19.23%
2014 N/A 10.64% 13.66% 19.19%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2017 11.11% 14.40% 14.95% 23.85%
2016 N/A 11.28% 15.68% 23.73%
2015 N/A 12.06% 15.42% 22.12%
2014 N/A 13.00% 17.24% 25.29%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2017 11.11% 13.40% 12.55% 17.38%
2016 N/A 12.57% 11.32% 16.09%
2015 N/A 11.57% 12.34% 18.67%
2014 N/A 10.33% 13.45% 18.68%
Info
Child Access to Primary Care Practitioners 2018 Plan State Avg Nat Avg 90th Pctl.
12-24 month old Child Access to Primary Care Practitioners 100.00% 98.57% 98.19% 99.60%
25 month to 6 year old Child Access to Primary Care Practitioners 93.87% 94.36% 93.13% 97.39%
7-11 year old Child Access to Primary Care Practitioners 95.29% 95.22% 93.87% 98.50%
12-19 year old Child Access to Primary Care Practitioners 91.99% 92.36% 91.48% 97.12%
Child Access to Primary Care Practitioners Year Plan State Avg. Natl. Avg. 90th Pctl.
12-24 month old Child Access to Primary Care Practitioners 2017 97.80% 98.09% 97.93% 99.50%
2016 N/A 98.34% 98.09% 99.72%
2015 N/A 98.78% 98.03% 99.48%
2014 N/A 98.49% 97.87% 99.62%
25 month to 6 year old Child Access to Primary Care Practitioners 2017 95.48% 94.63% 92.58% 96.95%
2016 N/A 94.33% 92.60% 96.46%
2015 N/A 94.16% 92.67% 96.64%
2014 N/A 93.85% 92.33% 96.52%
7-11 year old Child Access to Primary Care Practitioners 2017 94.06% 95.40% 93.43% 98.48%
2016 N/A 94.38% 93.25% 98.25%
2015 N/A 94.23% 93.23% 97.92%
2014 N/A 93.78% 93.02% 97.87%
12-19 year old Child Access to Primary Care Practitioners 2017 91.05% 92.00% 91.08% 96.99%
2016 N/A 91.45% 90.76% 96.39%
2015 N/A 91.30% 90.66% 96.19%
2014 N/A 90.84% 90.44% 96.28%
Info
Prenatal and Postpartum Care 2018 Plan State Avg Nat Avg 90th Pctl.
Postpartum Care 66.46% 75.10% 75.89% 88.80%
Timeliness of Prenatal Care 89.24% 88.15% 84.75% 94.17%
Prenatal and Postpartum Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Postpartum Care 2017 56.59% 73.45% 75.05% 88.13%
2016 N/A 74.50% 73.95% 88.85%
2015 N/A 73.91% 73.72% 87.50%
2014 N/A 77.29% 77.64% 88.65%
Timeliness of Prenatal Care 2017 81.01% 86.37% 84.34% 94.89%
2016 N/A 86.71% 85.57% 96.28%
2015 N/A 86.80% 84.28% 94.56%
2014 N/A 86.83% 88.00% 96.23%
Behavioral Health
Info
Antidepressant Medication Management 2018 Plan State Avg Nat Avg 90th Pctl.
Antidepressant Medication Management - Effective Acute Phase Treatment 76.40% 71.96% 68.64% 77.59%
Antidepressant Medication Management - Effective Continuation Phase Treatment 55.28% 54.22% 53.01% 60.39%
Antidepressant Medication Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Antidepressant Medication Management - Effective Acute Phase Treatment 2017 78.19% 71.12% 67.11% 75.76%
2016 N/A 70.29% 66.56% 74.77%
2015 N/A 67.61% 65.82% 74.06%
2014 N/A 68.52% 65.88% 75.35%
Antidepressant Medication Management - Effective Continuation Phase Treatment 2017 62.77% 54.87% 51.53% 60.24%
2016 N/A 53.51% 50.69% 58.60%
2015 N/A 49.81% 50.15% 57.56%
2014 N/A 50.31% 49.83% 59.11%
Info
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication 2018 Plan State Avg Nat Avg 90th Pctl.
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Initiation 32.26% 42.91% 39.85% 50.42%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 25.00% 40.32% 48.73% 60.57%
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication Year Plan State Avg. Natl. Avg. 90th Pctl.
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Initiation 2017 38.24% 41.27% 41.13% 50.83%
2016 N/A 41.91% 38.93% 48.61%
2015 N/A 41.43% 38.13% 50.00%
2014 N/A 39.00% 38.01% 46.81%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 2017 40.00% 55.09% 47.07% 58.44%
2016 N/A 46.92% 45.82% 56.86%
2015 N/A 49.06% 46.18% 58.06%
2014 N/A 46.49% 45.70% 57.75%
Info
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence 2018 Plan State Avg Nat Avg 90th Pctl.
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Follow-Up After Emergency Department Visit for Mental Illness 2018 Plan State Avg Nat Avg 90th Pctl.
Follow-Up After Emergency Department Visit for Mental Illness Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Follow-up After Hospitalization For Mental Illness 2018 Plan State Avg Nat Avg 90th Pctl.
Follow-up After Hospitalization For Mental Illness within 7 days after hospital discharge 48.48% 48.09% 44.98% 60.38%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 75.76% 69.84% 66.68% 80.29%
Follow-up After Hospitalization For Mental Illness Year Plan State Avg. Natl. Avg. 90th Pctl.
Follow-up After Hospitalization For Mental Illness within 7 days after hospital discharge 2017 67.65% 52.18% 46.63% 62.81%
2016 N/A 52.99% 52.06% 67.31%
2015 N/A 47.66% 50.57% 67.57%
2014 N/A 51.82% 52.21% 70.33%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 2017 82.35% 69.80% 68.66% 82.58%
2016 N/A 73.85% 71.36% 84.17%
2015 N/A 71.58% 69.72% 83.80%
2014 N/A 72.52% 70.72% 85.71%
Effectiveness of Care
Info
Asthma Medication Management 2018 Plan State Avg Nat Avg 90th Pctl.
Asthma Medication Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Cardiovascular Disease Management 2018 Plan State Avg Nat Avg 90th Pctl.
Controlling High Blood Pressure 58.15% 60.55% N/A N/A
Persistence of Beta-Blockers 87.50% 83.54% 82.37% 89.29%
Cardiovascular Disease Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Controlling High Blood Pressure 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Persistence of Beta-Blockers 2017 90.00% 85.80% 85.18% 93.41%
2016 N/A 90.70% 83.61% 90.83%
2015 N/A 88.70% 84.68% 91.00%
2014 N/A 84.03% 83.50% 91.43%
Info
Common Childhood Illnesses 2018 Plan State Avg Nat Avg 90th Pctl.
Appropriate Testing for Children With Pharyngitis 93.99% 92.74% 87.97% 94.94%
Common Childhood Illnesses Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Testing for Children With Pharyngitis 2017 94.64% 92.30% 87.45% 94.64%
2016 N/A 90.38% 84.50% 93.75%
2015 N/A 90.13% 83.12% 93.11%
2014 N/A 88.64% 83.29% 91.40%
Info
Diabetes Care and Management 2018 Plan State Avg Nat Avg 90th Pctl.
Comprehensive Diabetes Care-Medical Attention for Nephropathy 90.02% 63.70% 62.59% 77.37%
Comprehensive Diabetes Care-Rate of Eye Exams 48.91% 62.46% 57.79% 66.33%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 30.17% 90.73% 90.33% 93.43%
Comprehensive Diabetes Care-Testing for HbA1c 90.27% 56.58% 54.40% 69.68%
Diabetes Care and Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Comprehensive Diabetes Care-Medical Attention for Nephropathy 2017 87.35% 63.40% 60.82% 76.41%
2016 N/A 60.88% 61.06% 78.35%
2015 N/A 61.03% 58.80% 75.68%
2014 N/A 63.33% 63.85% 76.00%
Comprehensive Diabetes Care-Rate of Eye Exams 2017 48.42% 62.51% 57.48% 67.15%
2016 N/A 58.36% 56.62% 66.39%
2015 N/A 57.59% 55.81% 66.67%
2014 N/A 59.12% 58.53% 68.61%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 2017 38.69% 90.80% 90.38% 93.61%
2016 N/A 90.56% 90.03% 92.71%
2015 N/A 91.11% 90.10% 93.40%
2014 N/A 86.26% 84.72% 89.60%
Comprehensive Diabetes Care-Testing for HbA1c 2017 90.27% 56.95% 54.06% 70.69%
2016 N/A 58.46% 52.96% 72.04%
2015 N/A 57.15% 52.47% 70.44%
2014 N/A 57.54% 54.98% 71.93%
Info
Drug Therapy in Rheumatoid Arthritis 2018 Plan State Avg Nat Avg 90th Pctl.
Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis 79.31% 88.42% 87.69% 94.27%
Drug Therapy in Rheumatoid Arthritis Year Plan State Avg. Natl. Avg. 90th Pctl.
Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis 2017 86.67% 90.16% 88.62% 93.75%
2016 N/A 89.05% 87.87% 93.92%
2015 N/A 89.72% 87.84% 92.86%
2014 N/A 88.05% 87.86% 93.59%
Info
Immunizations 2018 Plan State Avg Nat Avg 90th Pctl.
Childhood Immunization for Multiple Diseases Including Chicken Pox 70.99% 80.96% 79.32% 88.06%
Childhood Immunization for Multiple Diseases Including Pneumovax 67.18% 79.46% 77.50% 86.62%
Flu Vaccinations for Adults Ages 65 and Older 58.97% 53.53% 51.93% 61.07%
Immunizations Year Plan State Avg. Natl. Avg. 90th Pctl.
Childhood Immunization for Multiple Diseases Including Chicken Pox 2017 65.03% 73.55% 79.44% 89.14%
2016 N/A 75.86% 78.93% 89.03%
2015 N/A 74.15% 78.59% 88.08%
2014 N/A 72.96% 80.18% 88.07%
Childhood Immunization for Multiple Diseases Including Pneumovax 2017 62.84% 80.09% 77.67% 87.61%
2016 N/A 82.08% 77.04% 87.50%
2015 N/A 79.45% 76.49% 87.10%
2014 N/A 78.11% 78.13% 86.26%
Flu Vaccinations for Adults Ages 65 and Older 2017 0.49% 0.53% 49.33% 59.27%
2016 N/A 47.13% 47.47% 58.70%
2015 N/A 0.50% 47.85% 58.01%
2014 N/A 0.52% 49.45% 59.73%
Info
Persistent Medications 2018 Plan State Avg Nat Avg 90th Pctl.
Annual Monitoring for Patients on Persistent Medications 89.27% 86.50% 84.47% 88.08%
Persistent Medications Year Plan State Avg. Natl. Avg. 90th Pctl.
Annual Monitoring for Patients on Persistent Medications 2017 86.17% 85.73% 83.71% 87.04%
2016 N/A 84.90% 83.34% 87.04%
2015 N/A 83.34% 82.94% 86.72%
2014 N/A 83.28% 82.33% 86.25%
Info
Pharmacotherapy of COPD Exacerbation 2018 Plan State Avg Nat Avg 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 100.00% 85.49% 78.92% 87.88%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 80.00% 76.41% 74.76% 83.55%
Pharmacotherapy of COPD Exacerbation Year Plan State Avg. Natl. Avg. 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 2017 92.86% 80.88% 79.87% 87.50%
2016 N/A 84.12% 76.30% 85.98%
2015 N/A 78.48% 79.09% 87.10%
2014 N/A 80.03% 80.14% 86.90%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 2017 92.86% 78.84% 76.26% 84.38%
2016 N/A 79.54% 70.70% 81.82%
2015 N/A 72.98% 75.30% 84.56%
2014 N/A 75.53% 75.28% 83.54%
Info
Preventive Care 2018 Plan State Avg Nat Avg 90th Pctl.
Breast Cancer Screening 68.21% 72.13% 73.73% 81.17%
Chlamydia Screening in Women-all Age groups 45.71% 52.91% 51.41% 67.76%
Colorectal Cancer Screening 47.69% 64.94% 64.37% 76.52%
Preventive Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Breast Cancer Screening 2017 64.69% 71.85% 72.81% 80.91%
2016 N/A 71.80% 72.90% 80.63%
2015 N/A 72.07% 73.08% 81.53%
2014 N/A 72.22% 73.52% 81.91%
Chlamydia Screening in Women-all Age groups 2017 47.00% 51.46% 50.16% 66.08%
2016 N/A 49.79% 48.98% 63.50%
2015 N/A 47.89% 52.32% 64.06%
2014 N/A 48.07% 51.65% 63.48%
Colorectal Cancer Screening 2017 46.96% 65.16% 62.43% 74.72%
2016 N/A 64.67% 61.71% 74.09%
2015 N/A 63.31% 62.32% 73.84%
2014 N/A 63.41% 64.06% 74.86%
Info
Spirometry Testing 2018 Plan State Avg Nat Avg 90th Pctl.
Use of Spirometry Testing in the Assessment and diagnosis of COPD 46.67% 44.14% 41.48% 50.95%
Spirometry Testing Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Spirometry Testing in the Assessment and diagnosis of COPD 2017 55.17% 43.12% 41.90% 50.52%
2016 N/A 42.48% 42.55% 51.02%
2015 N/A 46.31% 42.44% 51.66%
2014 N/A 42.48% 42.16% 51.85%
Info
Statin Therapy 2018 Plan State Avg Nat Avg 90th Pctl.
Statin Therapy Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Weight Assessment and Counseling 2018 Plan State Avg Nat Avg 90th Pctl.
Adult BMI Assessment 70.41% 82.61% 81.07% 93.61%
Children/Adolescents BMI Assessment - Total 64.96% 73.74% 72.87% 90.00%
Children/Adolescents BMI Assessment - Ages 3-11 68.67% 76.94% 74.00% 90.91%
Children/Adolescents BMI Assessment - Ages 12-17 59.26% 69.73% 71.39% 88.97%
Counseling for Nutrition for Children/Adolescents - Total 66.18% 71.79% 67.72% 85.06%
Counseling for Nutrition for Children/Adolescents - Ages 3-11 69.48% 75.91% 69.85% 86.21%
Counseling for Nutrition for Children/Adolescents - Ages 12-17 61.11% 66.37% 64.92% 84.29%
Counseling for Physical Activity for Children/Adolescents - Total 61.56% 66.42% 63.08% 81.32%
Counseling for Physical Activity for Children/Adolescents - Ages 3-11 61.04% 65.48% 61.70% 80.92%
Counseling for Physical Activity for Children/Adolescents - Ages 12-17 62.35% 67.51% 64.79% 84.03%
Weight Assessment and Counseling Year Plan State Avg. Natl. Avg. 90th Pctl.
Adult BMI Assessment 2017 61.32% 79.49% 79.78% 93.20%
2016 N/A 77.87% 76.17% 91.85%
2015 N/A 75.90% 74.19% 91.76%
2014 N/A 76.28% 75.36% 91.20%
Children/Adolescents BMI Assessment - Total 2017 61.56% 70.41% 70.59% 88.08%
2016 N/A 69.07% 65.62% 88.08%
2015 N/A 60.49% 60.37% 83.78%
2014 N/A 61.63% 61.08% 85.37%
Children/Adolescents BMI Assessment - Ages 3-11 2017 63.97% 71.37% 71.84% 88.89%
2016 N/A 70.86% 67.11% 88.19%
2015 N/A 63.37% 61.61% 84.69%
2014 N/A 60.91% 60.86% 86.64%
Children/Adolescents BMI Assessment - Ages 12-17 2017 57.93% 68.96% 68.94% 87.82%
2016 N/A 66.72% 64.28% 87.29%
2015 N/A 56.47% 58.77% 83.62%
2014 N/A 62.60% 61.34% 85.47%
Counseling for Nutrition for Children/Adolescents - Total 2017 59.61% 69.47% 65.50% 83.21%
2016 N/A 66.76% 61.76% 83.68%
2015 N/A 63.88% 58.94% 80.79%
2014 N/A 65.02% 60.64% 80.05%
Counseling for Nutrition for Children/Adolescents - Ages 3-11 2017 63.56% 71.63% 68.20% 84.82%
2016 N/A 69.25% 64.59% 85.48%
2015 N/A 67.34% 61.49% 82.89%
2014 N/A 68.39% 63.58% 84.21%
Counseling for Nutrition for Children/Adolescents - Ages 12-17 2017 53.66% 66.54% 61.92% 80.26%
2016 N/A 63.42% 58.79% 81.87%
2015 N/A 59.10% 55.64% 77.85%
2014 N/A 60.63% 56.75% 76.92%
Counseling for Physical Activity for Children/Adolescents - Total 2017 51.58% 64.30% 59.96% 77.32%
2016 N/A 60.41% 55.96% 79.44%
2015 N/A 59.53% 54.50% 78.85%
2014 N/A 62.13% 57.09% 77.30%
Counseling for Physical Activity for Children/Adolescents - Ages 3-11 2017 48.58% 62.31% 58.84% 75.00%
2016 N/A 58.91% 54.72% 76.52%
2015 N/A 58.85% 53.14% 76.08%
2014 N/A 60.95% 55.78% 76.72%
Counseling for Physical Activity for Children/Adolescents - Ages 12-17 2017 56.10% 66.86% 61.40% 79.89%
2016 N/A 62.44% 58.47% 83.05%
2015 N/A 60.35% 56.39% 80.86%
2014 N/A 63.65% 58.73% 78.07%
Health Plan Stability/Descriptive
Info
Administrative Data 2018 Plan State Avg Nat Avg 90th Pctl.
Administrative Ratio 0.16 0.13 86.19 92.68
Medical Cost Ratio 0.79 0.83 92.60 95.85
Number of Enrollees 14,892 140,630 92 96
Number of Physicians 84,706 94,540 87 95
Premium Per Member Per Month $423 $499 N/A N/A
Profit/Loss Ratio 0.05 0.05 N/A N/A
Administrative Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Administrative Ratio 2017 0.17 0.12 86.39 93.13
2016 0.19 0.15 N/A N/A
2015 0.19 0.14 N/A N/A
2014 0.23 0.14 N/A N/A
Medical Cost Ratio 2017 0.82 0.83 93.13 96.59
2016 0.88 0.83 N/A N/A
2015 0.73 0.82 N/A N/A
2014 0.73 0.81 N/A N/A
Number of Enrollees 2017 21,040 133,992 92 97
2016 27,510 136,796 N/A N/A
2015 22,874 124,097 N/A N/A
2014 18,580 115,428 N/A N/A
Number of Physicians 2017 79,982 81,926 87 95
2016 72,651 73,426 N/A N/A
2015 65,263 90,027 N/A N/A
2014 50,861 63,157 N/A N/A
Premium Per Member Per Month 2017 $352 $370 N/A N/A
2016 $313 $370 N/A N/A
2015 $318 $375 N/A N/A
2014 $335 $412 N/A N/A
Profit/Loss Ratio 2017 0.01 0.05 N/A N/A
2016 -0.07 0.03 N/A N/A
2015 0.07 0.03 N/A N/A
2014 0.02 0.06 N/A N/A
Info
Board Certification Rates for Providers 2018 Plan State Avg Nat Avg 90th Pctl.
Board Certification for Geriatricians 58.33% 69.82% N/A N/A
Board Certification for Pediatricians 85.98% 86.24% N/A N/A
Board Certification Rate for Family Medicine Physicians 85.23% 83.01% N/A N/A
Board Certification Rate for Internal Medicine Physicians 74.94% 79.67% N/A N/A
Board Certification Rate for OB/GYN Providers 83.10% 84.25% N/A N/A
Board Certification Rate for Other Specialists 74.79% 81.57% N/A N/A
Board Certification Rates for Providers Year Plan State Avg. Natl. Avg. 90th Pctl.
Board Certification for Geriatricians 2017 63.00% 71.38% N/A N/A
2016 N/A 73.44% N/A N/A
2015 N/A 71.06% N/A N/A
2014 N/A 74.73% N/A N/A
Board Certification for Pediatricians 2017 84.00% 85.50% N/A N/A
2016 N/A 87.02% N/A N/A
2015 N/A 88.14% N/A N/A
2014 N/A 88.13% N/A N/A
Board Certification Rate for Family Medicine Physicians 2017 81.00% 81.38% N/A N/A
2016 N/A 80.32% N/A N/A
2015 N/A 82.53% N/A N/A
2014 N/A 82.93% N/A N/A
Board Certification Rate for Internal Medicine Physicians 2017 74.00% 81.00% N/A N/A
2016 N/A 81.15% N/A N/A
2015 N/A 82.59% N/A N/A
2014 N/A 83.98% N/A N/A
Board Certification Rate for OB/GYN Providers 2017 82.00% 83.00% N/A N/A
2016 N/A 83.36% N/A N/A
2015 N/A 83.51% N/A N/A
2014 N/A 83.71% N/A N/A
Board Certification Rate for Other Specialists 2017 74.00% 81.88% N/A N/A
2016 N/A 83.25% N/A N/A
2015 N/A 82.88% N/A N/A
2014 N/A 84.44% N/A N/A
Info
Financial Data 2018 Plan State Avg Nat Avg 90th Pctl.
Income $3,296,121 $47,837,732 N/A N/A
Net Worth $26,914,092 $303,649,748 N/A N/A
Premiums Earned $96,247,408 $879,518,893 N/A N/A
Financial Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Income 2017 $277,269 $34,422,501 N/A N/A
2016 $-4,890,121 $38,212,136 N/A N/A
2015 $3,438,659 $19,029,685 N/A N/A
2014 $1,088,809 $50,732,622 N/A N/A
Net Worth 2017 $22,523,667 $263,890,874 N/A N/A
2016 $18,427,637 $267,217,323 N/A N/A
2015 $17,645,367 $237,291,717 N/A N/A
2014 $12,139,629 $250,764,247 N/A N/A
Premiums Earned 2017 $104,799,970 $645,600,589 N/A N/A
2016 $95,876,576 $644,862,921 N/A N/A
2015 $79,978,908 $552,705,214 N/A N/A
2014 $42,248,104 $470,221,984 N/A N/A
Info
Years in Business 2018 Plan State Avg Nat Avg 90th Pctl.
Years in Business N/A 36 N/A N/A
Years in Business Year Plan State Avg. Natl. Avg. 90th Pctl.
Years in Business 2017 N/A 35 N/A N/A
2016 N/A 34 N/A N/A
2015 N/A 33 N/A N/A
2014 N/A 32 N/A N/A
Member Satisfaction
Info
Member Satisfaction 2018 Plan State Avg Nat Avg 90th Pctl.
Getting Care Quickly N/A 85.27% 85.23% 89.89%
Getting Needed Care N/A 85.53% 86.33% 90.45%
How Well Doctors Communicate N/A 94.70% 95.31% 97.22%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 55.73% 64.78% 64.53% 76.79%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 81.93% 84.82% 84.41% 88.57%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 69.03% 76.02% 78.17% 83.95%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 80.95% 84.08% 85.14% 89.78%
Member Satisfaction Year Plan State Avg. Natl. Avg. 90th Pctl.
Getting Care Quickly 2017 N/A 87.22% 85.34% 89.83%
2016 N/A 85.81% 85.14% 90.00%
2015 N/A 85.61% 85.00% 89.71%
2014 N/A 86.12% 85.79% 90.17%
Getting Needed Care 2017 N/A 87.44% 86.71% 90.37%
2016 N/A 86.38% 87.25% 91.54%
2015 N/A 86.51% 86.79% 91.23%
2014 N/A 88.34% 87.95% 92.13%
How Well Doctors Communicate 2017 N/A 94.74% 95.10% 96.91%
2016 N/A 95.22% 95.39% 97.21%
2015 N/A 94.90% 95.20% 97.10%
2014 N/A 95.30% 95.26% 97.16%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 2017 50.39% 61.26% 62.44% 75.00%
2016 N/A 62.47% 62.27% 74.92%
2015 N/A 62.71% 62.65% 74.57%
2014 N/A 58.77% 64.71% 76.75%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 2017 77.94% 83.86% 84.62% 88.77%
2016 N/A 83.44% 84.72% 88.74%
2015 N/A 83.49% 83.85% 89.05%
2014 N/A 85.38% 84.24% 88.27%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 2017 75.00% 76.98% 77.27% 82.99%
2016 N/A 77.49% 77.19% 83.29%
2015 N/A 76.25% 76.99% 82.76%
2014 N/A 79.49% 78.26% 83.66%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 2017 78.64% 83.95% 84.60% 89.86%
2016 N/A 84.65% 84.57% 88.37%
2015 N/A 83.85% 84.24% 88.77%
2014 N/A 84.37% 84.70% 88.96%
Overuse/Appropriateness
Info
Antipsychotics 2018 Plan State Avg Nat Avg 90th Pctl.
Antipsychotics Year Plan State Avg. Natl. Avg. 90th Pctl.
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Cervical Cancer Screening in Adolescent Females 2018 Plan State Avg Nat Avg 90th Pctl.
Cervical Cancer Screening in Adolescent Females Year Plan State Avg. Natl. Avg. 90th Pctl.
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Lower Back Pain 2018 Plan State Avg Nat Avg 90th Pctl.
Use of Imaging for Low Back Pain 73.45% 74.77% 75.11% 82.95%
Lower Back Pain Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Imaging for Low Back Pain 2017 70.73% 73.85% 75.16% 82.29%
2016 N/A 73.58% 72.67% 80.11%
2015 N/A 74.11% 74.57% 81.25%
2014 N/A 72.44% 74.82% 81.95%
Info
Respiratory 2018 Plan State Avg Nat Avg 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 93.70% 92.50% 91.22% 95.48%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 31.44% 33.60% 33.16% 48.28%
Respiratory Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 2017 93.88% 90.92% 89.19% 94.59%
2016 N/A 88.81% 88.51% 94.80%
2015 N/A 87.71% 88.11% 94.26%
2014 N/A 87.19% 87.39% 94.57%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 2017 24.21% 30.67% 30.99% 49.52%
2016 N/A 27.03% 28.19% 41.72%
2015 N/A 25.68% 26.11% 38.04%
2014 N/A 25.67% 25.79% 36.11%
Info
Use of Opiods 2018 Plan State Avg Nat Avg 90th Pctl.
Use of Opiods Year Plan State Avg. Natl. Avg. 90th Pctl.
Utilization
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Antibiotic Utilization 2018 Plan State Avg Nat Avg 90th Pctl.
Antibiotic Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Child and Adolescent Well Child Visits 2018 Plan State Avg Nat Avg 90th Pctl.
Well Child Visits in the First 15 Months of Life 73.20% 85.93% 81.33% 90.72%
Well Child Visits in the 3rd - 6th Years 83.42% 83.85% 80.95% 91.86%
Adolescent Well-Care Visits 51.60% 53.54% 52.57% 71.93%
Child and Adolescent Well Child Visits Year Plan State Avg. Natl. Avg. 90th Pctl.
Well Child Visits in the First 15 Months of Life 2017 81.14% 85.68% 80.53% 90.78%
2016 N/A 83.40% 80.76% 90.36%
2015 N/A 84.01% 79.35% 89.12%
2014 N/A 82.63% 79.12% 89.64%
Well Child Visits in the 3rd - 6th Years 2017 81.21% 83.18% 79.11% 91.03%
2016 N/A 82.50% 78.30% 90.11%
2015 N/A 80.48% 77.75% 89.74%
2014 N/A 80.03% 77.37% 88.75%
Adolescent Well-Care Visits 2017 50.26% 53.24% 50.46% 70.44%
2016 N/A 50.35% 49.68% 67.70%
2015 N/A 49.34% 48.26% 64.50%
2014 N/A 48.09% 47.51% 64.76%
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Mental Health Utilization 2018 Plan State Avg Nat Avg 90th Pctl.
Mental Health Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Plan All-Cause Readmissions 2018 Plan State Avg Nat Avg 90th Pctl.
Plan All-Cause Readmissions Year Plan State Avg. Natl. Avg. 90th Pctl.

2018 data updated on: 11/14/2019