Health Insurance in Virginia

Optima Health Plan

Company Information

  • Company Providing Plan:Optima Health Plan
  • Address:4417 Corporation Lane
    Virginia Beach, VA 23462
  • Telephone :757-552-7401
  • Website:www.sentara.com
2017
Number of Enrollees: 303,866
PMPM: $425
Number of Physicians: 16,458
NCQA Accreditation: Commendable

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


Coverage Areas

Counties

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


Cities

Bedford, Bristol, Buena Vista, Charlottesville, Chesapeake, Colonial Heights, Covington, Danville, Emporia, Franklin, Fredericksburg, Galax, Hampton, Harrisonburg, Hopewell, Lexington, Lynchburg, Martinsville, 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

2017 2016 2015 2014 2013
Number of Enrollees 303,866 294,873 292,937 314,913 320,048
PMPM $425 $396 $372 $366 $340
Medical Cost Ratio 90% 91% 90% 89% 90%
Administrative Ratio 9% 8% 9% 8% 7%
Profit/Loss Ratio 1% 1% 1% 4% 4%
Number of Physicians 16,458 15,931 15,836 14,947 14,380

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

Financial Data

2017 2016 2015 2014 2013
Premiums Earned $1,491,595,258 $1,395,696,663 $1,331,267,695 $1,369,161,590 $1,302,391,927
Income $15,658,596 $9,628,472 $15,486,345 $51,477,534 $48,908,625
Net Worth $244,239,759 $222,565,488 $212,418,559 $197,650,782 $196,599,322

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

Performance

Access/Availability of Care
Info
Adult Access To Preventive/Ambulatory Health Services 2017 Plan State Avg Nat Avg 90th Pctl.
Adult Access (Age 20-44) To Preventive/Ambulatory Health Services 93.83% 92.73% 92.45% 95.43%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 96.57% 95.57% 95.61% 97.46%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 97.84% 97.82% 97.07% 98.47%
Adult Access To Preventive/Ambulatory Health Services Year Plan State Avg. Natl. Avg. 90th Pctl.
Adult Access (Age 20-44) To Preventive/Ambulatory Health Services 2016 93.62% 92.81% 92.73% 95.55%
2015 93.83% 92.25% 92.83% 95.45%
2014 94.13% 93.10% 92.91% 95.39%
2013 94.50% 93.27% 93.13% 95.56%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 2016 96.47% 95.78% 95.78% 97.61%
2015 96.76% 95.61% 95.90% 97.55%
2014 96.85% 96.03% 95.85% 97.54%
2013 97.15% 95.97% 95.93% 97.60%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 2016 97.65% 97.30% 97.19% 98.61%
2015 97.63% 96.84% 97.32% 96.73%
2014 97.93% 97.56% 97.50% 98.68%
2013 98.58% 97.45% 97.36% 98.63%
Info
Alcohol and Other Drug Dependence Treatment 2017 Plan State Avg Nat Avg 90th Pctl.
Initiation of Alcohol and Other Drug Dependence Treatment - Total 33.46% 36.14% 36.11% 42.01%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 35.42% 40.06% 39.91% 52.54%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 33.40% 36.00% 35.97% 41.96%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 11.55% 13.36% 12.65% 17.26%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 10.42% 14.40% 14.95% 23.85%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 11.59% 13.40% 12.55% 17.38%
Alcohol and Other Drug Dependence Treatment Year Plan State Avg. Natl. Avg. 90th Pctl.
Initiation of Alcohol and Other Drug Dependence Treatment - Total 2016 29.88% 35.69% 32.93% 40.24%
2015 31.70% 33.04% 33.42% 41.07%
2014 30.67% 32.51% 35.63% 44.19%
2013 33.75% 35.00% 39.01% 50.93%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2016 17.46% 40.15% 40.47% 51.96%
2015 36.49% 37.03% 39.62% 50.00%
2014 31.96% 37.09% 40.79% 52.00%
2013 28.00% 39.67% 41.13% 53.51%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2016 30.34% 35.55% 32.64% 40.33%
2015 31.51% 32.96% 33.20% 40.93%
2014 30.61% 32.16% 35.21% 43.92%
2013 34.04% 34.74% 38.83% 51.61%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 2016 8.65% 12.51% 11.46% 16.72%
2015 9.67% 11.61% 12.46% 19.23%
2014 9.71% 10.64% 13.66% 19.19%
2013 11.03% 12.12% 14.64% 21.16%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2016 3.17% 11.28% 15.68% 23.73%
2015 8.11% 12.06% 15.42% 22.12%
2014 7.22% 13.00% 17.24% 25.29%
2013 9.00% 18.05% 18.23% 27.05%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2016 8.85% 12.57% 11.32% 16.09%
2015 9.73% 11.57% 12.34% 18.67%
2014 9.83% 10.33% 13.45% 18.68%
2013 11.13% 11.84% 14.47% 21.31%
Info
Child Access to Primary Care Practitioners 2017 Plan State Avg Nat Avg 90th Pctl.
12-24 month old Child Access to Primary Care Practitioners 99.26% 98.09% 97.93% 99.50%
25 month to 6 year old Child Access to Primary Care Practitioners 95.40% 94.63% 92.58% 96.95%
7-11 year old Child Access to Primary Care Practitioners 95.22% 95.40% 93.43% 98.48%
12-19 year old Child Access to Primary Care Practitioners 91.36% 92.00% 91.08% 96.99%
Child Access to Primary Care Practitioners Year Plan State Avg. Natl. Avg. 90th Pctl.
12-24 month old Child Access to Primary Care Practitioners 2016 99.19% 98.34% 98.09% 99.72%
2015 98.48% 98.78% 98.03% 99.48%
2014 98.66% 98.49% 97.87% 99.62%
2013 99.58% 97.92% 97.99% 99.48%
25 month to 6 year old Child Access to Primary Care Practitioners 2016 95.05% 94.33% 92.60% 96.46%
2015 94.39% 94.16% 92.67% 96.64%
2014 93.89% 93.85% 92.33% 96.52%
2013 93.61% 93.53% 92.38% 96.50%
7-11 year old Child Access to Primary Care Practitioners 2016 94.74% 94.38% 93.25% 98.25%
2015 94.07% 94.23% 93.23% 97.92%
2014 93.63% 93.78% 93.02% 97.87%
2013 94.29% 93.78% 93.11% 97.89%
12-19 year old Child Access to Primary Care Practitioners 2016 90.19% 91.45% 90.76% 96.39%
2015 89.43% 91.30% 90.66% 96.19%
2014 89.11% 90.84% 90.44% 96.28%
2013 89.25% 90.58% 90.31% 96.28%
Info
Prenatal and Postpartum Care 2017 Plan State Avg Nat Avg 90th Pctl.
Postpartum Care 82.10% 73.45% 75.05% 88.13%
Timeliness of Prenatal Care 92.58% 86.37% 84.34% 94.89%
Prenatal and Postpartum Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Postpartum Care 2016 84.35% 74.50% 73.95% 88.85%
2015 85.44% 73.91% 73.72% 87.50%
2014 82.52% 77.29% 77.64% 88.65%
2013 83.04% 81.38% 91.35% 97.14%
Timeliness of Prenatal Care 2016 89.57% 86.71% 85.57% 96.28%
2015 88.51% 86.80% 84.28% 94.56%
2014 89.84% 86.83% 88.00% 96.23%
2013 88.17% 91.63% 81.00% 90.48%
Effectiveness of Care
Info
Asthma Medication Management 2017 Plan State Avg Nat Avg 90th Pctl.
Medication Management for People With Asthma at least 50% Compliance - Total 76.22% 76.58% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 5-11 68.59% 66.50% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 12-18 63.24% 68.06% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 19-50 76.81% 75.34% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 51-64 82.39% 84.54% N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Total 55.12% 54.32% 50.48% 57.69%
Medication Management for People With Asthma at least 75% Compliance - Ages 5-11 42.96% 42.35% 40.22% 52.99%
Medication Management for People With Asthma at least 75% Compliance - Ages 12-18 37.30% 41.76% 37.80% 47.11%
Medication Management for People With Asthma at least 75% Compliance - Ages 19-50 56.63% 52.86% 48.60% 57.87%
Medication Management for People With Asthma at least 75% Compliance - Ages 51-64 63.58% 64.50% 59.65% 67.58%
Asthma Medication Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Medication Management for People With Asthma at least 50% Compliance - Total 2016 75.20% 73.20% N/A N/A
2015 72.44% 71.52% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 5-11 2016 68.14% 67.58% N/A N/A
2015 61.84% 64.34% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 12-18 2016 66.67% 65.72% N/A N/A
2015 62.87% 60.17% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 19-50 2016 74.55% 71.77% N/A N/A
2015 70.05% 68.82% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 51-64 2016 80.97% 79.36% N/A N/A
2015 81.71% 78.55% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Total 2016 52.73% 51.17% 48.54% 56.96%
2015 48.71% 48.01% 46.20% 55.00%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Ages 5-11 2016 48.23% 39.03% 37.58% 48.84%
2015 37.72% 36.59% 37.85% 49.09%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Ages 12-18 2016 36.67% 35.03% 35.83% 46.97%
2015 35.15% 35.39% 34.97% 45.26%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Ages 19-50 2016 51.89% 50.18% 46.16% 55.80%
2015 46.64% 45.56% 43.39% 53.13%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Ages 51-64 2016 60.27% 59.39% 57.47% 65.75%
2015 59.15% 58.44% 55.49% 65.28%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Info
Asthma Medication Ratio 2017 Plan State Avg Nat Avg 90th Pctl.
Controller/Total Asthma Medication Ratio - Total 83.99% 84.01% 79.04% 85.85%
Controller/Total Asthma Medication Ratio - Ages 5-11 86.36% 86.06% 86.90% 93.55%
Controller/Total Asthma Medication Ratio - Ages 12-18 84.21% 84.80% 76.69% 85.94%
Controller/Total Asthma Medication Ratio - Ages 19-50 80.14% 78.94% 74.23% 81.70%
Controller/Total Asthma Medication Ratio - Ages 51-64 86.99% 89.17% 82.83% 89.28%
Asthma Medication Ratio Year Plan State Avg. Natl. Avg. 90th Pctl.
Controller/Total Asthma Medication Ratio - Total 2016 84.02% 80.60% 78.29% 85.46%
2015 82.44% 81.09% 77.99% 83.76%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Controller/Total Asthma Medication Ratio - Ages 5-11 2016 92.98% 91.67% 86.40% 93.97%
2015 90.00% 88.49% 86.99% 92.47%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Controller/Total Asthma Medication Ratio - Ages 12-18 2016 87.10% 81.12% 78.30% 86.34%
2015 81.64% 78.19% 77.09% 84.67%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Controller/Total Asthma Medication Ratio - Ages 19-50 2016 77.88% 75.24% 73.51% 81.08%
2015 75.90% 75.16% 72.38% 80.79%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Controller/Total Asthma Medication Ratio - Ages 51-64 2016 85.81% 83.27% 81.70% 88.64%
2015 85.21% 85.39% 81.87% 88.89%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Info
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication 2017 Plan State Avg Nat Avg 90th Pctl.
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Initiation 35.15% 41.27% 41.13% 50.83%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 40.57% 55.09% 47.07% 58.44%
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication Year Plan State Avg. Natl. Avg. 90th Pctl.
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Initiation 2016 32.91% 41.91% 38.93% 48.61%
2015 40.68% 41.43% 38.13% 50.00%
2014 32.82% 39.00% 38.01% 46.81%
2013 34.27% 35.14% 40.10% 51.06%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 2016 36.75% 46.92% 45.82% 56.86%
2015 48.98% 49.06% 46.18% 58.06%
2014 34.85% 46.49% 45.70% 57.75%
2013 43.45% 41.32% 46.66% 58.62%
Info
Cardiovascular Disease Management 2017 Plan State Avg Nat Avg 90th Pctl.
Controlling High Blood Pressure 59.75% 56.61% 59.90% 74.82%
Persistence of Beta-Blockers 87.40% 85.80% 85.18% 93.41%
Cardiovascular Disease Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Controlling High Blood Pressure 2016 56.31% 56.91% 60.31% 74.43%
2015 61.96% 58.35% 58.69% 73.89%
2014 59.71% 59.30% 62.63% 75.63%
2013 62.92% 60.92% 63.30% 74.65%
Persistence of Beta-Blockers 2016 86.36% 90.70% 83.61% 90.83%
2015 90.07% 88.70% 84.68% 91.00%
2014 84.44% 84.03% 83.50% 91.43%
2013 81.13% 83.43% 83.39% 91.72%
Info
Common Childhood Illnesses 2017 Plan State Avg Nat Avg 90th Pctl.
Appropriate Testing for Children With Pharyngitis 93.55% 92.30% 87.45% 94.64%
Common Childhood Illnesses Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Testing for Children With Pharyngitis 2016 90.72% 90.38% 84.50% 93.75%
2015 89.16% 90.13% 83.12% 93.11%
2014 89.11% 88.64% 83.29% 91.40%
2013 89.34% 87.54% 81.45% 91.30%
Info
Diabetes Care and Management 2017 Plan State Avg Nat Avg 90th Pctl.
Comprehensive Diabetes Care-Blood Pressure Control (<140/90 mm Hg) 63.14% 63.40% 60.82% 76.41%
Comprehensive Diabetes Care-HbA1c control (<8.0%) 64.18% 62.51% 57.48% 67.15%
Comprehensive Diabetes Care-Rate of Eye Exams 71.13% 56.95% 54.06% 70.69%
Comprehensive Diabetes Care-Rate of Medical Attention for Diabetic Nephropathy 89.55% 90.80% 90.38% 93.61%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 26.55% 27.63% 31.91% 21.41%
Comprehensive Diabetes Care-Testing for HbA1c 90.21% 91.52% 90.96% 94.18%
Diabetes Care and Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Comprehensive Diabetes Care-Blood Pressure Control (<140/90 mm Hg) 2016 62.80% 60.88% 61.06% 78.35%
2015 64.34% 61.03% 58.80% 75.68%
2014 64.35% 63.33% 63.85% 76.00%
2013 39.16% 42.35% 64.44% 76.22%
Comprehensive Diabetes Care-HbA1c control (<8.0%) 2016 64.22% 58.36% 56.62% 66.39%
2015 62.41% 57.59% 55.81% 66.67%
2014 73.92% 59.12% 58.53% 68.61%
2013 67.92% 55.47% 58.87% 69.16%
Comprehensive Diabetes Care-Rate of Eye Exams 2016 72.04% 58.46% 52.96% 72.04%
2015 58.55% 57.15% 52.47% 70.44%
2014 60.29% 57.54% 54.98% 71.93%
2013 61.73% 56.05% 54.65% 71.53%
Comprehensive Diabetes Care-Rate of Medical Attention for Diabetic Nephropathy 2016 91.23% 90.56% 90.03% 92.71%
2015 89.64% 91.11% 90.10% 93.40%
2014 88.04% 86.26% 84.72% 89.60%
2013 86.06% 84.97% 83.75% 89.19%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 2016 24.64% 30.47% 32.15% 20.98%
2015 26.02% 30.83% 33.90% 20.20%
2014 21.29% 31.37% 30.48% 19.33%
2013 23.89% 34.40% 30.71% 19.46%
Comprehensive Diabetes Care-Testing for HbA1c 2016 91.00% 90.38% 90.32% 94.83%
2015 91.81% 91.13% 90.54% 94.69%
2014 92.58% 89.01% 90.34% 94.86%
2013 91.15% 88.32% 89.62% 94.23%
Info
Drug Therapy in Rheumatoid Arthritis 2017 Plan State Avg Nat Avg 90th Pctl.
Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis 92.43% 90.16% 88.62% 93.75%
Drug Therapy in Rheumatoid Arthritis Year Plan State Avg. Natl. Avg. 90th Pctl.
Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis 2016 91.58% 89.05% 87.87% 93.92%
2015 92.38% 89.72% 87.84% 92.86%
2014 88.98% 88.05% 87.86% 93.59%
2013 89.79% 88.24% 87.95% 94.49%
Info
Immunizations 2017 Plan State Avg Nat Avg 90th Pctl.
Childhood Immunization for Multiple diseases including Chicken Pox 90.27% 81.72% 79.44% 89.14%
Childhood Immunization for Multiple diseases including pneumovax 89.03% 80.09% 77.67% 87.61%
Flu Vaccinations for Adults Ages 18–64 0.66% 0.53% N/A N/A
Immunizations for Adolescents - Combination 71.53% 80.48% 80.23% 89.54%
Immunizations for Adolescents - Meningococcal 71.78% 82.05% 81.75% 90.27%
Immunizations for Adolescents - Tdap 95.86% 91.65% 88.91% 94.65%
Immunizations Year Plan State Avg. Natl. Avg. 90th Pctl.
Childhood Immunization for Multiple diseases including Chicken Pox 2016 85.38% 84.29% 78.93% 89.03%
2015 82.87% 81.56% 78.59% 88.08%
2014 84.03% 80.25% 80.18% 88.07%
2013 84.03% 80.24% 78.39% 87.14%
Childhood Immunization for Multiple diseases including pneumovax 2016 82.60% 82.08% 77.04% 87.50%
2015 80.79% 79.45% 76.49% 87.10%
2014 82.18% 78.11% 78.13% 86.26%
2013 82.18% 78.73% 76.21% 85.40%
Flu Vaccinations for Adults Ages 18–64 2016 56.78% 47.13% N/A N/A
2015 0.53% 0.50% 47.85% 58.01%
2014 0.59% 0.52% 49.45% 59.73%
2013 0.54% 0.49% 49.06% 59.59%
Immunizations for Adolescents - Combination 2016 69.61% 77.95% 77.63% 88.81%
2015 67.59% 69.50% 74.25% 88.47%
2014 64.56% 67.04% 70.73% 87.34%
2013 61.65% 60.89% 66.54% 84.18%
Immunizations for Adolescents - Meningococcal 2016 70.53% 79.65% 79.20% 90.02%
2015 0.68% 0.72% 76.12% 89.29%
2014 0.65% 0.69% 72.59% 88.27%
2013 0.63% 0.64% 68.70% 85.25%
Immunizations for Adolescents - Tdap 2016 94.20% 91.29% 87.77% 95.38%
2015 0.94% 0.85% 86.03% 94.39%
2014 0.95% 0.85% 84.49% 95.15%
2013 0.93% 0.80% 80.83% 94.73%
Info
Mental Health: Care and Follow-up 2017 Plan State Avg Nat Avg 90th Pctl.
Antidepressant Medication Management-Acute Phase Treatment 69.60% 71.12% 67.11% 75.76%
Antidepressant Medication Management-Continuation Phase Treatment 53.81% 54.87% 51.53% 60.24%
Follow-up After Hospitalization For Mental Illness within 7 days after hospital discharge 51.23% 52.18% 46.63% 62.81%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 74.19% 69.80% 68.66% 82.58%
Mental Health: Care and Follow-up Year Plan State Avg. Natl. Avg. 90th Pctl.
Antidepressant Medication Management-Acute Phase Treatment 2016 68.70% 70.29% 66.56% 74.77%
2015 65.32% 67.61% 65.82% 74.06%
2014 61.87% 68.52% 65.88% 75.35%
2013 62.11% 65.67% 63.60% 73.26%
Antidepressant Medication Management-Continuation Phase Treatment 2016 52.37% 53.51% 50.69% 58.60%
2015 50.43% 49.81% 50.15% 57.56%
2014 46.10% 50.31% 49.83% 59.11%
2013 47.93% 48.37% 46.58% 57.12%
Follow-up After Hospitalization For Mental Illness within 7 days after hospital discharge 2016 58.73% 52.99% 52.06% 67.31%
2015 46.55% 47.66% 50.57% 67.57%
2014 63.06% 51.82% 52.21% 70.33%
2013 65.87% 55.07% 53.70% 69.16%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 2016 80.50% 73.85% 71.36% 84.17%
2015 66.55% 71.58% 69.72% 83.80%
2014 79.66% 72.52% 70.72% 85.71%
2013 82.51% 73.03% 72.56% 84.19%
Info
Persistent Medications 2017 Plan State Avg Nat Avg 90th Pctl.
Annual Monitoring for Patients on Persistent Medications 88.51% 85.73% 83.71% 87.04%
Persistent Medications Year Plan State Avg. Natl. Avg. 90th Pctl.
Annual Monitoring for Patients on Persistent Medications 2016 88.22% 84.90% 83.34% 87.04%
2015 87.13% 83.34% 82.94% 86.72%
2014 83.98% 83.28% 82.33% 86.25%
2013 84.67% 83.44% 82.32% 86.12%
Info
Pharmacotherapy of COPD Exacerbation 2017 Plan State Avg Nat Avg 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 78.39% 80.88% 79.87% 87.50%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 77.89% 78.84% 76.26% 84.38%
Pharmacotherapy of COPD Exacerbation Year Plan State Avg. Natl. Avg. 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 2016 84.52% 84.12% 76.30% 85.98%
2015 84.31% 78.48% 79.09% 87.10%
2014 76.37% 80.03% 80.14% 86.90%
2013 78.53% 78.88% 79.47% 87.58%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 2016 81.29% 79.54% 70.70% 81.82%
2015 75.16% 72.98% 75.30% 84.56%
2014 79.12% 75.53% 75.28% 83.54%
2013 81.68% 73.76% 75.40% 83.33%
Info
Preventive Care 2017 Plan State Avg Nat Avg 90th Pctl.
Breast Cancer Screening 77.61% 71.85% 72.81% 80.91%
Chlamydia Screening in Women-all Age groups 48.28% 51.46% 50.16% 66.08%
Colorectal Cancer Screening 73.77% 65.16% 62.43% 74.72%
Preventive Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Breast Cancer Screening 2016 77.04% 71.80% 72.90% 80.63%
2015 76.92% 72.07% 73.08% 81.53%
2014 74.73% 72.22% 73.52% 81.91%
2013 74.69% 72.82% 73.71% 80.78%
Chlamydia Screening in Women-all Age groups 2016 48.70% 49.79% 48.98% 63.50%
2015 47.94% 47.89% 52.32% 64.06%
2014 47.47% 48.07% 51.65% 63.48%
2013 47.18% 47.46% 46.20% 59.63%
Colorectal Cancer Screening 2016 67.01% 65.83% 61.71% 74.09%
2015 67.49% 64.43% 62.32% 73.84%
2014 59.26% 63.41% 64.06% 74.86%
2013 68.87% 65.36% 62.85% 72.75%
Info
Spirometry Testing 2017 Plan State Avg Nat Avg 90th Pctl.
Use of Spirometry Testing in the Assessment and diagnosis of COPD 45.54% 43.12% 41.90% 50.52%
Spirometry Testing Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Spirometry Testing in the Assessment and diagnosis of COPD 2016 43.30% 42.48% 42.55% 51.02%
2015 41.87% 46.31% 42.44% 51.66%
2014 40.22% 42.48% 42.16% 51.85%
2013 42.86% 43.20% 42.08% 50.99%
Info
Weight Assessment and Counseling 2017 Plan State Avg Nat Avg 90th Pctl.
Adult BMI Assessment 91.79% 79.49% 79.78% 93.20%
Children/Adolescents BMI Assessment - Total 72.61% 70.41% 70.59% 88.08%
Counseling for Nutrition for Children/Adolescents - Total 68.59% 69.47% 65.50% 83.21%
Counseling for Physical Activity for Children/Adolescents - Total 59.55% 64.30% 59.96% 77.32%
Weight Assessment and Counseling Year Plan State Avg. Natl. Avg. 90th Pctl.
Adult BMI Assessment 2016 86.08% 77.87% 76.17% 91.85%
2015 88.14% 75.90% 74.19% 91.76%
2014 88.59% 76.28% 75.36% 91.20%
2013 82.51% 72.78% 74.24% 90.00%
Children/Adolescents BMI Assessment - Total 2016 75.82% 69.07% 65.62% 88.08%
2015 70.47% 60.49% 60.37% 83.78%
2014 64.58% 61.63% 61.08% 85.37%
2013 55.09% 52.14% 54.90% 83.13%
Counseling for Nutrition for Children/Adolescents - Total 2016 69.01% 66.76% 61.76% 83.68%
2015 63.49% 63.88% 58.94% 80.79%
2014 58.10% 65.02% 60.64% 80.05%
2013 57.64% 61.17% 56.48% 79.32%
Counseling for Physical Activity for Children/Adolescents - Total 2016 59.86% 60.41% 55.96% 79.44%
2015 56.98% 59.53% 54.50% 78.85%
2014 54.63% 62.13% 57.09% 77.30%
2013 49.31% 56.47% 53.16% 74.70%
Health Plan Stability/Descriptive
Info
Administrative Data 2017 Plan State Avg Nat Avg 90th Pctl.
Administrative Ratio 0.09 0.12 86.39 93.13
Medical Cost Ratio 0.90 0.83 93.13 96.59
Number of Enrollees 303,866 133,992 92 97
Number of Physicians 16,458 81,926 87 95
Premium Per Member Per Month $425 $370 N/A N/A
Profit/Loss Ratio 0.01 0.05 79.44 89.14
Administrative Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Administrative Ratio 2016 0.08 0.15 N/A N/A
2015 0.09 0.14 N/A N/A
2014 0.08 0.14 N/A N/A
2013 0.07 0.14 N/A N/A
Medical Cost Ratio 2016 0.91 0.83 N/A N/A
2015 0.90 0.82 N/A N/A
2014 0.89 0.81 N/A N/A
2013 0.90 0.83 N/A N/A
Number of Enrollees 2016 294,873 136,796 N/A N/A
2015 292,937 124,097 N/A N/A
2014 314,913 115,428 N/A N/A
2013 320,048 98,253 N/A N/A
Number of Physicians 2016 15,931 73,426 N/A N/A
2015 15,836 90,027 N/A N/A
2014 14,947 63,157 N/A N/A
2013 14,380 64,207 N/A N/A
Premium Per Member Per Month 2016 $396 $370 N/A N/A
2015 $372 $375 N/A N/A
2014 $366 $412 N/A N/A
2013 $340 $544 N/A N/A
Profit/Loss Ratio 2016 0.01 0.03 N/A N/A
2015 0.01 0.04 N/A N/A
2014 0.04 0.06 N/A N/A
2013 0.04 0.03 N/A N/A
Info
Board Certification Rates for Providers 2017 Plan State Avg Nat Avg 90th Pctl.
Board Certification for Geriatricians 95.00% 71.38% N/A N/A
Board Certification for Pediatricians 92.00% 85.50% N/A N/A
Board Certification Rate for Family Medicine Physicians 90.00% 81.38% N/A N/A
Board Certification Rate for Internal Medicine Physicians 89.00% 81.00% N/A N/A
Board Certification Rate for OB/GYN Providers 90.00% 83.00% N/A N/A
Board Certification Rate for Other Specialists 91.00% 81.88% N/A N/A
Board Certification Rates for Providers Year Plan State Avg. Natl. Avg. 90th Pctl.
Board Certification for Geriatricians 2016 95.38% 73.44% N/A N/A
2015 83.33% 71.06% N/A N/A
2014 86.67% 74.73% 64.82% 87.50%
2013 69.44% 71.19% 63.29% 83.33%
Board Certification for Pediatricians 2016 94.06% 87.02% N/A N/A
2015 94.10% 88.14% N/A N/A
2014 95.06% 88.13% 83.89% 91.52%
2013 89.33% 86.01% 81.01% 90.29%
Board Certification Rate for Family Medicine Physicians 2016 88.77% 80.32% N/A N/A
2015 89.01% 82.53% N/A N/A
2014 89.55% 82.93% 77.41% 89.90%
2013 87.45% 81.36% 76.60% 88.80%
Board Certification Rate for Internal Medicine Physicians 2016 88.88% 81.15% N/A N/A
2015 87.59% 82.59% N/A N/A
2014 88.51% 83.98% 79.07% 88.73%
2013 85.03% 80.80% 78.18% 87.44%
Board Certification Rate for OB/GYN Providers 2016 90.25% 83.36% N/A N/A
2015 88.71% 83.51% N/A N/A
2014 89.31% 83.71% 79.30% 88.80%
2013 78.00% 80.44% 76.89% 87.80%
Board Certification Rate for Other Specialists 2016 92.07% 83.25% N/A N/A
2015 91.40% 82.88% N/A N/A
2014 92.36% 84.44% 78.09% 89.67%
2013 N/A 79.95% 74.88% 88.36%
Info
Financial Data 2017 Plan State Avg Nat Avg 90th Pctl.
Income $15,658,596 $34,422,501 N/A N/A
Net Worth $244,239,759 $263,890,874 N/A N/A
Premiums Earned $1,491,595,258 $645,600,589 N/A N/A
Financial Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Income 2016 $9,628,472 $38,212,136 N/A N/A
2015 $15,486,345 $19,029,685 N/A N/A
2014 $51,477,534 $50,732,622 N/A N/A
2013 $48,908,625 $44,817,532 N/A N/A
Net Worth 2016 $222,565,488 $267,217,323 N/A N/A
2015 $212,418,559 $237,291,717 N/A N/A
2014 $197,650,782 $250,764,247 N/A N/A
2013 $196,599,322 $222,343,959 N/A N/A
Premiums Earned 2016 $1,395,696,663 $644,862,921 N/A N/A
2015 $1,331,267,695 $552,705,214 N/A N/A
2014 $1,369,161,590 $470,221,984 N/A N/A
2013 $1,302,391,927 $403,549,832 N/A N/A
Info
Years in Business 2017 Plan State Avg Nat Avg 90th Pctl.
Years in Business 33 35 N/A N/A
Years in Business Year Plan State Avg. Natl. Avg. 90th Pctl.
Years in Business 2016 32 34 N/A N/A
2015 31 33 N/A N/A
2014 30 32 N/A N/A
2013 29 31 N/A N/A
Member Satisfaction
Info
Member Satisfaction 2017 Plan State Avg Nat Avg 90th Pctl.
Getting Care Quickly 87.80% 87.22% 85.34% 89.83%
Getting Needed Care 88.20% 87.44% 86.71% 90.37%
How Well Doctors Communicate 96.79% 94.74% 95.10% 96.91%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 59.40% 61.26% 62.44% 75.00%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 84.43% 83.86% 84.62% 88.77%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 81.22% 76.98% 77.27% 82.99%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 87.90% 83.95% 84.60% 89.86%
Member Satisfaction Year Plan State Avg. Natl. Avg. 90th Pctl.
Getting Care Quickly 2016 87.42% 85.81% 85.14% 90.00%
2015 85.95% 85.61% 85.00% 89.71%
2014 86.07% 86.12% 85.79% 90.17%
2013 86.23% 86.65% 86.84% 90.75%
Getting Needed Care 2016 87.37% 86.38% 87.25% 91.54%
2015 87.41% 86.51% 86.79% 91.23%
2014 90.10% 88.34% 87.95% 92.13%
2013 88.84% 87.20% 88.05% 92.37%
How Well Doctors Communicate 2016 96.20% 95.22% 95.39% 97.21%
2015 95.96% 94.90% 95.20% 97.10%
2014 96.96% 95.30% 95.26% 97.16%
2013 93.90% 94.13% 94.94% 96.97%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 2016 60.24% 62.47% 62.27% 74.92%
2015 62.00% 62.71% 62.65% 74.57%
2014 56.43% 58.77% 64.71% 76.75%
2013 67.31% 65.03% 66.21% 78.29%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 2016 85.93% 83.44% 84.72% 88.74%
2015 82.87% 83.49% 83.85% 89.05%
2014 87.05% 85.38% 84.24% 88.27%
2013 86.22% 83.04% 84.52% 89.47%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 2016 76.81% 77.49% 77.19% 83.29%
2015 77.46% 76.25% 76.99% 82.76%
2014 80.40% 79.49% 78.26% 83.66%
2013 80.65% 76.64% 78.14% 84.28%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 2016 87.45% 84.65% 84.57% 88.37%
2015 84.57% 83.85% 84.24% 88.77%
2014 85.91% 84.37% 84.70% 88.96%
2013 86.58% 83.92% 84.96% 89.71%
Overuse/Appropriateness
Info
Antipsychotics 2017 Plan State Avg Nat Avg 90th Pctl.
Metabolic Monitoring for Children and Adolescents on Antipsychotics - Ages 1-17 36.26% 50.55% 36.07% 48.57%
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 55.00% 58.14% 54.52% 68.67%
Use of Multiple Concurrent Antipsychotics in Children and Adolescents - Ages 1-17 3.50% 2.39% N/A N/A
Antipsychotics Year Plan State Avg. Natl. Avg. 90th Pctl.
Metabolic Monitoring for Children and Adolescents on Antipsychotics - Ages 1-17 2016 22.11% 34.87% 35.80% 45.93%
2015 27.27% 37.02% 33.94% 45.45%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 2016 66.67% 61.93% 58.30% 75.00%
2015 62.65% 61.38% 54.40% 70.49%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Use of Multiple Concurrent Antipsychotics in Children and Adolescents - Ages 1-17 2016 5.37% 2.06% N/A N/A
2015 1.91% 1.70% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Info
Cervical Cancer Screening in Adolescent Females 2017 Plan State Avg Nat Avg 90th Pctl.
Non-Recommended Cervical Cancer Screening in Adolescent Females 0.79% 0.94% 1.47% 0.50%
Cervical Cancer Screening in Adolescent Females Year Plan State Avg. Natl. Avg. 90th Pctl.
Non-Recommended Cervical Cancer Screening in Adolescent Females 2016 0.96% 1.60% 1.84% 0.62%
2015 0.02% 0.02% 2.40% 0.93%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Info
Lower Back Pain 2017 Plan State Avg Nat Avg 90th Pctl.
Use of Imaging for Low Back Pain 68.47% 73.85% 75.16% 82.29%
Lower Back Pain Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Imaging for Low Back Pain 2016 68.67% 73.58% 72.67% 80.11%
2015 68.00% 74.11% 74.57% 81.25%
2014 68.42% 72.44% 74.82% 81.95%
2013 67.94% 73.66% 74.48% 81.27%
Info
Respiratory 2017 Plan State Avg Nat Avg 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 89.01% 90.92% 89.19% 94.59%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 24.80% 31.47% 30.99% 49.52%
Respiratory Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 2016 86.33% 88.81% 88.51% 94.80%
2015 88.75% 87.71% 88.11% 94.26%
2014 85.02% 87.19% 87.39% 94.57%
2013 76.28% 82.80% 85.30% 92.63%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 2016 17.28% 27.03% 28.19% 41.72%
2015 15.25% 25.68% 26.11% 38.04%
2014 17.20% 25.67% 25.79% 36.11%
2013 15.04% 22.74% 23.86% 30.84%
Utilization
Info
Antibiotic Utilization 2017 Plan State Avg Nat Avg 90th Pctl.
Average number of antibiotic prescriptions per member per year - Total 0.84 0.77 0.76 0.90
Average number of antibiotic prescriptions per member per year - Ages 0-9 0.93 0.87 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 0.59 0.57 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 0.76 0.67 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 0.84 0.75 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 0.97 0.88 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 1.07 1.00 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 1.31 1.12 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 2.32 1.12 N/A N/A
Days suppplied per antibiotic prescription - Total 9.73 10.02 9.88 10.83
Days suppplied per antibiotic prescription - Ages 0-9 9.83 10.05 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 12.03 12.69 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 9.42 9.84 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 9.26 9.59 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 9.78 9.86 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 9.64 9.85 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 12.09 10.60 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 14.39 9.87 N/A N/A
Prescriptions of concern - Total 0.37 0.35 0.36 0.45
Prescriptions of concern - Ages 0-9 0.35 0.35 N/A N/A
Prescriptions of concern - Ages 10-17 0.21 0.22 N/A N/A
Prescriptions of concern - Ages 18-34 0.31 0.28 N/A N/A
Prescriptions of concern - Ages 35-49 0.39 0.37 N/A N/A
Prescriptions of concern - Ages 50-64 0.46 0.44 N/A N/A
Prescriptions of concern - Ages 65-74 0.51 0.50 N/A N/A
Prescriptions of concern - Ages 75-85 0.42 0.54 N/A N/A
Prescriptions of concern - Ages 85 plus 0.50 0.48 N/A N/A
Antibiotic Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Average number of antibiotic prescriptions per member per year - Total 2016 0.87 0.79 0.76 0.90
2015 0.89 0.80 0.81 0.97
2014 0.67 0.75 0.79 0.96
2013 0.82 0.83 0.81 0.98
Average number of antibiotic prescriptions per member per year - Ages 0-9 2016 1.05 0.97 N/A N/A
2015 0.99 0.94 N/A N/A
2014 0.61 0.84 N/A N/A
2013 0.79 0.93 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 2016 0.63 0.60 N/A N/A
2015 0.61 0.60 N/A N/A
2014 0.44 0.56 N/A N/A
2013 0.55 0.62 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 2016 0.78 0.69 N/A N/A
2015 0.81 0.70 N/A N/A
2014 0.64 0.67 N/A N/A
2013 0.75 0.74 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 2016 0.87 0.77 N/A N/A
2015 0.90 0.80 N/A N/A
2014 0.71 0.76 N/A N/A
2013 0.85 0.83 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 2016 0.96 0.87 N/A N/A
2015 1.00 0.90 N/A N/A
2014 0.76 0.84 N/A N/A
2013 0.93 0.92 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 2016 1.09 0.99 N/A N/A
2015 1.15 1.07 N/A N/A
2014 0.86 0.96 N/A N/A
2013 1.09 1.05 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 2016 1.16 1.23 N/A N/A
2015 1.28 1.08 N/A N/A
2014 1.04 1.09 N/A N/A
2013 1.22 1.11 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 2016 1.06 0.73 N/A N/A
2015 2.89 1.67 N/A N/A
2014 1.19 1.37 N/A N/A
2013 1.42 1.67 N/A N/A
Days suppplied per antibiotic prescription - Total 2016 9.68 10.09 9.88 10.83
2015 9.85 10.26 10.12 11.03
2014 9.92 10.44 10.32 11.18
2013 9.89 10.44 10.45 11.35
Days suppplied per antibiotic prescription - Ages 0-9 2016 9.73 10.04 N/A N/A
2015 9.73 9.99 N/A N/A
2014 9.64 10.01 N/A N/A
2013 9.76 10.00 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 2016 11.97 12.80 N/A N/A
2015 12.82 13.32 N/A N/A
2014 12.99 13.65 N/A N/A
2013 12.73 13.72 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 2016 9.30 10.07 N/A N/A
2015 9.47 10.33 N/A N/A
2014 9.61 10.65 N/A N/A
2013 9.58 10.61 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 2016 9.21 9.62 N/A N/A
2015 9.42 9.83 N/A N/A
2014 9.57 9.95 N/A N/A
2013 9.55 9.93 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 2016 9.79 9.82 N/A N/A
2015 9.86 9.90 N/A N/A
2014 9.84 10.04 N/A N/A
2013 9.82 10.07 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 2016 9.76 9.93 N/A N/A
2015 9.53 10.18 N/A N/A
2014 9.89 10.43 N/A N/A
2013 9.70 10.23 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 2016 11.94 10.59 N/A N/A
2015 11.35 9.93 N/A N/A
2014 10.72 10.54 N/A N/A
2013 9.80 10.32 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 2016 9.08 9.43 N/A N/A
2015 9.84 9.54 N/A N/A
2014 11.94 10.65 N/A N/A
2013 10.30 8.73 N/A N/A
Prescriptions of concern - Total 2016 0.41 0.38 0.36 0.45
2015 0.43 0.40 0.41 0.52
2014 0.32 0.37 0.39 0.49
2013 0.41 0.42 0.41 0.52
Prescriptions of concern - Ages 0-9 2016 0.45 0.43 N/A N/A
2015 0.42 0.41 N/A N/A
2014 0.25 0.38 N/A N/A
2013 0.35 0.44 N/A N/A
Prescriptions of concern - Ages 10-17 2016 0.25 0.24 N/A N/A
2015 0.23 0.25 N/A N/A
2014 0.16 0.22 N/A N/A
2013 0.22 0.25 N/A N/A
Prescriptions of concern - Ages 18-34 2016 0.35 0.31 N/A N/A
2015 0.37 0.32 N/A N/A
2014 0.28 0.30 N/A N/A
2013 0.34 0.34 N/A N/A
Prescriptions of concern - Ages 35-49 2016 0.44 0.40 N/A N/A
2015 0.47 0.42 N/A N/A
2014 0.37 0.41 N/A N/A
2013 0.45 0.45 N/A N/A
Prescriptions of concern - Ages 50-64 2016 0.49 0.46 N/A N/A
2015 0.53 0.49 N/A N/A
2014 0.39 0.45 N/A N/A
2013 0.49 0.50 N/A N/A
Prescriptions of concern - Ages 65-74 2016 0.53 0.51 N/A N/A
2015 0.60 0.57 N/A N/A
2014 0.44 0.51 N/A N/A
2013 0.56 0.56 N/A N/A
Prescriptions of concern - Ages 75-85 2016 0.51 0.65 N/A N/A
2015 0.60 0.59 N/A N/A
2014 0.52 0.51 N/A N/A
2013 0.62 0.57 N/A N/A
Prescriptions of concern - Ages 85 plus 2016 0.44 0.34 N/A N/A
2015 1.44 0.82 N/A N/A
2014 0.56 0.55 N/A N/A
2013 0.76 1.15 N/A N/A
Info
Child and Adolescent Well Child Visits 2017 Plan State Avg Nat Avg 90th Pctl.
Well Child Visits in the First 15 Months of Life 86.73% 85.68% 80.53% 90.78%
Well Child Visits in the 3rd - 6th Years 83.68% 83.18% 79.11% 91.03%
Adolescent Well-Care Visits 48.92% 53.24% 50.46% 70.44%
Child and Adolescent Well Child Visits Year Plan State Avg. Natl. Avg. 90th Pctl.
Well Child Visits in the First 15 Months of Life 2016 84.71% 83.40% 80.76% 90.36%
2015 85.93% 84.01% 79.35% 89.12%
2014 87.40% 82.63% 79.12% 89.64%
2013 88.38% 83.44% 79.34% 89.83%
Well Child Visits in the 3rd - 6th Years 2016 81.33% 82.50% 78.30% 90.11%
2015 81.26% 80.48% 77.75% 89.74%
2014 78.99% 80.03% 77.37% 88.75%
2013 76.45% 78.43% 75.89% 88.25%
Adolescent Well-Care Visits 2016 46.28% 50.35% 49.68% 67.70%
2015 44.77% 49.34% 48.26% 64.50%
2014 42.58% 48.09% 47.51% 64.76%
2013 41.21% 46.84% 46.27% 63.82%
Info
Mental Health Utilization 2017 Plan State Avg Nat Avg 90th Pctl.
Mental Health Utilization - Any service - Total 8.91% 6.52% 7.29% 10.36%
Mental Health Utilization - Any service - Ages 0-12 7.78% 5.17% N/A N/A
Mental Health Utilization - Any service - Ages 13-17 15.41% 11.78% N/A N/A
Mental Health Utilization - Any service - Ages 18-64 8.71% 6.48% N/A N/A
Mental Health Utilization - Any service - Ages 65 plus 3.92% 3.06% N/A N/A
Mental Health Utilization - ED - Ages 0-12 0.00% 0.01% N/A N/A
Mental Health Utilization - ED - Ages 13-17 0.02% 0.06% N/A N/A
Mental Health Utilization - ED - Ages 18-64 0.00% 0.02% N/A N/A
Mental Health Utilization - ED - Ages 65 plus 0.02% 0.02% N/A N/A
Mental Health Utilization - Inpatient - Total 0.14% 0.15% 0.13% 0.21%
Mental Health Utilization - Inpatient - Ages 0-12 0.02% 0.03% N/A N/A
Mental Health Utilization - Inpatient - Ages 13-17 0.25% 0.47% N/A N/A
Mental Health Utilization - Inpatient - Ages 18-64 0.15% 0.15% N/A N/A
Mental Health Utilization - Inpatient - Ages 65 plus 0.07% 0.06% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Total 0.01% 0.03% 0.08% 0.21%
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 0.07% 0.08% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 18-64 0.01% 0.02% 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 - Ages 0-12 7.74% 5.11% N/A N/A
Mental Health Utilization - Outpatient - Ages 13-17 15.07% 11.29% N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 8.58% 6.30% N/A N/A
Mental Health Utilization - Outpatient - Ages 65 plus 3.85% 2.97% N/A N/A
Mental Health Utilization - Telehealth - Ages 0-12 0.00% 0.00% N/A N/A
Mental Health Utilization - Telehealth - Ages 13-17 0.00% 0.01% N/A N/A
Mental Health Utilization - Telehealth - Ages 18-64 0.00% 0.02% N/A N/A
Mental Health Utilization - Telehealth - Ages 65 plus 0.00% 0.00% N/A N/A
Mental Health Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Mental Health Utilization - Any service - Total 2016 8.42% 6.65% 6.82% 10.37%
2015 8.37% 6.65% 6.71% 9.72%
2014 7.88% 7.59% 7.15% 10.70%
2013 7.93% 6.78% 7.20% 11.03%
Mental Health Utilization - Any service - Ages 0-12 2016 7.17% 5.25% N/A N/A
2015 6.65% 5.08% N/A N/A
2014 6.38% 5.49% N/A N/A
2013 6.63% 5.17% N/A N/A
Mental Health Utilization - Any service - Ages 13-17 2016 13.78% 12.10% N/A N/A
2015 13.65% 11.13% N/A N/A
2014 13.11% 12.47% N/A N/A
2013 13.07% 10.96% N/A N/A
Mental Health Utilization - Any service - Ages 18-64 2016 8.34% 6.59% N/A N/A
2015 8.36% 6.69% N/A N/A
2014 7.85% 7.72% N/A N/A
2013 7.91% 6.86% N/A N/A
Mental Health Utilization - Any service - Ages 65 plus 2016 3.12% 3.39% N/A N/A
2015 3.55% 3.67% N/A N/A
2014 3.79% 4.08% N/A N/A
2013 3.99% 3.25% N/A N/A
Mental Health Utilization - ED - Ages 0-12 2016 7.17% 5.26% N/A N/A
2015 6.63% 5.07% N/A N/A
2014 6.37% 5.47% N/A N/A
2013 6.61% 5.15% N/A N/A
Mental Health Utilization - ED - Ages 13-17 2016 13.71% 12.16% N/A N/A
2015 13.59% 11.02% N/A N/A
2014 13.05% 12.33% N/A N/A
2013 13.03% 10.84% N/A N/A
Mental Health Utilization - ED - Ages 18-64 2016 8.31% 6.56% N/A N/A
2015 8.32% 6.62% N/A N/A
2014 7.80% 7.64% N/A N/A
2013 7.86% 6.80% N/A N/A
Mental Health Utilization - ED - Ages 65 plus 2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Total 2016 0.24% 0.25% 0.24% 0.31%
2015 0.27% 0.25% 0.24% 0.31%
2014 0.25% 0.30% 0.26% 0.35%
2013 0.26% 0.26% 0.26% 0.37%
Mental Health Utilization - Inpatient - Ages 0-12 2016 0.09% 0.07% N/A N/A
2015 0.12% 0.07% N/A N/A
2014 0.11% 0.09% N/A N/A
2013 0.10% 0.06% N/A N/A
Mental Health Utilization - Inpatient - Ages 13-17 2016 0.65% 0.79% N/A N/A
2015 0.84% 0.77% N/A N/A
2014 0.78% 0.99% N/A N/A
2013 0.85% 0.82% N/A N/A
Mental Health Utilization - Inpatient - Ages 18-64 2016 0.24% 0.25% N/A N/A
2015 0.26% 0.24% N/A N/A
2014 0.23% 0.29% N/A N/A
2013 0.24% 0.25% N/A N/A
Mental Health Utilization - Inpatient - Ages 65 plus 2016 0.07% 0.18% N/A N/A
2015 0.07% 0.10% N/A N/A
2014 0.17% 0.18% N/A N/A
2013 0.26% 0.18% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Total 2016 0.05% 0.12% 0.17% 0.35%
2015 0.05% 0.10% 0.16% 0.34%
2014 0.02% 0.11% 0.16% 0.36%
2013 0.02% 0.09% 0.14% 0.28%
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 0-12 2016 0.10% 0.07% N/A N/A
2015 0.06% 0.05% N/A N/A
2014 0.03% 0.06% N/A N/A
2013 0.02% 0.05% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 13-17 2016 0.13% 0.43% N/A N/A
2015 0.17% 0.37% N/A N/A
2014 0.01% 0.42% N/A N/A
2013 0.03% 0.34% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 18-64 2016 0.04% 0.11% N/A N/A
2015 0.04% 0.09% N/A N/A
2014 0.02% 0.10% N/A N/A
2013 0.02% 0.08% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 65 plus 2016 0.00% 0.02% N/A N/A
2015 0.00% 0.02% N/A N/A
2014 0.00% 0.02% N/A N/A
2013 0.00% 0.02% N/A N/A
Mental Health Utilization - Outpatient - Ages 0-12 2016 7.17% 5.26% N/A N/A
2015 6.63% 5.07% N/A N/A
2014 6.37% 5.47% N/A N/A
2013 6.61% 5.15% N/A N/A
Mental Health Utilization - Outpatient - Ages 13-17 2016 13.71% 12.16% N/A N/A
2015 13.59% 11.02% N/A N/A
2014 13.05% 12.33% N/A N/A
2013 13.03% 10.84% N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 2016 8.31% 6.56% N/A N/A
2015 8.32% 6.62% N/A N/A
2014 7.80% 7.64% N/A N/A
2013 7.86% 6.80% N/A N/A
Mental Health Utilization - Outpatient - Ages 65 plus 2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Ages 0-12 2016 7.17% 5.26% N/A N/A
2015 6.63% 5.07% N/A N/A
2014 6.37% 5.47% N/A N/A
2013 6.61% 5.15% N/A N/A
Mental Health Utilization - Telehealth - Ages 13-17 2016 13.71% 12.16% N/A N/A
2015 13.59% 11.02% N/A N/A
2014 13.05% 12.33% N/A N/A
2013 13.03% 10.84% N/A N/A
Mental Health Utilization - Telehealth - Ages 18-64 2016 8.31% 6.56% N/A N/A
2015 8.32% 6.62% N/A N/A
2014 7.80% 7.64% N/A N/A
2013 7.86% 6.80% N/A N/A
Mental Health Utilization - Telehealth - Ages 65 plus 2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Info
Plan All-Cause Readmissions 2017 Plan State Avg Nat Avg 90th Pctl.
Plan All-Cause Readmissions Ages 18-44 13.14% 12.99% N/A N/A
Plan All-Cause Readmissions Ages 45-54 11.58% 11.71% N/A N/A
Plan All-Cause Readmissions Ages 55-64 11.33% 11.93% N/A N/A
Plan All-Cause Readmissions Total 11.95% 12.19% N/A N/A
Plan All-Cause Readmissions Year Plan State Avg. Natl. Avg. 90th Pctl.
Plan All-Cause Readmissions Ages 18-44 2016 0.13% 0.12% N/A N/A
2015 0.13% 0.12% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Plan All-Cause Readmissions Ages 45-54 2016 0.11% 0.12% N/A N/A
2015 0.12% 0.11% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Plan All-Cause Readmissions Ages 55-64 2016 0.11% 0.11% N/A N/A
2015 0.11% 0.11% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Plan All-Cause Readmissions Total 2016 0.12% 0.12% N/A N/A
2015 0.12% 0.11% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A