Health Insurance in Virginia

HMO Profile

  1. Home
  2. Health Insurance
  3. HMO Profile

OPTIMUM CHOICE, INC.

Company Information

  • Company Providing Plan:UnitedHealth Group
  • Address:9800 HEALTH CARE LANE, MN017-E900
    MINNETONKA MN 55343
  • Telephone :240-683-5250
  • Website:WWW.UHC.COM
2021
Number of Enrollees: *12,267
PMPM: *$467
Number of Physicians: *95,009
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

Accomack, Albemarle, Alleghany, Amelia, Appomattox, Arlington, Augusta, Bath, Bedford, Bland, Botetourt, Buchanan, Buckingham, Campbell, Caroline, Carroll, Charles City, Charlotte, Chesterfield, Clarke, Craig, Culpeper, Cumberland, Dickenson, Dinwiddie, Fairfax, Fauquier, Floyd, Fluvanna, Franklin, Frederick, Giles, Gloucester, Goochland, Grayson, Greene, Greensville, Halifax, Hanover, Henrico, Highland, Isle of Wight, James City, King and Queen, King George, King William, Lee, Loudoun, Louisa, Lunenburg, Madison, Mathews, Mecklenburg, Middlesex, Montgomery, Nelson, New Kent, Northampton, Northumberland, Nottoway, Orange, Page, Patrick, Pittsylvania, Powhatan, Prince Edward, Prince George, Prince William, Pulaski, Rappahannock, Richmond, Roanoke, Rockingham, Russell, Scott, Smyth, Southampton, Spotsylvania, Stafford, Surry, Sussex, Tazewell, Washington, Westmoreland, Wise, Wythe, York

Cities

Alexandria, Bristol, Charlottesville, Chesapeake, Clifton Forge, Colonial Heights, Covington, Danville, Emporia, Fairfax, Falls Church, Franklin, Fredericksburg, Galax, Hampton, Harrisonburg, Hopewell, Manassas, Manassas Park, Newport News, Norfolk, Norton, Petersburg, Poquoson, Portsmouth, Radford, Richmond, Roanoke, Salem, Staunton, Suffolk, Virginia Beach, Waynesboro, Williamsburg, Winchester

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

Administrative Data

2021 2020 2019 2018 2017
*Number of Enrollees 12,267 11,467 15,951 19,012 15,028
PMPM $467 $446 $379 $369 $361
*Medical Cost Ratio 77% 77% 80% 73% 78%
*Administrative Ratio 16% 20% 17% 18% 15%
*Profit/Loss Ratio 9% 4% 4% 10% 7%
*Number of Physicians 95,009 82,581 68,683 67,323 63,577

*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 $71,786,826 $73,339,294 $79,820,333 $78,432,406 $52,057,443
*Income $18,807,711 $7,796,081 $8,064,099 $21,053,057 $10,844,824
*Net Worth $42,483,725 $38,833,267 $41,479,893 $33,897,415 $22,379,138

*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 92.75% 94.34% 93.47% 96.29%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 94.83% 96.22% 96.12% 97.63%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 95.77% 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 92.19% 93.90% 92.88% 95.71%
2019 91.19% 92.78% 92.66% 95.76%
2018 91.07% 92.43% 92.33% 95.45%
2017 91.81% 92.73% 92.45% 95.43%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 2020 94.02% 96.11% 95.86% 97.54%
2019 93.68% 95.78% 95.87% 97.69%
2018 93.72% 95.50% 95.64% 97.49%
2017 93.84% 95.57% 95.61% 97.46%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 2020 94.81% 96.79% 96.95% 98.30%
2019 95.88% 97.13% 97.14% 98.42%
2018 95.84% 97.15% 97.17% 98.45%
2017 97.22% 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 36.67% 38.29% 34.72% 43.21%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 75.00% 45.84% 41.60% 52.08%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 36.30% 38.22% 34.53% 43.21%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 12.62% 14.66% 11.91% 15.33%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 0.00% 16.85% 15.29% 22.05%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 12.74% 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 37.53% 40.49% 36.39% 45.24%
2019 34.44% 39.13% 35.63% 41.36%
2018 34.67% 37.53% 35.68% 42.36%
2017 29.74% 36.14% 36.11% 42.01%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2020 22.22% 35.48% 44.95% 59.06%
2019 16.67% 36.19% 42.41% 54.29%
2018 41.67% 49.35% 40.21% 51.02%
2017 50.00% 40.06% 39.91% 52.54%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2020 37.82% 40.55% 36.18% 45.12%
2019 34.80% 39.20% 35.47% 40.96%
2018 34.53% 37.34% 35.51% 42.35%
2017 29.20% 36.00% 35.97% 41.96%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 2020 13.20% 15.16% 12.46% 17.48%
2019 11.98% 13.47% 12.31% 16.44%
2018 12.40% 14.69% 12.58% 17.04%
2017 9.48% 13.36% 12.65% 17.26%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2020 11.11% 14.80% 17.76% 27.27%
2019 0.00% 10.34% 16.48% 27.14%
2018 16.67% 18.18% 16.91% 25.00%
2017 0.00% 14.40% 14.95% 23.85%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2020 13.24% 15.15% 12.33% 17.48%
2019 12.22% 13.52% 12.20% 16.41%
2018 12.31% 14.58% 12.47% 16.97%
2017 9.73% 13.40% 12.55% 17.38%
Info
Prenatal and Postpartum Care 2021 Plan State Avg Nat Avg 90th Pctl.
Postpartum Care 76.51% 80.79% 81.70% 93.89%
Timeliness of Prenatal Care 87.94% 86.12% 83.24% 94.16%
Prenatal and Postpartum Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Postpartum Care 2020 48.99% 74.05% 78.11% 92.47%
2019 72.68% 78.66% 80.52% 91.97%
2018 72.68% 75.10% 75.89% 88.80%
2017 67.88% 73.45% 75.05% 88.13%
Timeliness of Prenatal Care 2020 55.96% 79.76% 81.82% 93.92%
2019 86.07% 86.76% 85.57% 95.33%
2018 86.07% 88.15% 84.75% 94.17%
2017 84.18% 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 69.23% 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 58.33% 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 76.12% 79.35% 76.18% 83.11%
Antidepressant Medication Management - Effective Continuation Phase Treatment 58.76% 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 71.05% 77.14% 73.70% 81.07%
2019 71.26% 73.53% 71.19% 78.79%
2018 71.45% 71.96% 68.64% 77.59%
2017 68.66% 71.12% 67.11% 75.76%
Antidepressant Medication Management - Effective Continuation Phase Treatment 2020 55.43% 59.69% 57.32% 64.22%
2019 53.96% 55.44% 54.90% 62.18%
2018 54.08% 54.22% 53.01% 60.39%
2017 52.63% 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 33.78% 41.24% 36.60% 48.10%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 20.00% 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 45.88% 45.87% 41.24% 50.34%
2019 38.75% 42.67% 40.66% 51.30%
2018 42.86% 42.91% 39.85% 50.42%
2017 52.94% 41.27% 41.13% 50.83%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 2020 40.00% 56.56% 48.67% 59.32%
2019 46.15% 50.69% 47.95% 58.82%
2018 47.06% 40.32% 48.73% 60.57%
2017 54.55% 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 10.87% 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 10.87% 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 17.24% 14.52% 13.45% 21.43%
2019 4.65% 8.56% 11.48% 18.26%
2018 10.13% 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 17.24% 19.84% 18.03% 26.07%
2019 8.14% 14.74% 15.35% 24.56%
2018 11.39% 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 35.48% 44.60% 50.67% 70.54%
Follow-Up After Emergency Department Visit for Mental Illness within 30 days after hospital discharge 58.06% 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 35.85% 48.22% 47.90% 68.29%
2019 36.05% 45.64% 48.70% 70.67%
2018 28.57% 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 45.28% 59.38% 62.36% 78.77%
2019 52.33% 60.35% 62.59% 77.75%
2018 43.96% 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 50.75% 49.75% 48.70% 63.60%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 76.12% 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 41.43% 49.46% 49.62% 63.68%
2019 44.76% 49.77% 45.66% 58.20%
2018 42.61% 48.09% 44.98% 60.38%
2017 48.94% 52.18% 46.63% 62.81%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 2020 65.71% 72.67% 70.00% 79.46%
2019 65.71% 72.38% 67.81% 80.65%
2018 66.96% 69.84% 66.68% 80.29%
2017 67.02% 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 5-11 100.00% 92.78% 89.65% 96.23%
Asthma Medication Ratio - Ages 12-18 70.59% 85.93% 83.38% 90.21%
Asthma Medication Ratio - Ages 19-50 67.26% 82.29% 78.35% 87.18%
Asthma Medication Ratio - Ages 51-64 88.00% 86.60% 83.59% 90.22%
Asthma Medication Ratio - Total 78.05% 85.07% 81.23% 87.41%
Asthma Medication Ratio Year Plan State Avg. Natl. Avg. 90th Pctl.
Asthma Medication Ratio - Ages 5-11 2020 94.44% 93.70% 89.98% 95.00%
2019 93.10% 86.54% 85.94% 93.20%
2018 75.00% 85.26% 87.15% 93.97%
2017 85.19% 86.06% 86.90% 93.55%
Asthma Medication Ratio - Ages 12-18 2020 80.95% 84.76% 81.90% 89.30%
2019 96.67% 84.88% 77.43% 86.25%
2018 84.62% 84.71% 78.77% 84.72%
2017 81.48% 84.80% 76.69% 85.94%
Asthma Medication Ratio - Ages 19-50 2020 67.18% 78.90% 75.62% 84.47%
2019 72.22% 80.50% 74.07% 81.27%
2018 78.05% 82.69% 75.11% 82.84%
2017 71.43% 78.94% 74.23% 81.70%
Asthma Medication Ratio - Ages 51-64 2020 82.11% 85.69% 82.47% 89.38%
2019 86.49% 86.85% 81.27% 88.51%
2018 82.80% 86.11% 82.81% 89.49%
2017 85.88% 89.17% 82.83% 89.28%
Asthma Medication Ratio - Total 2020 76.11% 83.04% 79.76% 85.85%
2019 81.53% 83.92% 78.10% 84.69%
2018 80.08% 84.32% 79.34% 85.18%
2017 79.10% 84.01% 79.04% 85.85%
Info
Cardiovascular Disease Management 2021 Plan State Avg Nat Avg 90th Pctl.
Controlling High Blood Pressure 54.99% 60.64% 59.95% 73.24%
Persistence of Beta-Blockers 88.89% 88.98% 86.08% 93.62%
Cardiovascular Disease Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Controlling High Blood Pressure 2020 5.38% 43.15% 53.49% 69.10%
2019 56.69% 60.96% 61.02% 74.21%
2018 56.69% 60.55% N/A N/A
2017 N/A N/A N/A N/A
Persistence of Beta-Blockers 2020 80.00% 87.06% 87.38% 94.19%
2019 94.29% 88.62% 85.16% 92.47%
2018 74.07% 83.54% 82.37% 89.29%
2017 78.57% 85.80% 85.18% 93.41%
Info
Cervical Cancer Screening 2021 Plan State Avg Nat Avg 90th Pctl.
Cervical Cancer Screening 72.13% 76.66% 75.48% 81.94%
Cervical Cancer Screening Year Plan State Avg. Natl. Avg. 90th Pctl.
Cervical Cancer Screening 2020 67.44% 75.44% 75.50% 81.71%
2019 74.85% 78.50% 77.40% 83.91%
2018 74.85% 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 82.71% 82.09% 79.49% 89.15%
Common Childhood Illnesses Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Testing for Children With Pharyngitis 2020 90.06% 90.05% 84.77% 92.62%
2019 89.99% 90.44% 86.62% 93.98%
2018 93.95% 92.74% 87.97% 94.94%
2017 88.77% 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) 56.93% 59.77% 62.09% 75.43%
Comprehensive Diabetes Care-HbA1c control (<8.0%) 57.66% 61.24% 59.64% 67.11%
Comprehensive Diabetes Care-Rate of Eye Exams 43.07% 57.17% 52.65% 64.30%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 32.60% 28.15% 29.94% 21.90%
Comprehensive Diabetes Care-Testing for HbA1c 87.35% 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 4.67% 44.59% 55.85% 73.48%
2019 59.37% 62.53% 63.23% 77.86%
2018 59.37% 63.70% 62.59% 77.37%
2017 59.85% 63.40% 60.82% 76.41%
Comprehensive Diabetes Care-HbA1c control (<8.0%) 2020 47.46% 55.20% 55.37% 65.50%
2019 58.39% 63.81% 58.07% 66.33%
2018 58.39% 62.46% 57.79% 66.33%
2017 58.39% 62.51% 57.48% 67.15%
Comprehensive Diabetes Care-Rate of Eye Exams 2020 36.66% 53.44% 50.27% 64.23%
2019 41.61% 58.32% 55.45% 69.32%
2018 41.61% 56.58% 54.40% 69.68%
2017 44.89% 56.95% 54.06% 70.69%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 2020 44.24% 36.05% 34.87% 23.45%
2019 30.66% 26.09% 30.80% 20.82%
2018 30.66% 27.18% 30.85% 20.62%
2017 29.38% 27.63% 31.91% 21.41%
Comprehensive Diabetes Care-Testing for HbA1c 2020 84.30% 86.71% 87.74% 91.73%
2019 91.73% 92.45% 91.60% 94.71%
2018 91.73% 92.11% 91.29% 94.71%
2017 91.79% 91.52% 90.96% 94.18%
Info
Immunizations 2021 Plan State Avg Nat Avg 90th Pctl.
Childhood Immunization for Multiple Diseases (Combo 10) 68.03% 66.38% 60.60% 73.21%
Childhood Immunization for Multiple Diseases Including Pneumovax 89.34% 82.74% 78.15% 88.27%
Flu Vaccinations for Adults Ages 18-64 N/A 59.29% 55.31% 65.85%
Immunizations for Adolescents - Combination 2 33.33% 39.82% 34.09% 44.04%
Immunizations for Adolescents - HPV 34.89% 41.73% 35.37% 46.00%
Immunizations for Adolescents - Meningococcal 89.10% 86.88% 85.91% 93.19%
Immunizations for Adolescents - Tdap 93.46% 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 56.81% 74.94% 75.84% 87.36%
2019 80.76% 81.30% 78.32% 87.99%
2018 77.36% 79.46% 77.50% 86.62%
2017 76.09% 80.09% 77.67% 87.61%
Flu Vaccinations for Adults Ages 18-64 2020 53.64% 57.13% 57.41% 67.88%
2019 48.50% 59.38% 55.06% 65.24%
2018 50.81% 53.06% 51.93% 61.07%
2017 49.64% 55.21% 49.33% 59.27%
Immunizations for Adolescents - Combination 2 2020 24.79% 35.09% 31.84% 39.17%
2019 25.25% 33.16% 29.59% 40.63%
2018 79.90% 79.55% 82.25% 91.52%
2017 79.26% 80.48% 80.23% 89.54%
Immunizations for Adolescents - HPV 2020 28.45% 37.80% 33.38% 42.34%
2019 27.72% 35.43% 31.21% 42.46%
2018 22.42% 32.22% 28.05% 37.23%
2017 21.74% 28.29% 23.98% 32.36%
Immunizations for Adolescents - Meningococcal 2020 76.06% 80.71% 85.83% 93.12%
2019 80.45% 81.83% 85.01% 92.59%
2018 80.67% 80.66% 83.69% 92.94%
2017 82.27% 82.05% 81.75% 90.27%
Immunizations for Adolescents - Tdap 2020 89.01% 92.47% 90.62% 95.13%
2019 92.08% 92.23% 90.47% 95.13%
2018 89.95% 91.16% 89.95% 95.62%
2017 88.63% 91.65% 88.91% 94.65%
Info
Pharmacotherapy of COPD Exacerbation 2021 Plan State Avg Nat Avg 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 80.00% 86.14% 81.56% 89.58%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 85.00% 80.22% 74.79% 84.78%
Pharmacotherapy of COPD Exacerbation Year Plan State Avg. Natl. Avg. 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 2020 85.37% 86.03% 81.34% 88.51%
2019 82.69% 83.91% 80.32% 88.97%
2018 79.66% 85.49% 78.92% 87.88%
2017 68.75% 80.88% 79.87% 87.50%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 2020 75.61% 75.06% 74.31% 85.07%
2019 80.77% 81.14% 76.90% 87.69%
2018 69.49% 76.41% 74.76% 83.55%
2017 75.00% 78.84% 76.26% 84.38%
Info
Preventive Care 2021 Plan State Avg Nat Avg 90th Pctl.
Breast Cancer Screening 65.31% 72.93% 72.44% 79.62%
Chlamydia Screening in Women-all Age groups 43.58% 51.90% 48.47% 62.71%
Colorectal Cancer Screening 47.45% 63.99% 64.90% 76.16%
Preventive Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Breast Cancer Screening 2020 64.42% 72.56% 72.44% 79.39%
2019 65.31% 72.92% 74.81% 81.58%
2018 65.44% 72.13% 73.73% 81.17%
2017 65.97% 71.85% 72.81% 80.91%
Chlamydia Screening in Women-all Age groups 2020 43.95% 49.80% 48.49% 63.85%
2019 48.49% 54.77% 51.86% 67.02%
2018 47.96% 52.91% 51.41% 67.76%
2017 44.76% 51.46% 50.16% 66.08%
Colorectal Cancer Screening 2020 41.48% 60.99% 63.64% 74.42%
2019 53.04% 68.10% 66.15% 77.91%
2018 48.91% 64.94% 64.37% 76.52%
2017 57.18% 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 24.32% 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 23.96% 37.53% 37.16% 43.86%
2019 42.53% 39.81% 42.11% 52.78%
2018 42.65% 44.14% 41.48% 50.95%
2017 38.10% 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) 84.78% 86.25% 84.99% 90.85%
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 40–75 years (Female) 81.08% 74.86% 76.91% 83.87%
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - Total 83.88% 83.06% 82.86% 88.32%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 21-75 years (Male) 77.95% 78.10% 80.36% 87.04%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 40–75 years (Female) 75.00% 77.02% 76.97% 85.47%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - Total 77.25% 77.77% 79.53% 86.44%
Statin Therapy for Patients with Diabetes - Received Therapy 61.90% 66.92% 66.45% 72.23%
Statin Therapy for Patients with Diabetes - Statin Adherence 80% 72.41% 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 84.17% 85.75% 84.86% 89.67%
2019 81.65% 85.53% 84.83% 90.71%
2018 80.09% 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 78.16% 77.46% 75.69% 81.94%
2019 72.60% 75.96% 74.89% 81.82%
2018 75.47% 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 82.66% 83.41% 82.46% 87.85%
2019 79.71% 82.97% 82.41% 88.24%
2018 79.18% 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 75.69% 81.24% 81.04% 86.60%
2019 73.39% 78.19% 78.73% 85.40%
2018 69.36% 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 76.47% 78.29% 77.58% 86.55%
2019 64.15% 75.98% 73.50% 82.09%
2018 70.00% 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 75.87% 80.47% 80.55% 86.26%
2019 71.59% 77.63% 77.38% 84.14%
2018 69.48% 74.49% 75.95% 82.83%
2017 N/A N/A N/A N/A
Statin Therapy for Patients with Diabetes - Received Therapy 2020 62.87% 66.42% 65.49% 71.27%
2019 61.71% 65.53% 64.43% 70.97%
2018 60.06% 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 66.27% 73.48% 74.69% 82.04%
2019 67.90% 71.84% 71.74% 79.50%
2018 62.72% 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 70.80% 77.31% 75.21% 89.14%
Children/Adolescents BMI Assessment - Ages 3-11 74.60% 78.77% 76.73% 90.56%
Children/Adolescents BMI Assessment - Ages 12-17 65.03% 75.37% 73.29% 87.42%
Counseling for Nutrition for Children/Adolescents - Total 68.86% 74.98% 69.95% 83.70%
Counseling for Nutrition for Children/Adolescents - Ages 3-11 71.77% 77.08% 72.50% 86.18%
Counseling for Nutrition for Children/Adolescents - Ages 12-17 64.42% 72.13% 66.75% 82.14%
Counseling for Physical Activity for Children/Adolescents - Total 65.69% 71.34% 66.55% 80.86%
Counseling for Physical Activity for Children/Adolescents - Ages 3-11 66.53% 69.93% 66.24% 81.08%
Counseling for Physical Activity for Children/Adolescents - Ages 12-17 64.42% 73.30% 66.87% 83.09%
Weight Assessment and Counseling Year Plan State Avg. Natl. Avg. 90th Pctl.
Children/Adolescents BMI Assessment - Total 2020 27.91% 61.27% 70.64% 88.81%
2019 72.41% 74.97% 74.90% 90.00%
2018 72.41% 73.74% 72.87% 90.00%
2017 64.96% 70.41% 70.59% 88.08%
Children/Adolescents BMI Assessment - Ages 3-11 2020 28.89% 64.54% 72.11% 88.89%
2019 74.89% 78.68% 76.00% 90.91%
2018 74.89% 76.94% 74.00% 90.91%
2017 64.73% 71.37% 71.84% 88.89%
Children/Adolescents BMI Assessment - Ages 12-17 2020 26.58% 57.19% 68.80% 87.79%
2019 68.90% 70.46% 73.46% 89.29%
2018 68.90% 69.73% 71.39% 88.97%
2017 65.29% 68.96% 68.94% 87.82%
Counseling for Nutrition for Children/Adolescents - Total 2020 16.30% 56.08% 65.06% 82.43%
2019 67.34% 72.58% 68.74% 85.24%
2018 67.34% 71.79% 67.72% 85.06%
2017 64.23% 69.47% 65.50% 83.21%
Counseling for Nutrition for Children/Adolescents - Ages 3-11 2020 18.10% 59.21% 67.32% 84.32%
2019 71.86% 77.02% 71.33% 86.49%
2018 71.86% 75.91% 69.85% 86.21%
2017 64.73% 71.63% 68.20% 84.82%
Counseling for Nutrition for Children/Adolescents - Ages 12-17 2020 13.87% 52.10% 62.24% 79.49%
2019 60.98% 66.89% 65.44% 84.29%
2018 60.98% 66.37% 64.92% 84.29%
2017 63.53% 66.54% 61.92% 80.26%
Counseling for Physical Activity for Children/Adolescents - Total 2020 11.30% 52.21% 60.81% 80.29%
2019 62.28% 66.86% 64.24% 82.78%
2018 62.28% 66.42% 63.08% 81.32%
2017 60.10% 64.30% 59.96% 77.32%
Counseling for Physical Activity for Children/Adolescents - Ages 3-11 2020 11.69% 52.27% 60.31% 81.14%
2019 62.77% 66.12% 63.39% 82.53%
2018 62.77% 65.48% 61.70% 80.92%
2017 56.43% 62.31% 58.84% 75.00%
Counseling for Physical Activity for Children/Adolescents - Ages 12-17 2020 10.77% 51.96% 61.40% 79.85%
2019 61.59% 67.67% 65.38% 84.68%
2018 61.59% 67.51% 64.79% 84.03%
2017 65.29% 66.86% 61.40% 79.89%
Health Plan Stability/Descriptive
Info
Administrative Data 2021 Plan State Avg Nat Avg 90th Pctl.
Administrative Ratio 0.16 0.12 N/A N/A
Medical Cost Ratio 0.77 0.85 N/A N/A
Number of Enrollees 12,267 189,570 N/A N/A
Number of Physicians 95,009 144,761 N/A N/A
Premium Per Member Per Month $467 $582 N/A N/A
Profit/Loss Ratio 0.09 0.04 N/A N/A
Administrative Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Administrative Ratio 2020 0.20 0.13 N/A N/A
2019 0.17 0.12 N/A N/A
2018 0.18 0.14 86.19 92.68
2017 0.15 0.12 86.39 93.13
Medical Cost Ratio 2020 0.77 0.81 N/A N/A
2019 0.80 0.84 N/A N/A
2018 0.73 0.83 92.60 95.85
2017 0.78 0.83 93.13 96.59
Number of Enrollees 2020 11,467 157,206 N/A N/A
2019 15,951 136,748 N/A N/A
2018 19,012 129,656 92 96
2017 15,028 133,992 92 97
Number of Physicians 2020 82,581 118,547 N/A N/A
2019 68,683 105,314 N/A N/A
2018 67,323 86,806 87 95
2017 63,577 81,926 87 95
Premium Per Member Per Month 2020 $446 $529 N/A N/A
2019 $379 $511 N/A N/A
2018 $369 $517 N/A N/A
2017 $361 $370 N/A N/A
Profit/Loss Ratio 2020 0.04 0.06 N/A N/A
2019 0.04 0.04 N/A N/A
2018 0.10 0.04 N/A N/A
2017 0.07 0.05 N/A N/A
Info
Financial Data 2021 Plan State Avg Nat Avg 90th Pctl.
Income $18,807,711 $84,171,275 N/A N/A
Net Worth $42,483,725 $444,659,972 N/A N/A
Premiums Earned $71,786,826 $1,315,605,350 N/A N/A
Financial Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Income 2020 $7,796,081 $108,797,768 N/A N/A
2019 $8,064,099 $81,234,487 N/A N/A
2018 $21,053,057 $44,046,244 N/A N/A
2017 $10,844,824 $34,422,501 N/A N/A
Net Worth 2020 $38,833,267 $381,868,187 N/A N/A
2019 $41,479,893 $340,553,480 N/A N/A
2018 $33,897,415 $279,558,644 N/A N/A
2017 $22,379,138 $263,890,874 N/A N/A
Premiums Earned 2020 $73,339,294 $1,079,933,473 N/A N/A
2019 $79,820,333 $936,529,722 N/A N/A
2018 $78,432,406 $815,577,345 N/A N/A
2017 $52,057,443 $645,600,589 N/A N/A
Info
Years in Business 2021 Plan State Avg Nat Avg 90th Pctl.
Years in Business N/A 39 N/A N/A
Years in Business Year Plan State Avg. Natl. Avg. 90th Pctl.
Years in Business 2020 N/A 38 N/A N/A
2019 31 37 N/A N/A
2018 30 36 N/A N/A
2017 29 35 N/A N/A
Member Satisfaction
Info
Member Satisfaction 2021 Plan State Avg Nat Avg 90th Pctl.
Getting Care Quickly N/A 83.79% 83.12% 89.04%
Getting Needed Care N/A 85.63% 84.05% 89.10%
How Well Doctors Communicate N/A 94.61% 95.28% 97.41%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 54.21% 66.71% 67.27% 78.31%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) N/A 83.98% 84.85% 88.79%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) N/A 78.88% 77.89% 84.07%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) N/A 83.94% 85.47% 90.41%
Member Satisfaction Year Plan State Avg. Natl. Avg. 90th Pctl.
Getting Care Quickly 2020 N/A 85.38% 86.32% 91.51%
2019 86.53% 87.14% 86.32% 90.57%
2018 84.01% 85.27% 85.23% 89.89%
2017 N/A 87.22% 85.34% 89.83%
Getting Needed Care 2020 86.48% 87.88% 88.01% 92.51%
2019 84.46% 87.88% 87.38% 91.22%
2018 83.11% 85.53% 86.33% 90.45%
2017 83.54% 87.44% 86.71% 90.37%
How Well Doctors Communicate 2020 94.57% 95.93% 95.93% 97.98%
2019 95.23% 94.99% 95.85% 97.38%
2018 95.38% 94.70% 95.31% 97.22%
2017 90.64% 94.74% 95.10% 96.91%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 2020 51.81% 65.21% 69.04% 80.59%
2019 55.62% 69.24% 67.91% 78.57%
2018 50.78% 64.78% 64.53% 76.79%
2017 48.68% 61.26% 62.44% 75.00%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 2020 N/A 86.67% 87.14% 91.18%
2019 88.07% 88.18% 86.27% 90.20%
2018 83.33% 84.82% 84.41% 88.57%
2017 82.35% 83.86% 84.62% 88.77%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 2020 72.80% 79.32% 80.71% 87.04%
2019 71.15% 79.81% 80.27% 86.36%
2018 71.17% 76.02% 78.17% 83.95%
2017 68.18% 76.98% 77.27% 82.99%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 2020 84.52% 85.69% 86.56% 91.30%
2019 88.27% 87.91% 87.34% 90.94%
2018 83.33% 84.08% 85.14% 89.78%
2017 79.43% 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 50.00% 45.59% 35.85% 48.30%
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 44.44% 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 37.84% 38.77% 31.82% 42.98%
2019 45.45% 42.62% 37.50% 49.28%
2018 53.85% 44.74% 36.17% 47.41%
2017 33.33% 50.55% 36.07% 48.57%
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 2020 47.06% 60.42% 62.97% 76.39%
2019 40.00% 63.47% 61.05% 78.36%
2018 52.63% 57.96% 56.00% 70.54%
2017 31.58% 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 0.40% 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 0.42% 0.46% 0.67% 0.19%
2019 0.93% 0.58% 0.85% 0.24%
2018 1.15% 0.71% 1.05% 0.33%
2017 0.94% 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 80.00% 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 81.96% 77.22% 78.53% 85.60%
2019 79.91% 77.01% 76.69% 83.47%
2018 78.19% 74.77% 75.11% 82.95%
2017 79.56% 73.85% 75.16% 82.29%
Info
Respiratory 2021 Plan State Avg Nat Avg 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 96.29% 95.68% 94.48% 98.12%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 46.12% 44.79% 46.61% 61.68%
Respiratory Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 2020 93.58% 93.12% 91.57% 95.67%
2019 91.73% 91.87% 90.76% 95.51%
2018 92.66% 92.50% 91.22% 95.48%
2017 90.00% 90.92% 89.19% 94.59%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 2020 37.95% 41.88% 43.24% 59.45%
2019 36.92% 38.42% 39.91% 54.09%
2018 30.76% 33.60% 33.16% 48.28%
2017 29.56% 30.67% 30.99% 49.52%
Info
Use of Opiods 2021 Plan State Avg Nat Avg 90th Pctl.
Use of Opioids at High Dosage 6.56% 6.26% 5.24% 1.88%
Use of Opioids From Multiple Providers - Multiple Pharmacies 1.43% 1.32% 1.59% 0.33%
Use of Opioids From Multiple Providers - Multiple Prescribers 16.63% 16.64% 13.69% 8.71%
Use of Opioids From Multiple Providers - Multiple Prescribers and Multiple Pharmacies 0.71% 0.70% 0.77% 0.00%
Use of Opiods Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Opioids at High Dosage 2020 5.61% 6.49% 5.76% 1.88%
2019 6.38% 6.96% 6.08% 1.88%
2018 3.89% 5.32% 4.54% 1.87%
2017 N/A N/A N/A N/A
Use of Opioids From Multiple Providers - Multiple Pharmacies 2020 1.93% 2.27% 1.67% 0.62%
2019 4.07% 3.75% 2.79% 0.69%
2018 6.02% 5.21% 3.80% 1.40%
2017 N/A N/A N/A N/A
Use of Opioids From Multiple Providers - Multiple Prescribers 2020 16.87% 16.62% 13.32% 8.20%
2019 19.16% 17.64% 14.51% 9.79%
2018 18.07% 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 0.88% 1.22% 0.76% 0.08%
2019 1.71% 1.70% 1.24% 0.00%
2018 3.22% 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 23.45% 23.22% 0.78% 0.58%
Acute Hospital Utilization - Surgery 8.91% 11.64% N/A N/A
Acute Hospital Utilization - Total Acute 32.35% 34.86% 1.02% 0.79%
Acute Hospital Utilization Rate Year Plan State Avg. Natl. Avg. 90th Pctl.
Acute Hospital Utilization - Medicine 2020 22.38% 21.48% 0.72% 0.53%
2019 23.93% 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 10.29% 11.94% N/A N/A
2019 12.57% 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 32.67% 33.42% 0.97% 0.78%
2019 36.51% 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 136.87% 138.89% 0.90% 0.72%
Emergency Department Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Emergency Department Utilization 2020 122.94% 124.84% N/A N/A
2019 179.43% 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) 4.74% 4.93% 0.60% 0.48%
Plan All-Cause Readmissions Ages 18-44 2.36% 4.20% N/A N/A
Plan All-Cause Readmissions Ages 45-54 3.26% 4.67% N/A N/A
Plan All-Cause Readmissions Ages 55-64 7.51% 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 4.41% 4.88% 0.58% 0.47%
2019 3.81% 4.32% 0.51% 0.37%
2018 8.74% 11.17% N/A N/A
2017 11.59% 12.19% N/A N/A
Plan All-Cause Readmissions Ages 18-44 2020 3.94% 4.26% N/A N/A
2019 3.26% 4.54% N/A N/A
2018 8.18% 11.41% N/A N/A
2017 13.09% 12.99% N/A N/A
Plan All-Cause Readmissions Ages 45-54 2020 4.26% 4.46% N/A N/A
2019 3.73% 4.35% N/A N/A
2018 8.20% 10.56% N/A N/A
2017 10.06% 11.71% N/A N/A
Plan All-Cause Readmissions Ages 55-64 2020 4.86% 5.69% N/A N/A
2019 4.31% 4.26% N/A N/A
2018 9.47% 11.21% N/A N/A
2017 11.55% 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 0.53 0.55 0.57 0.73
Average number of antibiotic prescriptions per member per year - Ages 0-9 0.41 0.39 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 0.33 0.31 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 0.48 0.52 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 0.54 0.57 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 0.65 0.67 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 0.62 0.75 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 0.77 0.82 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 0.00 1.42 N/A N/A
Days suppplied per antibiotic prescription - Total 9.450 10.197 10.210 11.220
Days suppplied per antibiotic prescription - Ages 0-9 10.690 10.540 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 13.340 14.793 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 9.190 9.754 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 9.230 9.787 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 9.070 10.114 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 9.300 10.241 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 6.430 8.940 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus N/A 11.142 N/A N/A
Prescriptions of concern - Total 0.210 0.209 0.230 0.340
Prescriptions of concern - Ages 0-9 0.14 0.14 N/A N/A
Prescriptions of concern - Ages 10-17 0.11 0.10 N/A N/A
Prescriptions of concern - Ages 18-34 0.18 0.18 N/A N/A
Prescriptions of concern - Ages 35-49 0.22 0.22 N/A N/A
Prescriptions of concern - Ages 50-64 0.29 0.28 N/A N/A
Prescriptions of concern - Ages 65-74 0.27 0.29 N/A N/A
Prescriptions of concern - Ages 75-85 0.19 0.27 N/A N/A
Prescriptions of concern - Ages 85 plus 0.00 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 0.54 0.57 0.57 0.71
2019 0.71 0.75 0.74 0.90
2018 0.71 0.74 0.71 0.88
2017 0.71 0.77 0.76 0.90
Average number of antibiotic prescriptions per member per year - Ages 0-9 2020 0.43 0.41 N/A N/A
2019 0.86 0.85 N/A N/A
2018 0.83 0.81 N/A N/A
2017 0.88 0.87 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 2020 0.33 0.33 N/A N/A
2019 0.52 0.52 N/A N/A
2018 0.55 0.52 N/A N/A
2017 0.58 0.57 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 2020 0.49 0.53 N/A N/A
2019 0.62 0.66 N/A N/A
2018 0.62 0.65 N/A N/A
2017 0.61 0.67 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 2020 0.55 0.59 N/A N/A
2019 0.69 0.74 N/A N/A
2018 0.69 0.73 N/A N/A
2017 0.67 0.75 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 2020 0.67 0.70 N/A N/A
2019 0.80 0.85 N/A N/A
2018 0.81 0.84 N/A N/A
2017 0.81 0.88 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 2020 0.73 0.77 N/A N/A
2019 0.94 0.95 N/A N/A
2018 0.92 0.97 N/A N/A
2017 0.90 1.00 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 2020 0.91 0.80 N/A N/A
2019 1.10 1.15 N/A N/A
2018 1.21 1.21 N/A N/A
2017 1.05 1.12 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 2020 0.31 1.56 N/A N/A
2019 0.00 0.95 N/A N/A
2018 0.69 1.32 N/A N/A
2017 0.53 1.12 N/A N/A
Days suppplied per antibiotic prescription - Total 2020 9.570 10.133 10.310 11.480
2019 9.360 9.888 9.890 10.660
2018 9.550 9.950 9.910 10.890
2017 9.680 10.024 9.880 10.830
Days suppplied per antibiotic prescription - Ages 0-9 2020 10.750 10.550 N/A N/A
2019 10.170 10.025 N/A N/A
2018 10.030 9.979 N/A N/A
2017 10.140 10.050 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 2020 12.750 14.369 N/A N/A
2019 11.580 12.591 N/A N/A
2018 12.490 12.948 N/A N/A
2017 12.090 12.689 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 2020 9.320 9.729 N/A N/A
2019 8.980 9.695 N/A N/A
2018 9.300 9.731 N/A N/A
2017 9.490 9.836 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 2020 9.080 9.703 N/A N/A
2019 9.180 9.488 N/A N/A
2018 9.140 9.568 N/A N/A
2017 9.170 9.591 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 2020 9.490 10.027 N/A N/A
2019 9.120 9.756 N/A N/A
2018 9.380 9.769 N/A N/A
2017 9.540 9.856 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 2020 9.410 9.997 N/A N/A
2019 9.210 9.766 N/A N/A
2018 8.980 9.830 N/A N/A
2017 9.590 9.850 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 2020 8.780 10.119 N/A N/A
2019 8.610 9.645 N/A N/A
2018 7.440 9.428 N/A N/A
2017 11.830 10.604 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 2020 10.000 10.606 N/A N/A
2019 N/A 9.997 N/A N/A
2018 7.000 9.026 N/A N/A
2017 7.000 9.873 N/A N/A
Prescriptions of concern - Total 2020 0.230 0.227 0.240 0.320
2019 0.330 0.339 0.330 0.430
2018 0.340 0.338 0.330 0.430
2017 0.330 0.354 0.360 0.450
Prescriptions of concern - Ages 0-9 2020 0.16 0.15 N/A N/A
2019 0.34 0.34 N/A N/A
2018 0.33 0.32 N/A N/A
2017 0.36 0.35 N/A N/A
Prescriptions of concern - Ages 10-17 2020 0.11 0.11 N/A N/A
2019 0.22 0.20 N/A N/A
2018 0.22 0.20 N/A N/A
2017 0.23 0.22 N/A N/A
Prescriptions of concern - Ages 18-34 2020 0.19 0.20 N/A N/A
2019 0.27 0.28 N/A N/A
2018 0.28 0.28 N/A N/A
2017 0.27 0.28 N/A N/A
Prescriptions of concern - Ages 35-49 2020 0.25 0.25 N/A N/A
2019 0.33 0.35 N/A N/A
2018 0.34 0.35 N/A N/A
2017 0.34 0.37 N/A N/A
Prescriptions of concern - Ages 50-64 2020 0.31 0.31 N/A N/A
2019 0.40 0.41 N/A N/A
2018 0.42 0.42 N/A N/A
2017 0.42 0.44 N/A N/A
Prescriptions of concern - Ages 65-74 2020 0.36 0.33 N/A N/A
2019 0.46 0.44 N/A N/A
2018 0.49 0.48 N/A N/A
2017 0.47 0.50 N/A N/A
Prescriptions of concern - Ages 75-85 2020 0.44 0.34 N/A N/A
2019 0.65 0.51 N/A N/A
2018 0.76 0.62 N/A N/A
2017 0.70 0.54 N/A N/A
Prescriptions of concern - Ages 85 plus 2020 0.00 0.41 N/A N/A
2019 0.00 0.36 N/A N/A
2018 0.00 0.45 N/A N/A
2017 0.27 0.48 N/A N/A
Info
Mental Health Utilization 2021 Plan State Avg Nat Avg 90th Pctl.
Mental Health Utilization - Any Service - Total 6.84% 9.40% 9.48% 13.63%
Mental Health Utilization - Any Service - Ages 0-12 4.09% 6.00% N/A N/A
Mental Health Utilization - Any Service - Ages 13-17 14.06% 16.24% N/A N/A
Mental Health Utilization - Any Service - Ages 18-64 6.92% 9.76% N/A N/A
Mental Health Utilization - Any Service - Ages 65 plus 2.03% 3.11% N/A N/A
Mental Health Utilization - ED - Total 0.06% 0.05% 0.07% 0.17%
Mental Health Utilization - ED - Ages 0-12 0.00% 0.02% N/A N/A
Mental Health Utilization - ED - Ages 13-17 0.22% 0.21% N/A N/A
Mental Health Utilization - ED - Ages 18-64 0.06% 0.04% N/A N/A
Mental Health Utilization - ED - Ages 65 plus 0.00% 0.01% N/A N/A
Mental Health Utilization - Inpatient - Total 0.18% 0.24% 0.25% 0.33%
Mental Health Utilization - Inpatient - Ages 0-12 0.05% 0.08% N/A N/A
Mental Health Utilization - Inpatient - Ages 13-17 0.60% 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 0.04% 0.08% 0.16% 0.31%
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 0-12 0.03% 0.03% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 13-17 0.11% 0.40% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 18-64 0.04% 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 4.29% 4.73% 5.70% 8.26%
Mental Health Utilization - Outpatient - Ages 0-12 3.01% 3.72% N/A N/A
Mental Health Utilization - Outpatient - Ages 13-17 10.46% 9.85% N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 4.20% 4.63% N/A N/A
Mental Health Utilization - Outpatient - Ages 65 plus 1.07% 1.73% N/A N/A
Mental Health Utilization - Telehealth - Total 4.09% 6.68% 6.01% 9.77%
Mental Health Utilization - Telehealth - Ages 0-12 2.07% 3.74% N/A N/A
Mental Health Utilization - Telehealth - Ages 13-17 8.39% 10.92% N/A N/A
Mental Health Utilization - Telehealth - Ages 18-64 4.19% 7.11% N/A N/A
Mental Health Utilization - Telehealth - Ages 65 plus 1.36% 1.96% N/A N/A
Mental Health Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Mental Health Utilization - Any Service - Total 2020 6.50% 9.13% 9.07% 12.95%
2019 6.44% 8.33% 8.86% 12.67%
2018 5.76% 7.63% 7.98% 11.76%
2017 N/A N/A N/A N/A
Mental Health Utilization - Any Service - Ages 0-12 2020 4.54% 6.25% N/A N/A
2019 4.79% 6.35% N/A N/A
2018 4.81% 6.12% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Any Service - Ages 13-17 2020 11.68% 15.31% N/A N/A
2019 13.16% 15.01% N/A N/A
2018 12.51% 13.96% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Any Service - Ages 18-64 2020 6.58% 9.40% N/A N/A
2019 6.36% 8.45% N/A N/A
2018 5.55% 7.62% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Any Service - Ages 65 plus 2020 2.25% 3.53% N/A N/A
2019 1.98% 3.17% N/A N/A
2018 2.02% 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 0.08% 0.09% 0.10% 0.22%
2017 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 0-12 2020 0.00% 0.01% N/A N/A
2019 0.05% 0.02% N/A N/A
2018 0.07% 0.05% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 13-17 2020 0.21% 0.10% N/A N/A
2019 0.28% 0.17% N/A N/A
2018 0.44% 0.28% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 18-64 2020 0.03% 0.03% N/A N/A
2019 0.02% 0.03% N/A N/A
2018 0.06% 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 0.00% 0.07% 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 - Inpatient - Total 2020 0.17% 0.22% 0.24% 0.31%
2019 0.23% 0.25% 0.27% 0.34%
2018 0.24% 0.27% 0.27% 0.34%
2017 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 0-12 2020 0.04% 0.07% N/A N/A
2019 0.11% 0.12% N/A N/A
2018 0.07% 0.12% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 13-17 2020 0.67% 0.79% N/A N/A
2019 0.78% 0.85% N/A N/A
2018 1.11% 0.95% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 18-64 2020 0.16% 0.20% N/A N/A
2019 0.21% 0.24% N/A N/A
2018 0.22% 0.26% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 65 plus 2020 0.08% 0.06% N/A N/A
2019 0.34% 0.11% N/A N/A
2018 0.00% 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 0.06% 0.07% 0.15% 0.30%
2019 0.11% 0.11% 0.20% 0.40%
2018 0.14% 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 0.07% 0.05% N/A N/A
2019 0.22% 0.10% N/A N/A
2018 0.22% 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 0.29% 0.26% N/A N/A
2019 0.50% 0.35% N/A N/A
2018 0.80% 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 0.04% 0.06% N/A N/A
2019 0.08% 0.09% N/A N/A
2018 0.09% 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 5.06% 7.22% 6.95% 9.99%
2019 6.32% 8.24% 8.73% 12.61%
2018 5.65% 7.53% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Ages 0-12 2020 3.98% 5.23% N/A N/A
2019 4.75% 6.32% N/A N/A
2018 4.79% 6.10% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Ages 13-17 2020 9.68% 12.84% N/A N/A
2019 12.84% 14.86% N/A N/A
2018 12.24% 13.80% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 2020 5.04% 7.35% N/A N/A
2019 6.26% 8.36% N/A N/A
2018 5.45% 7.51% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Ages 65 plus 2020 1.42% 2.62% N/A N/A
2019 1.89% 3.07% N/A N/A
2018 2.02% 3.16% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Total 2020 3.22% 4.92% 5.19% 8.37%
2019 0.09% 0.11% 0.11% 0.22%
2018 0.06% 0.10% 0.05% 0.11%
2017 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Ages 0-12 2020 1.76% 3.07% N/A N/A
2019 0.03% 0.04% N/A N/A
2018 0.03% 0.03% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Ages 13-17 2020 6.07% 8.30% N/A N/A
2019 0.00% 0.15% N/A N/A
2018 0.20% 0.19% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Ages 18-64 2020 3.30% 5.11% N/A N/A
2019 0.10% 0.12% N/A N/A
2018 0.05% 0.11% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Ages 65 plus 2020 1.42% 1.80% 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
2021 data updated on: 07/02/2024