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
2018
Number of Enrollees: 347,283
PMPM: $566
Number of Physicians: 17,219
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

2018 2017 2016 2015 2014
Number of Enrollees 347,283 303,866 294,873 292,937 314,913
PMPM $566 $425 $396 $372 $366
Medical Cost Ratio 85% 90% 91% 90% 89%
Administrative Ratio 10% 9% 8% 9% 8%
Profit/Loss Ratio 6% 1% 1% 1% 4%
Number of Physicians 17,219 16,458 15,931 15,836 14,947

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

Financial Data

2018 2017 2016 2015 2014
Premiums Earned $2,382,336,230 $1,491,595,258 $1,395,696,663 $1,331,267,695 $1,369,161,590
Income $139,305,813 $15,658,596 $9,628,472 $15,486,345 $51,477,534
Net Worth $315,612,837 $244,239,759 $222,565,488 $212,418,559 $197,650,782

*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 2018 Plan State Avg Nat Avg 90th Pctl.
Adult Access (Age 20-44) To Preventive/Ambulatory Health Services 93.74% 92.43% 92.33% 95.45%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 96.58% 95.50% 95.64% 97.49%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 97.95% 97.15% 97.17% 98.45%
Adult Access To Preventive/Ambulatory Health Services Year Plan State Avg. Natl. Avg. 90th Pctl.
Adult Access (Age 20-44) To Preventive/Ambulatory Health Services 2017 93.83% 92.73% 92.45% 95.43%
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%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 2017 96.57% 95.57% 95.61% 97.46%
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%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 2017 97.84% 97.82% 97.07% 98.47%
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%
Info
Alcohol and Other Drug Dependence Treatment 2018 Plan State Avg Nat Avg 90th Pctl.
Initiation of Alcohol and Other Drug Dependence Treatment - Total 35.18% 37.53% 35.68% 42.36%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 28.57% 49.35% 40.21% 51.02%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 35.31% 37.34% 35.51% 42.35%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 10.20% 14.69% 12.58% 17.04%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 3.57% 18.18% 16.91% 25.00%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 10.32% 14.58% 12.47% 16.97%
Alcohol and Other Drug Dependence Treatment Year Plan State Avg. Natl. Avg. 90th Pctl.
Initiation of Alcohol and Other Drug Dependence Treatment - Total 2017 33.46% 36.14% 36.11% 42.01%
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%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2017 35.42% 40.06% 39.91% 52.54%
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%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2017 33.40% 36.00% 35.97% 41.96%
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%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 2017 11.55% 13.36% 12.65% 17.26%
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%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2017 10.42% 14.40% 14.95% 23.85%
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%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2017 11.59% 13.40% 12.55% 17.38%
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%
Info
Child Access to Primary Care Practitioners 2018 Plan State Avg Nat Avg 90th Pctl.
12-24 month old Child Access to Primary Care Practitioners 99.10% 98.57% 98.19% 99.60%
25 month to 6 year old Child Access to Primary Care Practitioners 95.56% 94.36% 93.13% 97.39%
7-11 year old Child Access to Primary Care Practitioners 95.73% 95.22% 93.87% 98.50%
12-19 year old Child Access to Primary Care Practitioners 91.86% 92.36% 91.48% 97.12%
Child Access to Primary Care Practitioners Year Plan State Avg. Natl. Avg. 90th Pctl.
12-24 month old Child Access to Primary Care Practitioners 2017 99.26% 98.09% 97.93% 99.50%
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%
25 month to 6 year old Child Access to Primary Care Practitioners 2017 95.40% 94.63% 92.58% 96.95%
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%
7-11 year old Child Access to Primary Care Practitioners 2017 95.22% 95.40% 93.43% 98.48%
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%
12-19 year old Child Access to Primary Care Practitioners 2017 91.36% 92.00% 91.08% 96.99%
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%
Info
Prenatal and Postpartum Care 2018 Plan State Avg Nat Avg 90th Pctl.
Postpartum Care 88.80% 75.10% 75.89% 88.80%
Timeliness of Prenatal Care 92.40% 88.15% 84.75% 94.17%
Prenatal and Postpartum Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Postpartum Care 2017 82.10% 73.45% 75.05% 88.13%
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%
Timeliness of Prenatal Care 2017 92.58% 86.37% 84.34% 94.89%
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%
Behavioral Health
Info
Antidepressant Medication Management 2018 Plan State Avg Nat Avg 90th Pctl.
Antidepressant Medication Management - Effective Acute Phase Treatment 71.41% 71.96% 68.64% 77.59%
Antidepressant Medication Management - Effective Continuation Phase Treatment 55.88% 54.22% 53.01% 60.39%
Antidepressant Medication Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Antidepressant Medication Management - Effective Acute Phase Treatment 2017 69.60% 71.12% 67.11% 75.76%
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%
Antidepressant Medication Management - Effective Continuation Phase Treatment 2017 53.81% 54.87% 51.53% 60.24%
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%
Info
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication 2018 Plan State Avg Nat Avg 90th Pctl.
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Initiation 38.35% 42.91% 39.85% 50.42%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 50.00% 40.32% 48.73% 60.57%
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication Year Plan State Avg. Natl. Avg. 90th Pctl.
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Initiation 2017 35.15% 41.27% 41.13% 50.83%
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%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 2017 40.57% 55.09% 47.07% 58.44%
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%
Info
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence 2018 Plan State Avg Nat Avg 90th Pctl.
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence within 7 days after hospital discharge 9.94% 9.96% 10.81% 17.07%
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence within 30 days after hospital discharge 14.29% 13.52% 14.98% 23.11%
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 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence within 30 days after hospital discharge 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Info
Follow-Up After Emergency Department Visit for Mental Illness 2018 Plan State Avg Nat Avg 90th Pctl.
Follow-Up After Emergency Department Visit for Mental Illness within 7 days after hospital discharge 38.92% 38.46% 46.62% 66.57%
Follow-Up After Emergency Department Visit for Mental Illness within 30 days after hospital discharge 56.65% 53.38% 60.75% 77.57%
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 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Follow-Up After Emergency Department Visit for Mental Illness within 30 days after hospital discharge 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Info
Follow-up After Hospitalization For Mental Illness 2018 Plan State Avg Nat Avg 90th Pctl.
Follow-up After Hospitalization For Mental Illness within 7 days after hospital discharge 47.86% 48.09% 44.98% 60.38%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 73.29% 69.84% 66.68% 80.29%
Follow-up After Hospitalization For Mental Illness Year Plan State Avg. Natl. Avg. 90th Pctl.
Follow-up After Hospitalization For Mental Illness within 7 days after hospital discharge 2017 51.23% 52.18% 46.63% 62.81%
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%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 2017 74.19% 69.80% 68.66% 82.58%
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%
Effectiveness of Care
Info
Asthma Medication Management 2018 Plan State Avg Nat Avg 90th Pctl.
Medication Management for People With Asthma at least 50% Compliance - Total 76.56% 77.42% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 5-11 65.80% 63.81% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 12-18 64.24% 71.44% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 19-50 78.71% 77.64% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 51-64 81.83% 83.35% N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Total 57.32% 55.48% 51.74% 59.67%
Medication Management for People With Asthma at least 75% Compliance - Ages 5-11 48.05% 37.21% 38.94% 47.83%
Medication Management for People With Asthma at least 75% Compliance - Ages 12-18 37.75% 46.61% 38.67% 47.44%
Medication Management for People With Asthma at least 75% Compliance - Ages 19-50 57.12% 55.33% 50.37% 60.00%
Medication Management for People With Asthma at least 75% Compliance - Ages 51-64 66.73% 64.47% 61.41% 69.42%
Asthma Medication Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Medication Management for People With Asthma at least 50% Compliance - Total 2017 76.22% 76.58% N/A N/A
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
Medication Management for People With Asthma at least 50% Compliance - Ages 5-11 2017 68.59% 66.50% N/A N/A
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
Medication Management for People With Asthma at least 50% Compliance - Ages 12-18 2017 63.24% 68.06% N/A N/A
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
Medication Management for People With Asthma at least 50% Compliance - Ages 19-50 2017 76.81% 75.34% N/A N/A
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
Medication Management for People With Asthma at least 50% Compliance - Ages 51-64 2017 82.39% 84.54% N/A N/A
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
Medication Management for People With Asthma at least 75% Compliance - Total 2017 55.12% 54.32% 50.48% 57.69%
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
Medication Management for People With Asthma at least 75% Compliance - Ages 5-11 2017 42.96% 42.35% 40.22% 52.99%
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
Medication Management for People With Asthma at least 75% Compliance - Ages 12-18 2017 37.30% 41.76% 37.80% 47.11%
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
Medication Management for People With Asthma at least 75% Compliance - Ages 19-50 2017 56.63% 52.86% 48.60% 57.87%
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
Medication Management for People With Asthma at least 75% Compliance - Ages 51-64 2017 63.58% 64.50% 59.65% 67.58%
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
Info
Cardiovascular Disease Management 2018 Plan State Avg Nat Avg 90th Pctl.
Controlling High Blood Pressure 66.42% 60.55% N/A N/A
Persistence of Beta-Blockers 86.78% 83.54% 82.37% 89.29%
Cardiovascular Disease Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Controlling High Blood Pressure 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Persistence of Beta-Blockers 2017 87.40% 85.80% 85.18% 93.41%
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%
Info
Common Childhood Illnesses 2018 Plan State Avg Nat Avg 90th Pctl.
Appropriate Testing for Children With Pharyngitis 93.57% 92.74% 87.97% 94.94%
Common Childhood Illnesses Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Testing for Children With Pharyngitis 2017 93.55% 92.30% 87.45% 94.64%
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%
Info
Diabetes Care and Management 2018 Plan State Avg Nat Avg 90th Pctl.
Comprehensive Diabetes Care-Blood Pressure Control (<140/90 mm Hg) 68.23% 63.70% 62.59% 77.37%
Comprehensive Diabetes Care-HbA1c control (<8.0%) 66.15% 62.46% 57.79% 66.33%
Comprehensive Diabetes Care-Medical Attention for Nephropathy 88.80% 90.73% 90.33% 93.43%
Comprehensive Diabetes Care-Rate of Eye Exams 60.16% 56.58% 54.40% 69.68%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 26.82% 27.18% 30.85% 20.62%
Comprehensive Diabetes Care-Testing for HbA1c 91.67% 92.11% 91.29% 94.71%
Diabetes Care and Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Comprehensive Diabetes Care-Blood Pressure Control (<140/90 mm Hg) 2017 63.14% 63.40% 60.82% 76.41%
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%
Comprehensive Diabetes Care-HbA1c control (<8.0%) 2017 64.18% 62.51% 57.48% 67.15%
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%
Comprehensive Diabetes Care-Medical Attention for Nephropathy 2017 89.55% 90.80% 90.38% 93.61%
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%
Comprehensive Diabetes Care-Rate of Eye Exams 2017 71.13% 56.95% 54.06% 70.69%
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%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 2017 26.55% 27.63% 31.91% 21.41%
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%
Comprehensive Diabetes Care-Testing for HbA1c 2017 90.21% 91.52% 90.96% 94.18%
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%
Info
Drug Therapy in Rheumatoid Arthritis 2018 Plan State Avg Nat Avg 90th Pctl.
Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis 90.00% 88.42% 87.69% 94.27%
Drug Therapy in Rheumatoid Arthritis Year Plan State Avg. Natl. Avg. 90th Pctl.
Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis 2017 92.43% 90.16% 88.62% 93.75%
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%
Info
Immunizations 2018 Plan State Avg Nat Avg 90th Pctl.
Childhood Immunization for Multiple Diseases Including Chicken Pox 85.44% 80.96% 79.32% 88.06%
Childhood Immunization for Multiple Diseases Including Pneumovax 84.10% 79.46% 77.50% 86.62%
Flu Vaccinations for Adults Ages 65 and Older 58.39% 53.53% 51.93% 61.07%
Immunizations for Adolescents - Combination 72.51% 79.55% 82.25% 91.52%
Immunizations for Adolescents - HPV 28.95% 32.22% 28.05% 37.23%
Immunizations for Adolescents - Meningococcal 72.99% 80.66% 83.69% 92.94%
Immunizations for Adolescents - Tdap 96.11% 91.16% 89.95% 95.62%
Immunizations Year Plan State Avg. Natl. Avg. 90th Pctl.
Childhood Immunization for Multiple Diseases Including Chicken Pox 2017 90.27% 73.55% 79.44% 89.14%
2016 85.38% 75.86% 78.93% 89.03%
2015 82.87% 74.15% 78.59% 88.08%
2014 84.03% 72.96% 80.18% 88.07%
Childhood Immunization for Multiple Diseases Including Pneumovax 2017 89.03% 80.09% 77.67% 87.61%
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%
Flu Vaccinations for Adults Ages 65 and Older 2017 0.66% 0.53% 49.33% 59.27%
2016 56.78% 47.13% 47.47% 58.70%
2015 0.53% 0.50% 47.85% 58.01%
2014 0.59% 0.52% 49.45% 59.73%
Immunizations for Adolescents - Combination 2017 71.53% 80.48% 80.23% 89.54%
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%
Immunizations for Adolescents - HPV 2017 22.14% 28.29% 23.98% 32.36%
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%
Immunizations for Adolescents - Meningococcal 2017 71.78% 82.05% 81.75% 90.27%
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%
Immunizations for Adolescents - Tdap 2017 95.86% 91.65% 88.91% 94.65%
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%
Info
Persistent Medications 2018 Plan State Avg Nat Avg 90th Pctl.
Annual Monitoring for Patients on Persistent Medications 88.65% 86.50% 84.47% 88.08%
Persistent Medications Year Plan State Avg. Natl. Avg. 90th Pctl.
Annual Monitoring for Patients on Persistent Medications 2017 88.51% 85.73% 83.71% 87.04%
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%
Info
Pharmacotherapy of COPD Exacerbation 2018 Plan State Avg Nat Avg 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 83.23% 85.49% 78.92% 87.88%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 78.88% 76.41% 74.76% 83.55%
Pharmacotherapy of COPD Exacerbation Year Plan State Avg. Natl. Avg. 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 2017 78.39% 80.88% 79.87% 87.50%
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%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 2017 77.89% 78.84% 76.26% 84.38%
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%
Info
Preventive Care 2018 Plan State Avg Nat Avg 90th Pctl.
Breast Cancer Screening 77.56% 72.13% 73.73% 81.17%
Chlamydia Screening in Women-all Age groups 50.37% 52.91% 51.41% 67.76%
Colorectal Cancer Screening 76.52% 64.94% 64.37% 76.52%
Preventive Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Breast Cancer Screening 2017 77.61% 71.85% 72.81% 80.91%
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%
Chlamydia Screening in Women-all Age groups 2017 48.28% 51.46% 50.16% 66.08%
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%
Colorectal Cancer Screening 2017 73.77% 65.16% 62.43% 74.72%
2016 67.01% 64.67% 61.71% 74.09%
2015 67.49% 63.31% 62.32% 73.84%
2014 59.26% 63.41% 64.06% 74.86%
Info
Spirometry Testing 2018 Plan State Avg Nat Avg 90th Pctl.
Use of Spirometry Testing in the Assessment and diagnosis of COPD 43.74% 44.14% 41.48% 50.95%
Spirometry Testing Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Spirometry Testing in the Assessment and diagnosis of COPD 2017 45.54% 43.12% 41.90% 50.52%
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%
Info
Statin Therapy 2018 Plan State Avg Nat Avg 90th Pctl.
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 21-75 years (Male) 85.22% 84.45% 83.64% 89.14%
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 40–75 years (Female) 74.53% 76.45% 73.26% 81.82%
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - Total 82.11% 82.21% 81.23% 87.21%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 21-75 years (Male) 74.58% 75.19% 77.14% 82.88%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 40–75 years (Female) 68.73% 72.78% 72.12% 81.10%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - Total 73.03% 74.49% 75.95% 82.83%
Statin Therapy for Patients with Diabetes - Received Therapy 62.38% 63.94% 62.57% 70.05%
Statin Therapy for Patients with Diabetes - Statin Adherence 80% 68.28% 68.88% 69.52% 78.00%
Statin Therapy Year Plan State Avg. Natl. Avg. 90th Pctl.
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 21-75 years (Male) 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 40–75 years (Female) 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - Total 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 21-75 years (Male) 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 40–75 years (Female) 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - Total 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Statin Therapy for Patients with Diabetes - Received Therapy 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Statin Therapy for Patients with Diabetes - Statin Adherence 80% 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Info
Weight Assessment and Counseling 2018 Plan State Avg Nat Avg 90th Pctl.
Adult BMI Assessment 89.80% 82.61% 81.07% 93.61%
Children/Adolescents BMI Assessment - Total 72.86% 73.74% 72.87% 90.00%
Children/Adolescents BMI Assessment - Ages 3-11 73.01% 76.94% 74.00% 90.91%
Children/Adolescents BMI Assessment - Ages 12-17 72.67% 69.73% 71.39% 88.97%
Counseling for Nutrition for Children/Adolescents - Total 66.33% 71.79% 67.72% 85.06%
Counseling for Nutrition for Children/Adolescents - Ages 3-11 70.80% 75.91% 69.85% 86.21%
Counseling for Nutrition for Children/Adolescents - Ages 12-17 60.47% 66.37% 64.92% 84.29%
Counseling for Physical Activity for Children/Adolescents - Total 60.05% 66.42% 63.08% 81.32%
Counseling for Physical Activity for Children/Adolescents - Ages 3-11 57.96% 65.48% 61.70% 80.92%
Counseling for Physical Activity for Children/Adolescents - Ages 12-17 62.79% 67.51% 64.79% 84.03%
Weight Assessment and Counseling Year Plan State Avg. Natl. Avg. 90th Pctl.
Adult BMI Assessment 2017 91.79% 79.49% 79.78% 93.20%
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%
Children/Adolescents BMI Assessment - Total 2017 72.61% 70.41% 70.59% 88.08%
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%
Children/Adolescents BMI Assessment - Ages 3-11 2017 75.11% 71.37% 71.84% 88.89%
2016 77.87% 70.86% 67.11% 88.19%
2015 74.81% 63.37% 61.61% 84.69%
2014 67.07% 60.91% 60.86% 86.64%
Children/Adolescents BMI Assessment - Ages 12-17 2017 69.36% 68.96% 68.94% 87.82%
2016 72.83% 66.72% 64.28% 87.29%
2015 63.69% 56.47% 58.77% 83.62%
2014 61.29% 62.60% 61.34% 85.47%
Counseling for Nutrition for Children/Adolescents - Total 2017 68.59% 69.47% 65.50% 83.21%
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%
Counseling for Nutrition for Children/Adolescents - Ages 3-11 2017 73.78% 71.63% 68.20% 84.82%
2016 73.12% 69.25% 64.59% 85.48%
2015 69.85% 67.34% 61.49% 82.89%
2014 61.79% 68.39% 63.58% 84.21%
Counseling for Nutrition for Children/Adolescents - Ages 12-17 2017 61.85% 66.54% 61.92% 80.26%
2016 63.01% 63.42% 58.79% 81.87%
2015 53.57% 59.10% 55.64% 77.85%
2014 53.23% 60.63% 56.75% 76.92%
Counseling for Physical Activity for Children/Adolescents - Total 2017 59.55% 64.30% 59.96% 77.32%
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%
Counseling for Physical Activity for Children/Adolescents - Ages 3-11 2017 59.11% 62.31% 58.84% 75.00%
2016 58.10% 58.91% 54.72% 76.52%
2015 58.02% 58.85% 53.14% 76.08%
2014 53.25% 60.95% 55.78% 76.72%
Counseling for Physical Activity for Children/Adolescents - Ages 12-17 2017 60.12% 66.86% 61.40% 79.89%
2016 62.43% 62.44% 58.47% 83.05%
2015 55.36% 60.35% 56.39% 80.86%
2014 56.45% 63.65% 58.73% 78.07%
Health Plan Stability/Descriptive
Info
Administrative Data 2018 Plan State Avg Nat Avg 90th Pctl.
Administrative Ratio 0.10 0.13 86.19 92.68
Medical Cost Ratio 0.85 0.83 92.60 95.85
Number of Enrollees 347,283 140,630 92 96
Number of Physicians 17,219 94,540 87 95
Premium Per Member Per Month $566 $499 N/A N/A
Profit/Loss Ratio 0.06 0.05 N/A N/A
Administrative Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Administrative Ratio 2017 0.09 0.12 86.39 93.13
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
Medical Cost Ratio 2017 0.90 0.83 93.13 96.59
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
Number of Enrollees 2017 303,866 133,992 92 97
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
Number of Physicians 2017 16,458 81,926 87 95
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
Premium Per Member Per Month 2017 $425 $370 N/A N/A
2016 $396 $370 N/A N/A
2015 $372 $375 N/A N/A
2014 $366 $412 N/A N/A
Profit/Loss Ratio 2017 0.01 0.05 N/A N/A
2016 0.01 0.03 N/A N/A
2015 0.01 0.03 N/A N/A
2014 0.04 0.06 N/A N/A
Info
Board Certification Rates for Providers 2018 Plan State Avg Nat Avg 90th Pctl.
Board Certification for Geriatricians 95.83% 69.82% N/A N/A
Board Certification for Pediatricians 93.38% 86.24% N/A N/A
Board Certification Rate for Family Medicine Physicians 89.21% 83.01% N/A N/A
Board Certification Rate for Internal Medicine Physicians 88.38% 79.67% N/A N/A
Board Certification Rate for OB/GYN Providers 89.44% 84.25% N/A N/A
Board Certification Rate for Other Specialists 90.41% 81.57% N/A N/A
Board Certification Rates for Providers Year Plan State Avg. Natl. Avg. 90th Pctl.
Board Certification for Geriatricians 2017 95.00% 71.38% N/A N/A
2016 95.38% 73.44% N/A N/A
2015 83.33% 71.06% N/A N/A
2014 86.67% 74.73% N/A N/A
Board Certification for Pediatricians 2017 92.00% 85.50% N/A N/A
2016 94.06% 87.02% N/A N/A
2015 94.10% 88.14% N/A N/A
2014 95.06% 88.13% N/A N/A
Board Certification Rate for Family Medicine Physicians 2017 90.00% 81.38% N/A N/A
2016 88.77% 80.32% N/A N/A
2015 89.01% 82.53% N/A N/A
2014 89.55% 82.93% N/A N/A
Board Certification Rate for Internal Medicine Physicians 2017 89.00% 81.00% N/A N/A
2016 88.88% 81.15% N/A N/A
2015 87.59% 82.59% N/A N/A
2014 88.51% 83.98% N/A N/A
Board Certification Rate for OB/GYN Providers 2017 90.00% 83.00% N/A N/A
2016 90.25% 83.36% N/A N/A
2015 88.71% 83.51% N/A N/A
2014 89.31% 83.71% N/A N/A
Board Certification Rate for Other Specialists 2017 91.00% 81.88% N/A N/A
2016 92.07% 83.25% N/A N/A
2015 91.40% 82.88% N/A N/A
2014 92.36% 84.44% N/A N/A
Info
Financial Data 2018 Plan State Avg Nat Avg 90th Pctl.
Income $139,305,813 $47,837,732 N/A N/A
Net Worth $315,612,837 $303,649,748 N/A N/A
Premiums Earned $2,382,336,230 $879,518,893 N/A N/A
Financial Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Income 2017 $15,658,596 $34,422,501 N/A N/A
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
Net Worth 2017 $244,239,759 $263,890,874 N/A N/A
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
Premiums Earned 2017 $1,491,595,258 $645,600,589 N/A N/A
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
Info
Years in Business 2018 Plan State Avg Nat Avg 90th Pctl.
Years in Business 34 36 N/A N/A
Years in Business Year Plan State Avg. Natl. Avg. 90th Pctl.
Years in Business 2017 33 35 N/A N/A
2016 32 34 N/A N/A
2015 31 33 N/A N/A
2014 30 32 N/A N/A
Member Satisfaction
Info
Member Satisfaction 2018 Plan State Avg Nat Avg 90th Pctl.
Getting Care Quickly 87.06% 85.27% 85.23% 89.89%
Getting Needed Care 87.60% 85.53% 86.33% 90.45%
How Well Doctors Communicate 95.85% 94.70% 95.31% 97.22%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 64.31% 64.78% 64.53% 76.79%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 88.77% 84.82% 84.41% 88.57%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 79.86% 76.02% 78.17% 83.95%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 83.86% 84.08% 85.14% 89.78%
Member Satisfaction Year Plan State Avg. Natl. Avg. 90th Pctl.
Getting Care Quickly 2017 87.80% 87.22% 85.34% 89.83%
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%
Getting Needed Care 2017 88.20% 87.44% 86.71% 90.37%
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%
How Well Doctors Communicate 2017 96.79% 94.74% 95.10% 96.91%
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%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 2017 59.40% 61.26% 62.44% 75.00%
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%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 2017 84.43% 83.86% 84.62% 88.77%
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%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 2017 81.22% 76.98% 77.27% 82.99%
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%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 2017 87.90% 83.95% 84.60% 89.86%
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%
Overuse/Appropriateness
Info
Antipsychotics 2018 Plan State Avg Nat Avg 90th Pctl.
Metabolic Monitoring for Children and Adolescents on Antipsychotics - Ages 1-17 33.78% 44.74% 36.17% 47.41%
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 58.18% 57.96% 56.00% 70.54%
Use of Multiple Concurrent Antipsychotics in Children and Adolescents - Ages 1-17 4.10% 5.32% N/A N/A
Antipsychotics Year Plan State Avg. Natl. Avg. 90th Pctl.
Metabolic Monitoring for Children and Adolescents on Antipsychotics - Ages 1-17 2017 36.26% 50.55% 36.07% 48.57%
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
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 2017 55.00% 58.14% 54.52% 68.67%
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
Use of Multiple Concurrent Antipsychotics in Children and Adolescents - Ages 1-17 2017 3.50% 2.39% N/A N/A
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
Info
Cervical Cancer Screening in Adolescent Females 2018 Plan State Avg Nat Avg 90th Pctl.
Non-Recommended Cervical Cancer Screening in Adolescent Females 76.74% 77.90% 76.08% 83.21%
Cervical Cancer Screening in Adolescent Females Year Plan State Avg. Natl. Avg. 90th Pctl.
Non-Recommended Cervical Cancer Screening in Adolescent Females 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Info
Lower Back Pain 2018 Plan State Avg Nat Avg 90th Pctl.
Use of Imaging for Low Back Pain 70.09% 74.77% 75.11% 82.95%
Lower Back Pain Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Imaging for Low Back Pain 2017 68.47% 73.85% 75.16% 82.29%
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%
Info
Respiratory 2018 Plan State Avg Nat Avg 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 91.61% 92.50% 91.22% 95.48%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 31.56% 33.60% 33.16% 48.28%
Respiratory Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 2017 89.01% 90.92% 89.19% 94.59%
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%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 2017 24.80% 30.67% 30.99% 49.52%
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%
Info
Use of Opiods 2018 Plan State Avg Nat Avg 90th Pctl.
Use of Opioids at High Dosage 4.39% 5.32% 4.54% 1.87%
Use of Opioids From Multiple Providers - Multiple Pharmacies 5.55% 5.21% 3.80% 1.40%
Use of Opioids From Multiple Providers - Multiple Prescribers 17.97% 18.32% 15.02% 9.64%
Use of Opioids From Multiple Providers - Multiple Prescribers and Multiple Pharmacies 2.81% 2.68% 1.76% 0.47%
Use of Opiods Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Opioids at High Dosage 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Use of Opioids From Multiple Providers - Multiple Pharmacies 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Use of Opioids From Multiple Providers - Multiple Prescribers 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Use of Opioids From Multiple Providers - Multiple Prescribers and Multiple Pharmacies 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Utilization
Info
Antibiotic Utilization 2018 Plan State Avg Nat Avg 90th Pctl.
Average number of antibiotic prescriptions per member per year - Total 0.80 0.74 0.71 0.88
Average number of antibiotic prescriptions per member per year - Ages 0-9 0.84 0.81 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 0.52 0.52 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 0.73 0.65 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 0.81 0.73 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 0.92 0.84 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 1.01 0.97 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 1.37 1.21 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 1.71 1.32 N/A N/A
Days suppplied per antibiotic prescription - Total 9.770 9.950 9.910 10.890
Days suppplied per antibiotic prescription - Ages 0-9 9.930 9.979 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 12.170 12.948 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 9.340 9.731 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 9.430 9.568 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 9.850 9.769 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 9.480 9.830 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 10.990 9.428 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 7.280 9.026 N/A N/A
Prescriptions of concern - Total 0.340 0.338 0.330 0.430
Prescriptions of concern - Ages 0-9 0.32 0.32 N/A N/A
Prescriptions of concern - Ages 10-17 0.18 0.20 N/A N/A
Prescriptions of concern - Ages 18-34 0.29 0.28 N/A N/A
Prescriptions of concern - Ages 35-49 0.36 0.35 N/A N/A
Prescriptions of concern - Ages 50-64 0.43 0.42 N/A N/A
Prescriptions of concern - Ages 65-74 0.46 0.48 N/A N/A
Prescriptions of concern - Ages 75-85 0.54 0.62 N/A N/A
Prescriptions of concern - Ages 85 plus 0.76 0.45 N/A N/A
Antibiotic Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Average number of antibiotic prescriptions per member per year - Total 2017 0.84 0.77 0.76 0.90
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
Average number of antibiotic prescriptions per member per year - Ages 0-9 2017 0.93 0.87 N/A N/A
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
Average number of antibiotic prescriptions per member per year - Ages 10-17 2017 0.59 0.57 N/A N/A
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
Average number of antibiotic prescriptions per member per year - Ages 18-34 2017 0.76 0.67 N/A N/A
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
Average number of antibiotic prescriptions per member per year - Ages 35-49 2017 0.84 0.75 N/A N/A
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
Average number of antibiotic prescriptions per member per year - Ages 50-64 2017 0.97 0.88 N/A N/A
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
Average number of antibiotic prescriptions per member per year - Ages 65-74 2017 1.07 1.00 N/A N/A
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
Average number of antibiotic prescriptions per member per year - Ages 75-85 2017 1.31 1.12 N/A N/A
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
Average number of antibiotic prescriptions per member per year - Ages 85 plus 2017 2.32 1.12 N/A N/A
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
Days suppplied per antibiotic prescription - Total 2017 9.730 10.024 9.880 10.830
2016 9.680 10.090 9.880 10.830
2015 9.845 10.259 10.120 11.030
2014 9.920 10.444 10.320 11.180
Days suppplied per antibiotic prescription - Ages 0-9 2017 9.830 10.050 N/A N/A
2016 9.730 10.041 N/A N/A
2015 9.731 9.987 N/A N/A
2014 9.638 10.008 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 2017 12.030 12.689 N/A N/A
2016 11.970 12.799 N/A N/A
2015 12.821 13.321 N/A N/A
2014 12.993 13.648 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 2017 9.420 9.836 N/A N/A
2016 9.300 10.074 N/A N/A
2015 9.474 10.334 N/A N/A
2014 9.611 10.650 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 2017 9.260 9.591 N/A N/A
2016 9.210 9.620 N/A N/A
2015 9.421 9.825 N/A N/A
2014 9.572 9.954 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 2017 9.780 9.856 N/A N/A
2016 9.790 9.816 N/A N/A
2015 9.864 9.898 N/A N/A
2014 9.840 10.043 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 2017 9.640 9.850 N/A N/A
2016 9.760 9.929 N/A N/A
2015 9.526 10.178 N/A N/A
2014 9.893 10.427 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 2017 12.090 10.604 N/A N/A
2016 11.940 10.594 N/A N/A
2015 11.348 9.934 N/A N/A
2014 10.717 10.543 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 2017 14.390 9.873 N/A N/A
2016 9.080 9.431 N/A N/A
2015 9.844 9.538 N/A N/A
2014 11.939 10.648 N/A N/A
Prescriptions of concern - Total 2017 0.370 0.354 0.360 0.450
2016 0.410 0.383 0.360 0.450
2015 0.433 0.401 0.410 0.520
2014 0.323 0.374 0.390 0.490
Prescriptions of concern - Ages 0-9 2017 0.35 0.35 N/A N/A
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
Prescriptions of concern - Ages 10-17 2017 0.21 0.22 N/A N/A
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
Prescriptions of concern - Ages 18-34 2017 0.31 0.28 N/A N/A
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
Prescriptions of concern - Ages 35-49 2017 0.39 0.37 N/A N/A
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
Prescriptions of concern - Ages 50-64 2017 0.46 0.44 N/A N/A
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
Prescriptions of concern - Ages 65-74 2017 0.51 0.50 N/A N/A
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
Prescriptions of concern - Ages 75-85 2017 0.42 0.54 N/A N/A
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
Prescriptions of concern - Ages 85 plus 2017 0.50 0.48 N/A N/A
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
Info
Child and Adolescent Well Child Visits 2018 Plan State Avg Nat Avg 90th Pctl.
Well Child Visits in the First 15 Months of Life 88.13% 85.93% 81.33% 90.72%
Well Child Visits in the 3rd - 6th Years 84.49% 83.85% 80.95% 91.86%
Adolescent Well-Care Visits 50.17% 53.54% 52.57% 71.93%
Child and Adolescent Well Child Visits Year Plan State Avg. Natl. Avg. 90th Pctl.
Well Child Visits in the First 15 Months of Life 2017 86.73% 85.68% 80.53% 90.78%
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%
Well Child Visits in the 3rd - 6th Years 2017 83.68% 83.18% 79.11% 91.03%
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%
Adolescent Well-Care Visits 2017 48.92% 53.24% 50.46% 70.44%
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%
Info
Mental Health Utilization 2018 Plan State Avg Nat Avg 90th Pctl.
Mental Health Utilization - Any service - Total 9.52% 7.63% 7.98% 11.76%
Mental Health Utilization - Any service - Ages 0-12 8.39% 6.12% N/A N/A
Mental Health Utilization - Any service - Ages 13-17 16.95% 13.96% N/A N/A
Mental Health Utilization - Any service - Ages 18-64 9.27% 7.62% N/A N/A
Mental Health Utilization - Any service - Ages 65 plus 3.64% 3.20% N/A N/A
Mental Health Utilization - ED - Total 0.06% 0.09% 0.10% 0.22%
Mental Health Utilization - ED - Ages 0-12 0.07% 0.05% N/A N/A
Mental Health Utilization - ED - Ages 13-17 0.24% 0.28% N/A N/A
Mental Health Utilization - ED - Ages 18-64 0.05% 0.08% N/A N/A
Mental Health Utilization - ED - Ages 65 plus 0.00% 0.02% N/A N/A
Mental Health Utilization - Inpatient - Total 0.25% 0.27% 0.27% 0.34%
Mental Health Utilization - Inpatient - Ages 0-12 0.10% 0.12% N/A N/A
Mental Health Utilization - Inpatient - Ages 13-17 0.72% 0.95% N/A N/A
Mental Health Utilization - Inpatient - Ages 18-64 0.24% 0.26% N/A N/A
Mental Health Utilization - Inpatient - Ages 65 plus 0.05% 0.06% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Total 0.11% 0.12% 0.19% 0.38%
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 0-12 0.18% 0.15% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 13-17 0.46% 0.49% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 18-64 0.08% 0.09% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 65 plus 0.02% 0.02% N/A N/A
Mental Health Utilization - Outpatient - Total 9.47% 7.53% N/A N/A
Mental Health Utilization - Outpatient - Ages 0-12 8.37% 6.10% N/A N/A
Mental Health Utilization - Outpatient - Ages 13-17 16.85% 13.80% N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 9.21% 7.51% N/A N/A
Mental Health Utilization - Outpatient - Ages 65 plus 3.64% 3.16% N/A N/A
Mental Health Utilization - Telehealth - Total 0.03% 0.10% 0.05% 0.11%
Mental Health Utilization - Telehealth - Ages 0-12 0.01% 0.03% N/A N/A
Mental Health Utilization - Telehealth - Ages 13-17 0.05% 0.19% N/A N/A
Mental Health Utilization - Telehealth - Ages 18-64 0.04% 0.11% N/A N/A
Mental Health Utilization - Telehealth - Ages 65 plus 0.02% 0.02% N/A N/A
Mental Health Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Mental Health Utilization - Any service - Total 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Any service - Ages 0-12 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Any service - Ages 13-17 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Any service - Ages 18-64 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Any service - Ages 65 plus 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - ED - Total 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 0-12 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 13-17 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 18-64 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 65 plus 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Total 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 0-12 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 13-17 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 18-64 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 65 plus 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Total 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 0-12 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 13-17 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 18-64 2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2015 N/A N/A N/A N/A
2014 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 65 plus 2017 N/A N/A N/A N/A