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KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC.

Company Information

  • Company Providing Plan:Kaiser Foundation Group
  • Address:2101 EAST JEFFERSON STREET
    ROCKVILLE MD 20852
  • Telephone :301-816-2424
  • Website:WWW.KP.ORG
2021
Number of Enrollees: 167,944
PMPM: $524
Number of Physicians: 26,554
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

Arlington, Farifax, Fredericksburg, Loudon, Prince William and Stafford

Cities

Alexandria, Arlington, Ashburn, Burke, Fairfax, Falls Church, Fredericksburg, Leesburg, Manassas, McClean, Penderbrook, Reston, Springfield, Stafford, Sterling, Tysons Corner and Woodbridge

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

Administrative Data

2021 2020 2019 2018 2017
Number of Enrollees 167,944 165,398 166,997 204,481 180,972
PMPM $524 $540 $485 $422 $381
*Medical Cost Ratio 95% 89% 91% 92% 93%
*Administrative Ratio 6% 7% 7% 8% 9%
*Profit/Loss Ratio -1% 3% 2% 1% -2%
Number of Physicians 26,554 24,779 22,526 21,018 21,796

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

Financial Data

2021 2020 2019 2018 2017
Premiums Earned $1,060,133,281 $1,088,936,863 $987,167,018 $1,111,182,458 $826,114,677
*Income ($42,097,250) $158,618,704 $69,924,687 $23,848,771 ($85,020,295)
*Net Worth $671,289,215 $485,822,267 $350,508,538 $436,957,951 $160,228,051

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

Performance

Access/Availability of Care
Info
Adult Access To Preventive/Ambulatory Health Services 2021 Plan State Avg Nat Avg 90th Pctl.
Adult Access (Age 20-44) To Preventive/Ambulatory Health Services 93.97% 94.34% 93.47% 96.29%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 95.75% 96.22% 96.12% 97.63%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 96.48% 96.96% 96.96% 98.35%
Adult Access To Preventive/Ambulatory Health Services Year Plan State Avg. Natl. Avg. 90th Pctl.
Adult Access (Age 20-44) To Preventive/Ambulatory Health Services 2020 94.83% 93.90% 92.88% 95.71%
2019 94.23% 92.78% 92.66% 95.76%
2018 93.91% 92.43% 92.33% 95.45%
2017 93.61% 92.73% 92.45% 95.43%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 2020 96.59% 96.11% 95.86% 97.54%
2019 96.41% 95.78% 95.87% 97.69%
2018 96.35% 95.50% 95.64% 97.49%
2017 96.17% 95.57% 95.61% 97.46%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 2020 97.24% 96.79% 96.95% 98.30%
2019 97.00% 97.13% 97.14% 98.42%
2018 96.93% 97.15% 97.17% 98.45%
2017 96.99% 97.82% 97.07% 98.47%
Info
Alcohol and Other Drug Dependence Treatment 2021 Plan State Avg Nat Avg 90th Pctl.
Initiation of Alcohol and Other Drug Dependence Treatment - Total 56.75% 38.29% 34.72% 43.21%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 46.81% 45.84% 41.60% 52.08%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 56.98% 38.22% 34.53% 43.21%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 25.47% 14.66% 11.91% 15.33%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 34.04% 16.85% 15.29% 22.05%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 25.26% 14.60% 11.85% 15.56%
Alcohol and Other Drug Dependence Treatment Year Plan State Avg. Natl. Avg. 90th Pctl.
Initiation of Alcohol and Other Drug Dependence Treatment - Total 2020 67.70% 40.49% 36.39% 45.24%
2019 58.28% 39.13% 35.63% 41.36%
2018 56.84% 37.53% 35.68% 42.36%
2017 54.22% 36.14% 36.11% 42.01%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2020 63.33% 35.48% 44.95% 59.06%
2019 57.32% 36.19% 42.41% 54.29%
2018 61.90% 49.35% 40.21% 51.02%
2017 55.34% 40.06% 39.91% 52.54%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2020 67.82% 40.55% 36.18% 45.12%
2019 58.31% 39.20% 35.47% 40.96%
2018 56.68% 37.34% 35.51% 42.35%
2017 54.18% 36.00% 35.97% 41.96%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 2020 27.68% 15.16% 12.46% 17.48%
2019 24.18% 13.47% 12.31% 16.44%
2018 29.63% 14.69% 12.58% 17.04%
2017 24.19% 13.36% 12.65% 17.26%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2020 31.67% 14.80% 17.76% 27.27%
2019 30.49% 10.34% 16.48% 27.14%
2018 47.62% 18.18% 16.91% 25.00%
2017 40.78% 14.40% 14.95% 23.85%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2020 27.57% 15.15% 12.33% 17.48%
2019 23.96% 13.52% 12.20% 16.41%
2018 29.05% 14.58% 12.47% 16.97%
2017 23.56% 13.40% 12.55% 17.38%
Info
Prenatal and Postpartum Care 2021 Plan State Avg Nat Avg 90th Pctl.
Postpartum Care 97.08% 80.79% 81.70% 93.89%
Timeliness of Prenatal Care 99.27% 86.12% 83.24% 94.16%
Prenatal and Postpartum Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Postpartum Care 2020 95.83% 74.05% 78.11% 92.47%
2019 97.57% 78.66% 80.52% 91.97%
2018 97.00% 75.10% 75.89% 88.80%
2017 95.13% 73.45% 75.05% 88.13%
Timeliness of Prenatal Care 2020 99.17% 79.76% 81.82% 93.92%
2019 96.11% 86.76% 85.57% 95.33%
2018 97.00% 88.15% 84.75% 94.17%
2017 97.32% 86.37% 84.34% 94.89%
Behavioral Health
Info
Adherence to Antipsychotic Medications for Individuals with Schizophrenia 2021 Plan State Avg Nat Avg 90th Pctl.
Adherence to Antipsychotic Medications for Individuals With Schizophrenia 72.84% 67.45% 68.64% 79.03%
Adherence to Antipsychotic Medications for Individuals with Schizophrenia Year Plan State Avg. Natl. Avg. 90th Pctl.
Adherence to Antipsychotic Medications for Individuals With Schizophrenia 2020 100.00% 70.63% 69.41% 79.41%
2019 N/A N/A N/A N/A
2018 N/A N/A N/A N/A
2017 N/A N/A N/A N/A
Info
Antidepressant Medication Management 2021 Plan State Avg Nat Avg 90th Pctl.
Antidepressant Medication Management - Effective Acute Phase Treatment 85.63% 79.35% 76.18% 83.11%
Antidepressant Medication Management - Effective Continuation Phase Treatment 59.96% 61.51% 59.75% 67.55%
Antidepressant Medication Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Antidepressant Medication Management - Effective Acute Phase Treatment 2020 82.91% 77.14% 73.70% 81.07%
2019 79.77% 73.53% 71.19% 78.79%
2018 75.60% 71.96% 68.64% 77.59%
2017 73.31% 71.12% 67.11% 75.76%
Antidepressant Medication Management - Effective Continuation Phase Treatment 2020 54.59% 59.69% 57.32% 64.22%
2019 53.92% 55.44% 54.90% 62.18%
2018 49.08% 54.22% 53.01% 60.39%
2017 49.68% 54.87% 51.53% 60.24%
Info
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication 2021 Plan State Avg Nat Avg 90th Pctl.
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Initiation 75.33% 41.24% 36.60% 48.10%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 76.25% 45.63% 45.94% 60.34%
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication Year Plan State Avg. Natl. Avg. 90th Pctl.
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Initiation 2020 72.47% 45.87% 41.24% 50.34%
2019 64.46% 42.67% 40.66% 51.30%
2018 70.49% 42.91% 39.85% 50.42%
2017 70.23% 41.27% 41.13% 50.83%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 2020 81.68% 56.56% 48.67% 59.32%
2019 67.27% 50.69% 47.95% 58.82%
2018 73.48% 40.32% 48.73% 60.57%
2017 76.64% 55.09% 47.07% 58.44%
Info
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence 2021 Plan State Avg Nat Avg 90th Pctl.
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence within 7 days after hospital discharge 22.49% 12.52% 12.71% 21.05%
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence within 30 days after hospital discharge 33.97% 16.65% 17.10% 27.59%
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence Year Plan State Avg. Natl. Avg. 90th Pctl.
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence within 7 days after hospital discharge 2020 17.95% 14.52% 13.45% 21.43%
2019 21.83% 8.56% 11.48% 18.26%
2018 18.22% 9.96% 10.81% 17.07%
2017 N/A N/A N/A N/A
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence within 30 days after hospital discharge 2020 34.36% 19.84% 18.03% 26.07%
2019 36.68% 14.74% 15.35% 24.56%
2018 27.33% 13.52% 14.98% 23.11%
2017 N/A N/A N/A N/A
Info
Follow-Up After Emergency Department Visit for Mental Illness 2021 Plan State Avg Nat Avg 90th Pctl.
Follow-Up After Emergency Department Visit for Mental Illness within 7 days after hospital discharge 46.80% 44.60% 50.67% 70.54%
Follow-Up After Emergency Department Visit for Mental Illness within 30 days after hospital discharge 62.07% 61.91% 64.91% 82.58%
Follow-Up After Emergency Department Visit for Mental Illness Year Plan State Avg. Natl. Avg. 90th Pctl.
Follow-Up After Emergency Department Visit for Mental Illness within 7 days after hospital discharge 2020 54.05% 48.22% 47.90% 68.29%
2019 44.76% 45.64% 48.70% 70.67%
2018 46.08% 38.46% 46.62% 66.57%
2017 N/A N/A N/A N/A
Follow-Up After Emergency Department Visit for Mental Illness within 30 days after hospital discharge 2020 68.21% 59.38% 62.36% 78.77%
2019 59.55% 60.35% 62.59% 77.75%
2018 59.89% 53.38% 60.75% 77.57%
2017 N/A N/A N/A N/A
Info
Follow-up After Hospitalization For Mental Illness 2021 Plan State Avg Nat Avg 90th Pctl.
Follow-up After Hospitalization For Mental Illness within 7 days after hospital discharge 76.27% 49.75% 48.70% 63.60%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 88.57% 73.29% 71.44% 82.61%
Follow-up After Hospitalization For Mental Illness Year Plan State Avg. Natl. Avg. 90th Pctl.
Follow-up After Hospitalization For Mental Illness within 7 days after hospital discharge 2020 78.55% 49.46% 49.62% 63.68%
2019 65.71% 49.77% 45.66% 58.20%
2018 69.38% 48.09% 44.98% 60.38%
2017 68.56% 52.18% 46.63% 62.81%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 2020 88.28% 72.67% 70.00% 79.46%
2019 77.95% 72.38% 67.81% 80.65%
2018 79.12% 69.84% 66.68% 80.29%
2017 80.36% 69.80% 68.66% 82.58%
Effectiveness of Care
Info
Asthma Medication Ratio 2021 Plan State Avg Nat Avg 90th Pctl.
Asthma Medication Ratio - Ages 5-11 95.98% 92.78% 89.65% 96.23%
Asthma Medication Ratio - Ages 12-18 95.36% 85.93% 83.38% 90.21%
Asthma Medication Ratio - Ages 19-50 90.44% 82.29% 78.35% 87.18%
Asthma Medication Ratio - Ages 51-64 93.69% 86.60% 83.59% 90.22%
Asthma Medication Ratio - Total 92.39% 85.07% 81.23% 87.41%
Asthma Medication Ratio Year Plan State Avg. Natl. Avg. 90th Pctl.
Asthma Medication Ratio - Ages 5-11 2020 96.73% 93.70% 89.98% 95.00%
2019 92.36% 86.54% 85.94% 93.20%
2018 89.80% 85.26% 87.15% 93.97%
2017 87.64% 86.06% 86.90% 93.55%
Asthma Medication Ratio - Ages 12-18 2020 91.85% 84.76% 81.90% 89.30%
2019 89.52% 84.88% 77.43% 86.25%
2018 85.04% 84.71% 78.77% 84.72%
2017 80.83% 84.80% 76.69% 85.94%
Asthma Medication Ratio - Ages 19-50 2020 84.13% 78.90% 75.62% 84.47%
2019 87.30% 80.50% 74.07% 81.27%
2018 83.43% 82.69% 75.11% 82.84%
2017 83.44% 78.94% 74.23% 81.70%
Asthma Medication Ratio - Ages 51-64 2020 90.27% 85.69% 82.47% 89.38%
2019 92.88% 86.85% 81.27% 88.51%
2018 89.62% 86.11% 82.81% 89.49%
2017 89.47% 89.17% 82.83% 89.28%
Asthma Medication Ratio - Total 2020 88.02% 83.04% 79.76% 85.85%
2019 90.16% 83.92% 78.10% 84.69%
2018 86.65% 84.32% 79.34% 85.18%
2017 86.00% 84.01% 79.04% 85.85%
Info
Cardiovascular Disease Management 2021 Plan State Avg Nat Avg 90th Pctl.
Controlling High Blood Pressure 79.87% 60.64% 59.95% 73.24%
Persistence of Beta-Blockers 91.08% 88.98% 86.08% 93.62%
Cardiovascular Disease Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Controlling High Blood Pressure 2020 77.62% 43.15% 53.49% 69.10%
2019 84.91% 60.96% 61.02% 74.21%
2018 83.85% 60.55% N/A N/A
2017 N/A N/A N/A N/A
Persistence of Beta-Blockers 2020 91.18% 87.06% 87.38% 94.19%
2019 93.30% 88.62% 85.16% 92.47%
2018 90.17% 83.54% 82.37% 89.29%
2017 96.59% 85.80% 85.18% 93.41%
Info
Cervical Cancer Screening 2021 Plan State Avg Nat Avg 90th Pctl.
Cervical Cancer Screening 89.67% 76.66% 75.48% 81.94%
Cervical Cancer Screening Year Plan State Avg. Natl. Avg. 90th Pctl.
Cervical Cancer Screening 2020 88.81% 75.44% 75.50% 81.71%
2019 91.28% 78.50% 77.40% 83.91%
2018 91.28% 77.90% 76.08% 83.21%
2017 N/A N/A N/A N/A
Info
Common Childhood Illnesses 2021 Plan State Avg Nat Avg 90th Pctl.
Appropriate Testing for Children With Pharyngitis 62.69% 82.09% 79.49% 89.15%
Common Childhood Illnesses Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Testing for Children With Pharyngitis 2020 89.71% 90.05% 84.77% 92.62%
2019 94.41% 90.44% 86.62% 93.98%
2018 93.10% 92.74% 87.97% 94.94%
2017 92.50% 92.30% 87.45% 94.64%
Info
Diabetes Care and Management 2021 Plan State Avg Nat Avg 90th Pctl.
Comprehensive Diabetes Care-Blood Pressure Control (<140/90 mm Hg) 76.33% 59.77% 62.09% 75.43%
Comprehensive Diabetes Care-HbA1c control (<8.0%) 71.54% 61.24% 59.64% 67.11%
Comprehensive Diabetes Care-Rate of Eye Exams 87.50% 57.17% 52.65% 64.30%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 17.02% 28.15% 29.94% 21.90%
Comprehensive Diabetes Care-Testing for HbA1c 97.61% 91.18% 90.81% 93.92%
Diabetes Care and Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Comprehensive Diabetes Care-Blood Pressure Control (<140/90 mm Hg) 2020 77.13% 44.59% 55.85% 73.48%
2019 82.16% 62.53% 63.23% 77.86%
2018 84.15% 63.70% 62.59% 77.37%
2017 87.98% 63.40% 60.82% 76.41%
Comprehensive Diabetes Care-HbA1c control (<8.0%) 2020 68.61% 55.20% 55.37% 65.50%
2019 73.98% 63.81% 58.07% 66.33%
2018 71.58% 62.46% 57.79% 66.33%
2017 71.31% 62.51% 57.48% 67.15%
Comprehensive Diabetes Care-Rate of Eye Exams 2020 88.32% 53.44% 50.27% 64.23%
2019 90.06% 58.32% 55.45% 69.32%
2018 89.62% 56.58% 54.40% 69.68%
2017 83.36% 56.95% 54.06% 70.69%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 2020 21.17% 36.05% 34.87% 23.45%
2019 15.79% 26.09% 30.80% 20.82%
2018 15.57% 27.18% 30.85% 20.62%
2017 15.57% 27.63% 31.91% 21.41%
Comprehensive Diabetes Care-Testing for HbA1c 2020 92.70% 86.71% 87.74% 91.73%
2019 97.37% 92.45% 91.60% 94.71%
2018 98.09% 92.11% 91.29% 94.71%
2017 98.63% 91.52% 90.96% 94.18%
Info
Immunizations 2021 Plan State Avg Nat Avg 90th Pctl.
Childhood Immunization for Multiple Diseases (Combo 10) 76.04% 66.38% 60.60% 73.21%
Childhood Immunization for Multiple Diseases Including Pneumovax 91.37% 82.74% 78.15% 88.27%
Flu Vaccinations for Adults Ages 18-64 66.67% 59.29% 55.31% 65.85%
Immunizations for Adolescents - Combination 2 71.64% 39.82% 34.09% 44.04%
Immunizations for Adolescents - HPV 72.51% 41.73% 35.37% 46.00%
Immunizations for Adolescents - Meningococcal 93.27% 86.88% 85.91% 93.19%
Immunizations for Adolescents - Tdap 94.44% 93.05% 90.13% 95.38%
Immunizations Year Plan State Avg. Natl. Avg. 90th Pctl.
Childhood Immunization for Multiple Diseases (Combo 10) 2020 N/A N/A N/A N/A
2019 N/A N/A N/A N/A
2018 N/A N/A N/A N/A
2017 N/A N/A N/A N/A
Childhood Immunization for Multiple Diseases Including Pneumovax 2020 89.54% 74.94% 75.84% 87.36%
2019 90.27% 81.30% 78.32% 87.99%
2018 86.59% 79.46% 77.50% 86.62%
2017 90.28% 80.09% 77.67% 87.61%
Flu Vaccinations for Adults Ages 18-64 2020 68.49% 57.13% 57.41% 67.88%
2019 66.67% 59.38% 55.06% 65.24%
2018 61.69% 53.06% 51.93% 61.07%
2017 61.94% 55.21% 49.33% 59.27%
Immunizations for Adolescents - Combination 2 2020 71.28% 35.09% 31.84% 39.17%
2019 72.99% 33.16% 29.59% 40.63%
2018 89.96% 79.55% 82.25% 91.52%
2017 89.78% 80.48% 80.23% 89.54%
Immunizations for Adolescents - HPV 2020 72.07% 37.80% 33.38% 42.34%
2019 75.18% 35.43% 31.21% 42.46%
2018 66.47% 32.22% 28.05% 37.23%
2017 58.39% 28.29% 23.98% 32.36%
Immunizations for Adolescents - Meningococcal 2020 94.41% 80.71% 85.83% 93.12%
2019 93.92% 81.83% 85.01% 92.59%
2018 91.86% 80.66% 83.69% 92.94%
2017 90.02% 82.05% 81.75% 90.27%
Immunizations for Adolescents - Tdap 2020 96.01% 92.47% 90.62% 95.13%
2019 94.16% 92.23% 90.47% 95.13%
2018 93.60% 91.16% 89.95% 95.62%
2017 93.19% 91.65% 88.91% 94.65%
Info
Pharmacotherapy of COPD Exacerbation 2021 Plan State Avg Nat Avg 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 95.73% 86.14% 81.56% 89.58%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 86.32% 80.22% 74.79% 84.78%
Pharmacotherapy of COPD Exacerbation Year Plan State Avg. Natl. Avg. 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 2020 96.88% 86.03% 81.34% 88.51%
2019 97.56% 83.91% 80.32% 88.97%
2018 89.00% 85.49% 78.92% 87.88%
2017 93.30% 80.88% 79.87% 87.50%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 2020 85.16% 75.06% 74.31% 85.07%
2019 92.68% 81.14% 76.90% 87.69%
2018 81.34% 76.41% 74.76% 83.55%
2017 84.21% 78.84% 76.26% 84.38%
Info
Preventive Care 2021 Plan State Avg Nat Avg 90th Pctl.
Breast Cancer Screening 84.54% 72.93% 72.44% 79.62%
Chlamydia Screening in Women-all Age groups 80.52% 51.90% 48.47% 62.71%
Colorectal Cancer Screening 80.30% 63.99% 64.90% 76.16%
Preventive Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Breast Cancer Screening 2020 84.47% 72.56% 72.44% 79.39%
2019 87.38% 72.92% 74.81% 81.58%
2018 86.19% 72.13% 73.73% 81.17%
2017 87.62% 71.85% 72.81% 80.91%
Chlamydia Screening in Women-all Age groups 2020 62.34% 49.80% 48.49% 63.85%
2019 82.49% 54.77% 51.86% 67.02%
2018 75.82% 52.91% 51.41% 67.76%
2017 70.17% 51.46% 50.16% 66.08%
Colorectal Cancer Screening 2020 82.53% 60.99% 63.64% 74.42%
2019 84.81% 68.10% 66.15% 77.91%
2018 84.81% 64.94% 64.37% 76.52%
2017 84.95% 65.16% 62.43% 74.72%
Info
Spirometry Testing 2021 Plan State Avg Nat Avg 90th Pctl.
Use of Spirometry Testing in the Assessment and diagnosis of COPD 31.81% 34.87% 36.29% 45.50%
Spirometry Testing Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Spirometry Testing in the Assessment and diagnosis of COPD 2020 46.42% 37.53% 37.16% 43.86%
2019 47.54% 39.81% 42.11% 52.78%
2018 45.79% 44.14% 41.48% 50.95%
2017 47.08% 43.12% 41.90% 50.52%
Info
Statin Therapy 2021 Plan State Avg Nat Avg 90th Pctl.
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 21-75 years (Male) 90.47% 86.25% 84.99% 90.85%
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 40–75 years (Female) 86.09% 74.86% 76.91% 83.87%
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - Total 89.22% 83.06% 82.86% 88.32%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 21-75 years (Male) 77.98% 78.10% 80.36% 87.04%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 40–75 years (Female) 73.54% 77.02% 76.97% 85.47%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - Total 76.76% 77.77% 79.53% 86.44%
Statin Therapy for Patients with Diabetes - Received Therapy 76.09% 66.92% 66.45% 72.23%
Statin Therapy for Patients with Diabetes - Statin Adherence 80% 73.72% 74.32% 73.74% 81.61%
Statin Therapy Year Plan State Avg. Natl. Avg. 90th Pctl.
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 21-75 years (Male) 2020 90.96% 85.75% 84.86% 89.67%
2019 91.08% 85.53% 84.83% 90.71%
2018 90.35% 84.45% 83.64% 89.14%
2017 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 40–75 years (Female) 2020 85.49% 77.46% 75.69% 81.94%
2019 87.45% 75.96% 74.89% 81.82%
2018 84.49% 76.45% 73.26% 81.82%
2017 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - Total 2020 89.44% 83.41% 82.46% 87.85%
2019 90.14% 82.97% 82.41% 88.24%
2018 88.70% 82.21% 81.23% 87.21%
2017 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 21-75 years (Male) 2020 80.95% 81.24% 81.04% 86.60%
2019 80.49% 78.19% 78.73% 85.40%
2018 76.56% 75.19% 77.14% 82.88%
2017 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 40–75 years (Female) 2020 73.52% 78.29% 77.58% 86.55%
2019 76.82% 75.98% 73.50% 82.09%
2018 70.90% 72.78% 72.12% 81.10%
2017 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - Total 2020 78.98% 80.47% 80.55% 86.26%
2019 79.56% 77.63% 77.38% 84.14%
2018 75.04% 74.49% 75.95% 82.83%
2017 N/A N/A N/A N/A
Statin Therapy for Patients with Diabetes - Received Therapy 2020 77.36% 66.42% 65.49% 71.27%
2019 78.72% 65.53% 64.43% 70.97%
2018 78.24% 63.94% 62.57% 70.05%
2017 N/A N/A N/A N/A
Statin Therapy for Patients with Diabetes - Statin Adherence 80% 2020 73.45% 73.48% 74.69% 82.04%
2019 73.61% 71.84% 71.74% 79.50%
2018 69.20% 68.88% 69.52% 78.00%
2017 N/A N/A N/A N/A
Info
Weight Assessment and Counseling 2021 Plan State Avg Nat Avg 90th Pctl.
Children/Adolescents BMI Assessment - Total 99.42% 77.31% 75.21% 89.14%
Children/Adolescents BMI Assessment - Ages 3-11 99.06% 78.77% 76.73% 90.56%
Children/Adolescents BMI Assessment - Ages 12-17 100.00% 75.37% 73.29% 87.42%
Counseling for Nutrition for Children/Adolescents - Total 100.00% 74.98% 69.95% 83.70%
Counseling for Nutrition for Children/Adolescents - Ages 3-11 100.00% 77.08% 72.50% 86.18%
Counseling for Nutrition for Children/Adolescents - Ages 12-17 100.00% 72.13% 66.75% 82.14%
Counseling for Physical Activity for Children/Adolescents - Total 100.00% 71.34% 66.55% 80.86%
Counseling for Physical Activity for Children/Adolescents - Ages 3-11 100.00% 69.93% 66.24% 81.08%
Counseling for Physical Activity for Children/Adolescents - Ages 12-17 100.00% 73.30% 66.87% 83.09%
Weight Assessment and Counseling Year Plan State Avg. Natl. Avg. 90th Pctl.
Children/Adolescents BMI Assessment - Total 2020 94.00% 61.27% 70.64% 88.81%
2019 100.00% 74.97% 74.90% 90.00%
2018 100.00% 73.74% 72.87% 90.00%
2017 100.00% 70.41% 70.59% 88.08%
Children/Adolescents BMI Assessment - Ages 3-11 2020 96.61% 64.54% 72.11% 88.89%
2019 100.00% 78.68% 76.00% 90.91%
2018 100.00% 76.94% 74.00% 90.91%
2017 100.00% 71.37% 71.84% 88.89%
Children/Adolescents BMI Assessment - Ages 12-17 2020 90.24% 57.19% 68.80% 87.79%
2019 100.00% 70.46% 73.46% 89.29%
2018 100.00% 69.73% 71.39% 88.97%
2017 100.00% 68.96% 68.94% 87.82%
Counseling for Nutrition for Children/Adolescents - Total 2020 96.00% 56.08% 65.06% 82.43%
2019 100.00% 72.58% 68.74% 85.24%
2018 100.00% 71.79% 67.72% 85.06%
2017 100.00% 69.47% 65.50% 83.21%
Counseling for Nutrition for Children/Adolescents - Ages 3-11 2020 96.61% 59.21% 67.32% 84.32%
2019 100.00% 77.02% 71.33% 86.49%
2018 100.00% 75.91% 69.85% 86.21%
2017 100.00% 71.63% 68.20% 84.82%
Counseling for Nutrition for Children/Adolescents - Ages 12-17 2020 95.12% 52.10% 62.24% 79.49%
2019 100.00% 66.89% 65.44% 84.29%
2018 100.00% 66.37% 64.92% 84.29%
2017 100.00% 66.54% 61.92% 80.26%
Counseling for Physical Activity for Children/Adolescents - Total 2020 96.00% 52.21% 60.81% 80.29%
2019 100.00% 66.86% 64.24% 82.78%
2018 100.00% 66.42% 63.08% 81.32%
2017 100.00% 64.30% 59.96% 77.32%
Counseling for Physical Activity for Children/Adolescents - Ages 3-11 2020 96.61% 52.27% 60.31% 81.14%
2019 100.00% 66.12% 63.39% 82.53%
2018 100.00% 65.48% 61.70% 80.92%
2017 100.00% 62.31% 58.84% 75.00%
Counseling for Physical Activity for Children/Adolescents - Ages 12-17 2020 95.12% 51.96% 61.40% 79.85%
2019 100.00% 67.67% 65.38% 84.68%
2018 100.00% 67.51% 64.79% 84.03%
2017 100.00% 66.86% 61.40% 79.89%
Health Plan Stability/Descriptive
Info
Administrative Data 2021 Plan State Avg Nat Avg 90th Pctl.
Administrative Ratio 0.06 0.12 N/A N/A
Medical Cost Ratio 0.95 0.85 N/A N/A
Number of Enrollees 167,944 189,570 N/A N/A
Number of Physicians 26,554 144,761 N/A N/A
Premium Per Member Per Month $524 $582 N/A N/A
Profit/Loss Ratio -0.01 0.04 N/A N/A
Administrative Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Administrative Ratio 2020 0.07 0.13 N/A N/A
2019 0.07 0.12 N/A N/A
2018 0.08 0.14 86.19 92.68
2017 0.09 0.12 86.39 93.13
Medical Cost Ratio 2020 0.89 0.81 N/A N/A
2019 0.91 0.84 N/A N/A
2018 0.92 0.83 92.60 95.85
2017 0.93 0.83 93.13 96.59
Number of Enrollees 2020 165,398 157,206 N/A N/A
2019 166,997 136,748 N/A N/A
2018 204,481 129,656 92 96
2017 180,972 133,992 92 97
Number of Physicians 2020 24,779 118,547 N/A N/A
2019 22,526 105,314 N/A N/A
2018 21,018 86,806 87 95
2017 21,796 81,926 87 95
Premium Per Member Per Month 2020 $540 $529 N/A N/A
2019 $485 $511 N/A N/A
2018 $422 $517 N/A N/A
2017 $381 $370 N/A N/A
Profit/Loss Ratio 2020 0.03 0.06 N/A N/A
2019 0.02 0.04 N/A N/A
2018 0.01 0.04 N/A N/A
2017 -0.02 0.05 N/A N/A
Info
Financial Data 2021 Plan State Avg Nat Avg 90th Pctl.
Income $-42,097,250 $84,171,275 N/A N/A
Net Worth $671,289,215 $444,659,972 N/A N/A
Premiums Earned $1,060,133,281 $1,315,605,350 N/A N/A
Financial Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Income 2020 $158,618,704 $108,797,768 N/A N/A
2019 $69,924,687 $81,234,487 N/A N/A
2018 $23,848,771 $44,046,244 N/A N/A
2017 $-85,020,295 $34,422,501 N/A N/A
Net Worth 2020 $485,822,267 $381,868,187 N/A N/A
2019 $350,508,538 $340,553,480 N/A N/A
2018 $436,957,951 $279,558,644 N/A N/A
2017 $160,228,051 $263,890,874 N/A N/A
Premiums Earned 2020 $1,088,936,863 $1,079,933,473 N/A N/A
2019 $987,167,018 $936,529,722 N/A N/A
2018 $1,111,182,458 $815,577,345 N/A N/A
2017 $826,114,677 $645,600,589 N/A N/A
Info
Years in Business 2021 Plan State Avg Nat Avg 90th Pctl.
Years in Business 42 39 N/A N/A
Years in Business Year Plan State Avg. Natl. Avg. 90th Pctl.
Years in Business 2020 41 38 N/A N/A
2019 40 37 N/A N/A
2018 39 36 N/A N/A
2017 38 35 N/A N/A
Member Satisfaction
Info
Member Satisfaction 2021 Plan State Avg Nat Avg 90th Pctl.
Getting Care Quickly 79.10% 83.79% 83.12% 89.04%
Getting Needed Care 79.26% 85.63% 84.05% 89.10%
How Well Doctors Communicate 93.73% 94.61% 95.28% 97.41%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 78.91% 66.71% 67.27% 78.31%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 80.12% 83.98% 84.85% 88.79%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 79.83% 78.88% 77.89% 84.07%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 86.06% 83.94% 85.47% 90.41%
Member Satisfaction Year Plan State Avg. Natl. Avg. 90th Pctl.
Getting Care Quickly 2020 87.06% 85.38% 86.32% 91.51%
2019 83.12% 87.14% 86.32% 90.57%
2018 83.85% 85.27% 85.23% 89.89%
2017 82.25% 87.22% 85.34% 89.83%
Getting Needed Care 2020 89.20% 87.88% 88.01% 92.51%
2019 84.24% 87.88% 87.38% 91.22%
2018 84.09% 85.53% 86.33% 90.45%
2017 83.38% 87.44% 86.71% 90.37%
How Well Doctors Communicate 2020 94.41% 95.93% 95.93% 97.98%
2019 92.72% 94.99% 95.85% 97.38%
2018 93.37% 94.70% 95.31% 97.22%
2017 91.69% 94.74% 95.10% 96.91%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 2020 81.74% 65.21% 69.04% 80.59%
2019 80.87% 69.24% 67.91% 78.57%
2018 75.94% 64.78% 64.53% 76.79%
2017 74.26% 61.26% 62.44% 75.00%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 2020 91.89% 86.67% 87.14% 91.18%
2019 87.34% 88.18% 86.27% 90.20%
2018 85.63% 84.82% 84.41% 88.57%
2017 78.89% 83.86% 84.62% 88.77%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 2020 81.74% 79.32% 80.71% 87.04%
2019 88.66% 79.81% 80.27% 86.36%
2018 80.94% 76.02% 78.17% 83.95%
2017 78.86% 76.98% 77.27% 82.99%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 2020 84.58% 85.69% 86.56% 91.30%
2019 89.27% 87.91% 87.34% 90.94%
2018 84.14% 84.08% 85.14% 89.78%
2017 82.55% 83.95% 84.60% 89.86%
Overuse/Appropriateness
Info
Antipsychotics 2021 Plan State Avg Nat Avg 90th Pctl.
Metabolic Monitoring for Children and Adolescents on Antipsychotics - Ages 1-17 68.58% 45.59% 35.85% 48.30%
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 64.58% 60.14% 63.65% 75.31%
Antipsychotics Year Plan State Avg. Natl. Avg. 90th Pctl.
Metabolic Monitoring for Children and Adolescents on Antipsychotics - Ages 1-17 2020 75.00% 38.77% 31.82% 42.98%
2019 75.81% 42.62% 37.50% 49.28%
2018 69.21% 44.74% 36.17% 47.41%
2017 76.95% 50.55% 36.07% 48.57%
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 2020 72.64% 60.42% 62.97% 76.39%
2019 74.00% 63.47% 61.05% 78.36%
2018 76.74% 57.96% 56.00% 70.54%
2017 72.22% 58.14% 54.52% 68.67%
Info
Cervical Cancer Screening in Adolescent Females 2021 Plan State Avg Nat Avg 90th Pctl.
Non-Recommended Cervical Cancer Screening in Adolescent Females 0.05% 0.37% 0.59% 0.10%
Cervical Cancer Screening in Adolescent Females Year Plan State Avg. Natl. Avg. 90th Pctl.
Non-Recommended Cervical Cancer Screening in Adolescent Females 2020 0.04% 0.46% 0.67% 0.19%
2019 0.02% 0.58% 0.85% 0.24%
2018 0.04% 0.71% 1.05% 0.33%
2017 0.05% 0.94% 1.47% 0.50%
Info
Lower Back Pain 2021 Plan State Avg Nat Avg 90th Pctl.
Use of Imaging for Low Back Pain 83.30% 75.38% 77.23% 84.21%
Lower Back Pain Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Imaging for Low Back Pain 2020 88.59% 77.22% 78.53% 85.60%
2019 86.60% 77.01% 76.69% 83.47%
2018 86.33% 74.77% 75.11% 82.95%
2017 83.66% 73.85% 75.16% 82.29%
Info
Respiratory 2021 Plan State Avg Nat Avg 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 96.35% 95.68% 94.48% 98.12%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 58.96% 44.79% 46.61% 61.68%
Respiratory Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 2020 96.15% 93.12% 91.57% 95.67%
2019 94.85% 91.87% 90.76% 95.51%
2018 95.63% 92.50% 91.22% 95.48%
2017 95.40% 90.92% 89.19% 94.59%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 2020 60.34% 41.88% 43.24% 59.45%
2019 63.41% 38.42% 39.91% 54.09%
2018 73.78% 33.60% 33.16% 48.28%
2017 75.55% 30.67% 30.99% 49.52%
Info
Use of Opiods 2021 Plan State Avg Nat Avg 90th Pctl.
Use of Opioids at High Dosage 2.38% 6.26% 5.24% 1.88%
Use of Opioids From Multiple Providers - Multiple Pharmacies 0.08% 1.32% 1.59% 0.33%
Use of Opioids From Multiple Providers - Multiple Prescribers 17.02% 16.64% 13.69% 8.71%
Use of Opioids From Multiple Providers - Multiple Prescribers and Multiple Pharmacies 0.08% 0.70% 0.77% 0.00%
Use of Opiods Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Opioids at High Dosage 2020 2.15% 6.49% 5.76% 1.88%
2019 2.43% 6.96% 6.08% 1.88%
2018 2.06% 5.32% 4.54% 1.87%
2017 N/A N/A N/A N/A
Use of Opioids From Multiple Providers - Multiple Pharmacies 2020 0.00% 2.27% 1.67% 0.62%
2019 0.09% 3.75% 2.79% 0.69%
2018 2.24% 5.21% 3.80% 1.40%
2017 N/A N/A N/A N/A
Use of Opioids From Multiple Providers - Multiple Prescribers 2020 15.48% 16.62% 13.32% 8.20%
2019 16.69% 17.64% 14.51% 9.79%
2018 16.74% 18.32% 15.02% 9.64%
2017 N/A N/A N/A N/A
Use of Opioids From Multiple Providers - Multiple Prescribers and Multiple Pharmacies 2020 0.00% 1.22% 0.76% 0.08%
2019 0.04% 1.70% 1.24% 0.00%
2018 1.42% 2.68% 1.76% 0.47%
2017 N/A N/A N/A N/A
Risk Adjusted Utilization
Info
Acute Hospital Utilization Rate 2021 Plan State Avg Nat Avg 90th Pctl.
Acute Hospital Utilization - Medicine 19.53% 23.22% 0.78% 0.58%
Acute Hospital Utilization - Surgery 10.57% 11.64% N/A N/A
Acute Hospital Utilization - Total Acute 30.10% 34.86% 1.02% 0.79%
Acute Hospital Utilization Rate Year Plan State Avg. Natl. Avg. 90th Pctl.
Acute Hospital Utilization - Medicine 2020 19.60% 21.48% 0.72% 0.53%
2019 20.34% 26.50% 0.89% 0.68%
2018 N/A N/A N/A N/A
2017 N/A N/A N/A N/A
Acute Hospital Utilization - Surgery 2020 10.17% 11.94% N/A N/A
2019 12.05% 15.92% N/A N/A
2018 N/A N/A N/A N/A
2017 N/A N/A N/A N/A
Acute Hospital Utilization - Total Acute 2020 29.77% 33.42% 0.97% 0.78%
2019 32.38% 42.42% 1.09% 0.92%
2018 N/A N/A N/A N/A
2017 N/A N/A N/A N/A
Info
Emergency Department Utilization 2021 Plan State Avg Nat Avg 90th Pctl.
Emergency Department Utilization 64.95% 138.89% 0.90% 0.72%
Emergency Department Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Emergency Department Utilization 2020 57.65% 124.84% N/A N/A
2019 78.34% 187.39% 1.04% 0.82%
2018 N/A N/A N/A N/A
2017 N/A N/A N/A N/A
Info
Plan All-Cause Readmissions 2021 Plan State Avg Nat Avg 90th Pctl.
Plan All-Cause Readmissions Ages 18-64 (Total) 4.82% 4.93% 0.60% 0.48%
Plan All-Cause Readmissions Ages 18-44 4.18% 4.20% N/A N/A
Plan All-Cause Readmissions Ages 45-54 4.66% 4.67% N/A N/A
Plan All-Cause Readmissions Ages 55-64 5.46% 5.63% N/A N/A
Plan All-Cause Readmissions Year Plan State Avg. Natl. Avg. 90th Pctl.
Plan All-Cause Readmissions Ages 18-64 (Total) 2020 4.80% 4.88% 0.58% 0.47%
2019 4.99% 4.32% 0.51% 0.37%
2018 12.85% 11.17% N/A N/A
2017 12.84% 12.19% N/A N/A
Plan All-Cause Readmissions Ages 18-44 2020 4.41% 4.26% N/A N/A
2019 3.85% 4.54% N/A N/A
2018 12.08% 11.41% N/A N/A
2017 12.21% 12.99% N/A N/A
Plan All-Cause Readmissions Ages 45-54 2020 3.92% 4.46% N/A N/A
2019 4.65% 4.35% N/A N/A
2018 12.59% 10.56% N/A N/A
2017 12.22% 11.71% N/A N/A
Plan All-Cause Readmissions Ages 55-64 2020 5.69% 5.69% N/A N/A
2019 6.14% 4.26% N/A N/A
2018 13.65% 11.21% N/A N/A
2017 13.67% 11.93% N/A N/A
Utilization
Info
Antibiotic Utilization 2021 Plan State Avg Nat Avg 90th Pctl.
Average number of antibiotic prescriptions per member per year - Total 0.41 0.55 0.57 0.73
Average number of antibiotic prescriptions per member per year - Ages 0-9 0.22 0.39 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 0.17 0.31 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 0.41 0.52 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 0.44 0.57 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 0.49 0.67 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 0.56 0.75 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 0.61 0.82 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 0.59 1.42 N/A N/A
Days suppplied per antibiotic prescription - Total 11.210 10.197 10.210 11.220
Days suppplied per antibiotic prescription - Ages 0-9 11.610 10.540 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 18.470 14.793 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 10.850 9.754 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 10.850 9.787 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 11.000 10.114 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 10.570 10.241 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 10.020 8.940 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 11.330 11.142 N/A N/A
Prescriptions of concern - Total 0.130 0.209 0.230 0.340
Prescriptions of concern - Ages 0-9 0.07 0.14 N/A N/A
Prescriptions of concern - Ages 10-17 0.05 0.10 N/A N/A
Prescriptions of concern - Ages 18-34 0.12 0.18 N/A N/A
Prescriptions of concern - Ages 35-49 0.14 0.22 N/A N/A
Prescriptions of concern - Ages 50-64 0.18 0.28 N/A N/A
Prescriptions of concern - Ages 65-74 0.20 0.29 N/A N/A
Prescriptions of concern - Ages 75-85 0.23 0.27 N/A N/A
Prescriptions of concern - Ages 85 plus 0.23 0.32 N/A N/A
Antibiotic Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Average number of antibiotic prescriptions per member per year - Total 2020 0.44 0.57 0.57 0.71
2019 0.56 0.75 0.74 0.90
2018 0.52 0.74 0.71 0.88
2017 0.56 0.77 0.76 0.90
Average number of antibiotic prescriptions per member per year - Ages 0-9 2020 0.25 0.41 N/A N/A
2019 0.57 0.85 N/A N/A
2018 0.49 0.81 N/A N/A
2017 0.52 0.87 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 2020 0.18 0.33 N/A N/A
2019 0.29 0.52 N/A N/A
2018 0.28 0.52 N/A N/A
2017 0.31 0.57 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 2020 0.42 0.53 N/A N/A
2019 0.53 0.66 N/A N/A
2018 0.48 0.65 N/A N/A
2017 0.51 0.67 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 2020 0.47 0.59 N/A N/A
2019 0.58 0.74 N/A N/A
2018 0.53 0.73 N/A N/A
2017 0.58 0.75 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 2020 0.54 0.70 N/A N/A
2019 0.65 0.85 N/A N/A
2018 0.60 0.84 N/A N/A
2017 0.66 0.88 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 2020 0.58 0.77 N/A N/A
2019 0.64 0.95 N/A N/A
2018 0.68 0.97 N/A N/A
2017 0.76 1.00 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 2020 0.70 0.80 N/A N/A
2019 0.69 1.15 N/A N/A
2018 0.68 1.21 N/A N/A
2017 0.77 1.12 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 2020 0.76 1.56 N/A N/A
2019 0.68 0.95 N/A N/A
2018 0.60 1.32 N/A N/A
2017 0.91 1.12 N/A N/A
Days suppplied per antibiotic prescription - Total 2020 10.890 10.133 10.310 11.480
2019 10.620 9.888 9.890 10.660
2018 10.850 9.950 9.910 10.890
2017 10.950 10.024 9.880 10.830
Days suppplied per antibiotic prescription - Ages 0-9 2020 11.600 10.550 N/A N/A
2019 10.690 10.025 N/A N/A
2018 10.720 9.979 N/A N/A
2017 10.530 10.050 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 2020 17.560 14.369 N/A N/A
2019 14.760 12.591 N/A N/A
2018 15.240 12.948 N/A N/A
2017 15.160 12.689 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 2020 10.690 9.729 N/A N/A
2019 10.430 9.695 N/A N/A
2018 10.850 9.731 N/A N/A
2017 11.120 9.836 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 2020 10.510 9.703 N/A N/A
2019 10.350 9.488 N/A N/A
2018 10.460 9.568 N/A N/A
2017 10.470 9.591 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 2020 10.480 10.027 N/A N/A
2019 10.360 9.756 N/A N/A
2018 10.460 9.769 N/A N/A
2017 10.510 9.856 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 2020 10.630 9.997 N/A N/A
2019 10.290 9.766 N/A N/A
2018 10.690 9.830 N/A N/A
2017 10.980 9.850 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 2020 9.990 10.119 N/A N/A
2019 9.650 9.645 N/A N/A
2018 10.520 9.428 N/A N/A
2017 11.390 10.604 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 2020 11.290 10.606 N/A N/A
2019 11.380 9.997 N/A N/A
2018 10.680 9.026 N/A N/A
2017 11.080 9.873 N/A N/A
Prescriptions of concern - Total 2020 0.160 0.227 0.240 0.320
2019 0.240 0.339 0.330 0.430
2018 0.220 0.338 0.330 0.430
2017 0.240 0.354 0.360 0.450
Prescriptions of concern - Ages 0-9 2020 0.08 0.15 N/A N/A
2019 0.19 0.34 N/A N/A
2018 0.17 0.32 N/A N/A
2017 0.19 0.35 N/A N/A
Prescriptions of concern - Ages 10-17 2020 0.06 0.11 N/A N/A
2019 0.11 0.20 N/A N/A
2018 0.10 0.20 N/A N/A
2017 0.11 0.22 N/A N/A
Prescriptions of concern - Ages 18-34 2020 0.14 0.20 N/A N/A
2019 0.21 0.28 N/A N/A
2018 0.19 0.28 N/A N/A
2017 0.20 0.28 N/A N/A
Prescriptions of concern - Ages 35-49 2020 0.18 0.25 N/A N/A
2019 0.25 0.35 N/A N/A
2018 0.23 0.35 N/A N/A
2017 0.25 0.37 N/A N/A
Prescriptions of concern - Ages 50-64 2020 0.22 0.31 N/A N/A
2019 0.30 0.41 N/A N/A
2018 0.28 0.42 N/A N/A
2017 0.31 0.44 N/A N/A
Prescriptions of concern - Ages 65-74 2020 0.24 0.33 N/A N/A
2019 0.30 0.44 N/A N/A
2018 0.31 0.48 N/A N/A
2017 0.35 0.50 N/A N/A
Prescriptions of concern - Ages 75-85 2020 0.27 0.34 N/A N/A
2019 0.32 0.51 N/A N/A
2018 0.31 0.62 N/A N/A
2017 0.36 0.54 N/A N/A
Prescriptions of concern - Ages 85 plus 2020 0.29 0.41 N/A N/A
2019 0.30 0.36 N/A N/A
2018 0.25 0.45 N/A N/A
2017 0.38 0.48 N/A N/A
Info
Mental Health Utilization 2021 Plan State Avg Nat Avg 90th Pctl.
Mental Health Utilization - Any Service - Total 8.67% 9.40% 9.48% 13.63%
Mental Health Utilization - Any Service - Ages 0-12 5.90% 6.00% N/A N/A
Mental Health Utilization - Any Service - Ages 13-17 14.51% 16.24% N/A N/A
Mental Health Utilization - Any Service - Ages 18-64 9.11% 9.76% N/A N/A
Mental Health Utilization - Any Service - Ages 65 plus 3.99% 3.11% N/A N/A
Mental Health Utilization - ED - Total 0.08% 0.05% 0.07% 0.17%
Mental Health Utilization - ED - Ages 0-12 0.05% 0.02% N/A N/A
Mental Health Utilization - ED - Ages 13-17 0.30% 0.21% N/A N/A
Mental Health Utilization - ED - Ages 18-64 0.07% 0.04% N/A N/A
Mental Health Utilization - ED - Ages 65 plus 0.03% 0.01% N/A N/A
Mental Health Utilization - Inpatient - Total 0.20% 0.24% 0.25% 0.33%
Mental Health Utilization - Inpatient - Ages 0-12 0.07% 0.08% N/A N/A
Mental Health Utilization - Inpatient - Ages 13-17 0.80% 0.88% N/A N/A
Mental Health Utilization - Inpatient - Ages 18-64 0.18% 0.22% N/A N/A
Mental Health Utilization - Inpatient - Ages 65 plus 0.10% 0.08% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Total 0.03% 0.08% 0.16% 0.31%
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 0-12 0.02% 0.03% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 13-17 0.26% 0.40% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 18-64 0.02% 0.07% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 65 plus 0.00% 0.01% N/A N/A
Mental Health Utilization - Outpatient - Total 0.48% 4.73% 5.70% 8.26%
Mental Health Utilization - Outpatient - Ages 0-12 0.69% 3.72% N/A N/A
Mental Health Utilization - Outpatient - Ages 13-17 1.46% 9.85% N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 0.38% 4.63% N/A N/A
Mental Health Utilization - Outpatient - Ages 65 plus 0.32% 1.73% N/A N/A
Mental Health Utilization - Telehealth - Total 8.46% 6.68% 6.01% 9.77%
Mental Health Utilization - Telehealth - Ages 0-12 5.59% 3.74% N/A N/A
Mental Health Utilization - Telehealth - Ages 13-17 14.04% 10.92% N/A N/A
Mental Health Utilization - Telehealth - Ages 18-64 8.94% 7.11% N/A N/A
Mental Health Utilization - Telehealth - Ages 65 plus 3.77% 1.96% N/A N/A
Mental Health Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Mental Health Utilization - Any Service - Total 2020 9.26% 9.13% 9.07% 12.95%
2019 6.22% 8.33% 8.86% 12.67%
2018 5.85% 7.63% 7.98% 11.76%
2017 N/A N/A N/A N/A
Mental Health Utilization - Any Service - Ages 0-12 2020 6.12% 6.25% N/A N/A
2019 4.41% 6.35% N/A N/A
2018 4.79% 6.12% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Any Service - Ages 13-17 2020 14.74% 15.31% N/A N/A
2019 10.89% 15.01% N/A N/A
2018 10.77% 13.96% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Any Service - Ages 18-64 2020 9.78% 9.40% N/A N/A
2019 6.50% 8.45% N/A N/A
2018 5.92% 7.62% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Any Service - Ages 65 plus 2020 4.35% 3.53% N/A N/A
2019 2.36% 3.17% N/A N/A
2018 2.34% 3.20% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - ED - Total 2020 0.03% 0.03% 0.06% 0.15%
2019 0.04% 0.04% 0.08% 0.17%
2018 0.05% 0.09% 0.10% 0.22%
2017 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 0-12 2020 0.02% 0.01% N/A N/A
2019 0.02% 0.02% N/A N/A
2018 0.02% 0.05% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 13-17 2020 0.11% 0.10% N/A N/A
2019 0.21% 0.17% N/A N/A
2018 0.22% 0.28% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 18-64 2020 0.02% 0.03% N/A N/A
2019 0.03% 0.03% N/A N/A
2018 0.05% 0.08% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 65 plus 2020 0.00% 0.01% N/A N/A
2019 0.01% 0.07% N/A N/A
2018 0.03% 0.02% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Total 2020 0.20% 0.22% 0.24% 0.31%
2019 0.21% 0.25% 0.27% 0.34%
2018 0.22% 0.27% 0.27% 0.34%
2017 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 0-12 2020 0.08% 0.07% N/A N/A
2019 0.05% 0.12% N/A N/A
2018 0.05% 0.12% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 13-17 2020 0.73% 0.79% N/A N/A
2019 0.72% 0.85% N/A N/A
2018 0.82% 0.95% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 18-64 2020 0.18% 0.20% N/A N/A
2019 0.20% 0.24% N/A N/A
2018 0.21% 0.26% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 65 plus 2020 0.12% 0.06% N/A N/A
2019 0.12% 0.11% N/A N/A
2018 0.11% 0.06% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Total 2020 0.02% 0.07% 0.15% 0.30%
2019 0.02% 0.11% 0.20% 0.40%
2018 0.02% 0.12% 0.19% 0.38%
2017 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 0-12 2020 0.02% 0.05% N/A N/A
2019 0.02% 0.10% N/A N/A
2018 0.01% 0.15% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 13-17 2020 0.13% 0.26% N/A N/A
2019 0.13% 0.35% N/A N/A
2018 0.13% 0.49% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 18-64 2020 0.01% 0.06% N/A N/A
2019 0.01% 0.09% N/A N/A
2018 0.01% 0.09% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 65 plus 2020 0.00% 0.01% N/A N/A
2019 0.00% 0.02% N/A N/A
2018 0.00% 0.02% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Total 2020 7.97% 7.22% 6.95% 9.99%
2019 6.17% 8.24% 8.73% 12.61%
2018 5.72% 7.53% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Ages 0-12 2020 5.07% 5.23% N/A N/A
2019 4.40% 6.32% N/A N/A
2018 4.78% 6.10% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Ages 13-17 2020 13.26% 12.84% N/A N/A
2019 10.84% 14.86% N/A N/A
2018 10.57% 13.80% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 2020 8.50% 7.35% N/A N/A
2019 6.45% 8.36% N/A N/A
2018 5.77% 7.51% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Ages 65 plus 2020 2.75% 2.62% N/A N/A
2019 2.29% 3.07% N/A N/A
2018 2.24% 3.16% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Total 2020 3.62% 4.92% 5.19% 8.37%
2019 0.01% 0.11% 0.11% 0.22%
2018 0.26% 0.10% 0.05% 0.11%
2017 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Ages 0-12 2020 2.57% 3.07% N/A N/A
2019 0.01% 0.04% N/A N/A
2018 0.06% 0.03% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Ages 13-17 2020 6.56% 8.30% N/A N/A
2019 0.01% 0.15% N/A N/A
2018 0.33% 0.19% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Ages 18-64 2020 3.65% 5.11% N/A N/A
2019 0.01% 0.12% N/A N/A
2018 0.31% 0.11% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Ages 65 plus 2020 2.62% 1.80% N/A N/A
2019 0.01% 0.02% N/A N/A
2018 0.05% 0.02% N/A N/A
2017 N/A N/A N/A N/A
2021 data updated on: 07/02/2024