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Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.

Company Information

  • Company Providing Plan:Kaiser Permanente
  • Address:2101 East Jefferson Street
    Rockville, MD 20852
  • Telephone :301-816-6602
  • Website:www.kaiserpermanente.org
2016
Number of Enrollees: 180,359
PMPM: $350
Number of Physicians: 20,507
NCQA Accreditation: Excellent

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


Coverage Areas

Counties

Arlington, Fairfax, Falls Church, Fredericksburg, Loudoun, Prince William


Cities

Arlington, Ashburn, Burke, Falls Church, Fairfax, Fredericksburg, Leesburg, Manassas, McLean, Penderbrook, Reston, Springfield, Stafford, Sterling, Tyson's Corner, Woodbridge

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

Administrative Data

2016 2015 2014 2013 2012
Number of Enrollees 180,359 171,883 138,673 114,001 113,161
PMPM $350 $362 $388 $385 $370
*Medical Cost Ratio 89% 89% 89% 91% 93%
*Administrative Ratio 10% 11% 11% 9% 8%
*Profit/Loss Ratio 1% -0% -0% -1% -1%
Number of Physicians 20,507 19,970 19,950 19,358 18,697

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

Financial Data

2016 2015 2014 2013 2012
Premiums Earned $761,639,141 $733,571,440 $610,846,468 $529,390,905 $510,062,148
*Income $16,827,995 ($5,078,117) ($12,335,831) ($19,378,215) ($21,298,698)
*Net Worth $198,655,393 $209,174,462 $147,191,831 $176,010,947 $182,339,451

*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 2016 Plan State Avg Nat Avg 90th Pctl.
Adult Access (Age 20-44) To Preventive/Ambulatory Health Services 93.06% 92.81% 92.73% 95.55%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 95.87% 95.78% 95.78% 97.61%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 96.73% 97.30% 97.19% 98.61%
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 2015 93.26% 92.25% 92.83% 95.45%
2014 92.48% 93.10% 92.91% 95.39%
2013 92.69% 93.27% 93.13% 95.56%
2012 93.25% 93.53% 93.40% 95.86%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 2015 96.18% 95.61% 95.90% 97.55%
2014 95.84% 96.03% 95.85% 97.54%
2013 95.83% 95.97% 95.93% 97.60%
2012 96.07% 95.88% 95.84% 97.42%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 2015 96.74% 96.84% 97.32% 96.73%
2014 96.32% 97.56% 97.50% 98.68%
2013 96.23% 97.45% 97.36% 98.63%
2012 96.23% 97.38% 97.27% 98.74%
Info
Alcohol and Other Drug Dependence Treatment 2016 Plan State Avg Nat Avg 90th Pctl.
Initiation of Alcohol and Other Drug Dependence Treatment - Total 51.22% 35.69% 32.93% 40.24%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 46.88% 40.15% 40.47% 51.96%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 51.36% 35.55% 32.64% 40.33%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 22.28% 12.51% 11.46% 16.72%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 21.88% 11.28% 15.68% 23.73%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 22.30% 12.57% 11.32% 16.09%
Alcohol and Other Drug Dependence Treatment Year Plan State Avg. Natl. Avg. 90th Pctl.
Initiation of Alcohol and Other Drug Dependence Treatment - Total 2015 42.12% 33.04% 33.42% 41.07%
2014 33.16% 32.51% 35.63% 44.19%
2013 32.20% 35.00% 39.01% 50.93%
2012 33.24% 37.48% 40.13% 51.23%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2015 41.59% 37.03% 39.62% 50.00%
2014 34.44% 37.09% 40.79% 52.00%
2013 31.79% 39.67% 41.13% 53.51%
2012 N/A N/A N/A N/A
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2015 42.14% 32.96% 33.20% 40.93%
2014 33.10% 32.16% 35.21% 43.92%
2013 32.23% 34.74% 38.83% 51.61%
2012 N/A N/A N/A N/A
Engagement of Alcohol and Other Drug Dependence Treatment - Total 2015 15.09% 11.61% 12.46% 19.23%
2014 4.76% 10.64% 13.66% 19.19%
2013 9.80% 12.12% 14.64% 21.16%
2012 9.69% 11.95% 14.33% 20.35%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2015 13.27% 12.06% 15.42% 22.12%
2014 3.33% 13.00% 17.24% 25.29%
2013 13.29% 18.05% 18.23% 27.05%
2012 N/A N/A N/A N/A
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2015 15.17% 11.57% 12.34% 18.67%
2014 4.82% 10.33% 13.45% 18.68%
2013 9.58% 11.84% 14.47% 21.31%
2012 N/A N/A N/A N/A
Info
Child Access to Primary Care Practitioners 2016 Plan State Avg Nat Avg 90th Pctl.
12-24 month old Child Access to Primary Care Practitioners 98.03% 98.34% 98.09% 99.72%
25 month to 6 year old Child Access to Primary Care Practitioners 94.53% 94.33% 92.60% 96.46%
7-11 year old Child Access to Primary Care Practitioners 94.54% 94.38% 93.25% 98.25%
12-19 year old Child Access to Primary Care Practitioners 91.76% 91.45% 90.76% 96.39%
Child Access to Primary Care Practitioners Year Plan State Avg. Natl. Avg. 90th Pctl.
12-24 month old Child Access to Primary Care Practitioners 2015 97.43% 98.78% 98.03% 99.48%
2014 97.26% 98.49% 97.87% 99.62%
2013 96.50% 97.92% 97.99% 99.48%
2012 96.71% 97.87% 97.94% 99.58%
25 month to 6 year old Child Access to Primary Care Practitioners 2015 93.52% 94.16% 92.67% 96.64%
2014 92.50% 93.85% 92.33% 96.52%
2013 91.04% 93.53% 92.38% 96.50%
2012 91.78% 93.16% 92.31% 96.13%
7-11 year old Child Access to Primary Care Practitioners 2015 94.16% 94.23% 93.23% 97.92%
2014 93.12% 93.78% 93.02% 97.87%
2013 92.91% 93.78% 93.11% 97.89%
2012 93.07% 93.54% 92.93% 97.72%
12-19 year old Child Access to Primary Care Practitioners 2015 91.25% 91.30% 90.66% 96.19%
2014 90.34% 90.84% 90.44% 96.28%
2013 89.99% 90.58% 90.31% 96.28%
2012 90.14% 90.02% 90.01% 95.97%
Info
Prenatal and Postpartum Care 2016 Plan State Avg Nat Avg 90th Pctl.
Postpartum Care 93.28% 74.50% 73.95% 88.85%
Timeliness of Prenatal Care 97.76% 86.71% 85.57% 96.28%
Prenatal and Postpartum Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Postpartum Care 2015 92.45% 73.91% 73.72% 87.50%
2014 93.33% 77.29% 77.64% 88.65%
2013 93.20% 81.38% 91.35% 97.14%
2012 91.32% 81.20% 80.22% 90.25%
Timeliness of Prenatal Care 2015 95.60% 86.80% 84.28% 94.56%
2014 97.50% 86.83% 88.00% 96.23%
2013 96.60% 91.63% 81.00% 90.48%
2012 95.43% 91.51% 89.70% 96.97%
Effectiveness of Care
Info
Asthma Medication Management 2016 Plan State Avg Nat Avg 90th Pctl.
Medication Management for People With Asthma at least 50% Compliance - Total 68.03% 73.20% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 5-11 67.07% 67.58% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 12-18 55.42% 65.72% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 19-50 65.28% 71.77% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 51-64 72.40% 79.36% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 65-85 76.68% 82.66% N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Total 42.16% 51.17% 48.54% 56.96%
Medication Management for People With Asthma at least 75% Compliance - Ages 5-11 35.10% 39.03% 37.58% 48.84%
Medication Management for People With Asthma at least 75% Compliance - Ages 12-18 27.55% 35.03% 35.83% 46.97%
Medication Management for People With Asthma at least 75% Compliance - Ages 19-50 38.68% 50.18% 46.16% 55.80%
Medication Management for People With Asthma at least 75% Compliance - Ages 51-64 49.16% 59.39% 57.47% 65.75%
Medication Management for People With Asthma at least 75% Compliance - Ages 65-85 53.35% 62.35% 60.79% 70.92%
Asthma Medication Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Medication Management for People With Asthma at least 50% Compliance - Total 2015 66.83% 71.52% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 5-11 2015 63.93% 64.34% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 12-18 2015 56.60% 60.17% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 19-50 2015 64.68% 68.82% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 51-64 2015 71.67% 78.55% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 65-85 2015 70.89% 78.86% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Total 2015 42.10% 48.01% 46.20% 55.00%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Ages 5-11 2015 32.55% 36.59% 37.85% 49.09%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Ages 12-18 2015 26.10% 35.39% 34.97% 45.26%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Ages 19-50 2015 40.75% 45.56% 43.39% 53.13%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Ages 51-64 2015 48.84% 58.44% 55.49% 65.28%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Ages 65-85 2015 50.00% 56.41% 59.60% 70.59%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Info
Asthma Medication Ratio 2016 Plan State Avg Nat Avg 90th Pctl.
Controller/Total Asthma Medication Ratio - Total 81.11% 80.60% 78.29% 85.46%
Controller/Total Asthma Medication Ratio - Ages 5-11 86.62% 91.67% 86.40% 93.97%
Controller/Total Asthma Medication Ratio - Ages 12-18 76.90% 81.12% 78.30% 86.34%
Controller/Total Asthma Medication Ratio - Ages 19-50 77.32% 75.24% 73.51% 81.08%
Controller/Total Asthma Medication Ratio - Ages 51-64 83.78% 83.27% 81.70% 88.64%
Controller/Total Asthma Medication Ratio - Ages 65-85 84.62% 88.55% 84.66% 91.94%
Asthma Medication Ratio Year Plan State Avg. Natl. Avg. 90th Pctl.
Controller/Total Asthma Medication Ratio - Total 2015 80.01% 81.09% 77.99% 83.76%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Controller/Total Asthma Medication Ratio - Ages 5-11 2015 92.34% 88.49% 86.99% 92.47%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Controller/Total Asthma Medication Ratio - Ages 12-18 2015 81.06% 78.19% 77.09% 84.67%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Controller/Total Asthma Medication Ratio - Ages 19-50 2015 73.62% 75.16% 72.38% 80.79%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Controller/Total Asthma Medication Ratio - Ages 51-64 2015 82.83% 85.39% 81.87% 88.89%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Controller/Total Asthma Medication Ratio - Ages 65-85 2015 79.55% 87.62% 85.49% 92.31%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Info
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication 2016 Plan State Avg Nat Avg 90th Pctl.
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Initiation 65.26% 41.91% 38.93% 48.61%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 69.14% 46.92% 45.82% 56.86%
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 2015 66.10% 41.43% 38.13% 50.00%
2014 59.51% 39.00% 38.01% 46.81%
2013 26.49% 35.14% 40.10% 51.06%
2012 29.70% 36.75% 38.72% 48.58%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 2015 67.84% 49.06% 46.18% 58.06%
2014 62.61% 46.49% 45.70% 57.75%
2013 25.95% 41.32% 46.66% 58.62%
2012 25.13% 38.87% 45.07% 54.05%
Info
Cardiovascular Disease Management 2016 Plan State Avg Nat Avg 90th Pctl.
Controlling High Blood Pressure 90.34% 56.91% 60.31% 74.43%
Persistence of Beta-Blockers 93.94% 90.70% 83.61% 90.83%
Cardiovascular Disease Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Controlling High Blood Pressure 2015 91.19% 58.35% 58.69% 73.89%
2014 90.82% 59.30% 62.63% 75.63%
2013 85.90% 60.92% 63.30% 74.65%
2012 81.02% 59.78% 61.63% 72.94%
Persistence of Beta-Blockers 2015 88.00% 88.70% 84.68% 91.00%
2014 91.05% 84.03% 83.50% 91.43%
2013 77.60% 83.43% 83.39% 91.72%
2012 81.97% 82.94% 83.03% 92.98%
Info
Common Childhood Illnesses 2016 Plan State Avg Nat Avg 90th Pctl.
Appropriate Testing for Children With Pharyngitis 93.86% 90.38% 84.50% 93.75%
Common Childhood Illnesses Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Testing for Children With Pharyngitis 2015 95.48% 90.13% 83.12% 93.11%
2014 97.75% 88.64% 83.29% 91.40%
2013 95.76% 87.54% 81.45% 91.30%
2012 94.54% 87.53% 81.22% 91.58%
Info
Diabetes Care and Management 2016 Plan State Avg Nat Avg 90th Pctl.
Comprehensive Diabetes Care-Blood Pressure Control (<140/90 mm Hg) 85.77% 60.88% 61.06% 78.35%
Comprehensive Diabetes Care-HbA1c control (<8.0%) 66.67% 58.36% 56.62% 66.39%
Comprehensive Diabetes Care-Rate of Eye Exams 87.77% 58.46% 52.96% 72.04%
Comprehensive Diabetes Care-Rate of Medical Attention for Diabetic Nephropathy 96.53% 90.56% 90.03% 92.71%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 18.87% 30.47% 32.15% 20.98%
Comprehensive Diabetes Care-Testing for HbA1c 96.65% 90.38% 90.32% 94.83%
Diabetes Care and Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Comprehensive Diabetes Care-Blood Pressure Control (<140/90 mm Hg) 2015 85.95% 61.03% 58.80% 75.68%
2014 83.75% 63.33% 63.85% 76.00%
2013 68.27% 42.35% 64.44% 76.22%
2012 N/A N/A N/A N/A
Comprehensive Diabetes Care-HbA1c control (<8.0%) 2015 64.23% 57.59% 55.81% 66.67%
2014 61.19% 59.12% 58.53% 68.61%
2013 66.55% 55.47% 58.87% 69.16%
2012 N/A N/A N/A N/A
Comprehensive Diabetes Care-Rate of Eye Exams 2015 85.22% 57.15% 52.47% 70.44%
2014 82.49% 57.54% 54.98% 71.93%
2013 81.37% 56.05% 54.65% 71.53%
2012 86.27% 57.24% 55.70% 74.09%
Comprehensive Diabetes Care-Rate of Medical Attention for Diabetic Nephropathy 2015 95.99% 91.11% 90.10% 93.40%
2014 97.83% 86.26% 84.72% 89.60%
2013 95.88% 84.97% 83.75% 89.19%
2012 96.13% 85.74% 83.70% 89.54%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 2015 21.53% 30.83% 33.90% 20.20%
2014 22.74% 31.37% 30.48% 19.33%
2013 20.24% 34.40% 30.71% 19.46%
2012 18.66% 27.02% 28.85% 18.18%
Comprehensive Diabetes Care-Testing for HbA1c 2015 94.53% 91.13% 90.54% 94.69%
2014 94.58% 89.01% 90.34% 94.86%
2013 94.17% 88.32% 89.62% 94.23%
2012 96.30% 89.98% 89.76% 94.38%
Info
Drug Therapy in Rheumatoid Arthritis 2016 Plan State Avg Nat Avg 90th Pctl.
Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis 92.21% 89.05% 87.87% 93.92%
Drug Therapy in Rheumatoid Arthritis Year Plan State Avg. Natl. Avg. 90th Pctl.
Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis 2015 90.44% 89.72% 87.84% 92.86%
2014 88.70% 88.05% 87.86% 93.59%
2013 87.40% 88.24% 87.95% 94.49%
2012 88.03% 88.39% 87.47% 93.70%
Info
Immunizations 2016 Plan State Avg Nat Avg 90th Pctl.
Childhood Immunization for Multiple diseases including Chicken Pox 88.92% 84.29% 78.93% 89.03%
Childhood Immunization for Multiple diseases including pneumovax 87.89% 82.08% 77.04% 87.50%
Flu Vaccinations for Adults Ages 18–64 54.33% 47.13% N/A N/A
Immunizations for Adolescents - Combination 89.29% 77.95% 77.63% 88.81%
Immunizations for Adolescents - Meningococcal 90.27% 79.65% 79.20% 90.02%
Immunizations for Adolescents - Tdap 93.43% 91.29% 87.77% 95.38%
Immunizations Year Plan State Avg. Natl. Avg. 90th Pctl.
Childhood Immunization for Multiple diseases including Chicken Pox 2015 89.55% 81.56% 78.59% 88.08%
2014 91.00% 80.25% 80.18% 88.07%
2013 95.66% 80.24% 78.39% 87.14%
2012 92.10% 82.72% 79.83% 88.00%
Childhood Immunization for Multiple diseases including pneumovax 2015 88.09% 79.45% 76.49% 87.10%
2014 89.05% 78.11% 78.13% 86.26%
2013 94.64% 78.73% 76.21% 85.40%
2012 90.62% 78.74% 77.05% 86.00%
Flu Vaccinations for Adults Ages 18–64 2015 0.61% 0.50% 47.85% 58.01%
2014 0.59% 0.52% 49.45% 59.73%
2013 0.53% 0.49% 49.06% 59.59%
2012 N/A N/A N/A N/A
Immunizations for Adolescents - Combination 2015 93.20% 69.50% 74.25% 88.47%
2014 91.85% 67.04% 70.73% 87.34%
2013 84.62% 60.89% 66.54% 84.18%
2012 N/A N/A N/A N/A
Immunizations for Adolescents - Meningococcal 2015 0.93% 0.72% 76.12% 89.29%
2014 0.93% 0.69% 72.59% 88.27%
2013 0.86% 0.64% 68.70% 85.25%
2012 N/A N/A N/A N/A
Immunizations for Adolescents - Tdap 2015 0.96% 0.85% 86.03% 94.39%
2014 0.94% 0.85% 84.49% 95.15%
2013 0.89% 0.80% 80.83% 94.73%
2012 N/A N/A N/A N/A
Info
Mental Health: Care and Follow-up 2016 Plan State Avg Nat Avg 90th Pctl.
Antidepressant Medication Management-Acute Phase Treatment 74.16% 70.29% 66.56% 74.77%
Antidepressant Medication Management-Continuation Phase Treatment 51.21% 53.51% 50.69% 58.60%
Follow-up After Hospitalization For Mental Illness within 7 days after hospital discharge 70.09% 52.99% 52.06% 67.31%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 78.41% 73.85% 71.36% 84.17%
Mental Health: Care and Follow-up Year Plan State Avg. Natl. Avg. 90th Pctl.
Antidepressant Medication Management-Acute Phase Treatment 2015 71.96% 67.61% 65.82% 74.06%
2014 70.80% 68.52% 65.88% 75.35%
2013 65.11% 65.67% 63.60% 73.26%
2012 75.05% 69.62% 69.03% 77.57%
Antidepressant Medication Management-Continuation Phase Treatment 2015 43.94% 49.81% 50.15% 57.56%
2014 43.56% 50.31% 49.83% 59.11%
2013 40.17% 48.37% 46.58% 57.12%
2012 48.88% 52.80% 53.51% 61.69%
Follow-up After Hospitalization For Mental Illness within 7 days after hospital discharge 2015 68.80% 47.66% 50.57% 67.57%
2014 64.46% 51.82% 52.21% 70.33%
2013 63.16% 55.07% 53.70% 69.16%
2012 61.03% 61.69% 57.57% 73.88%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 2015 79.70% 71.58% 69.72% 83.80%
2014 77.85% 72.52% 70.72% 85.71%
2013 77.75% 73.03% 72.56% 84.19%
2012 74.58% 77.74% 75.42% 86.45%
Info
Persistent Medications 2016 Plan State Avg Nat Avg 90th Pctl.
Annual Monitoring for Patients on Persistent Medications 91.54% 84.90% 83.34% 87.04%
Persistent Medications Year Plan State Avg. Natl. Avg. 90th Pctl.
Annual Monitoring for Patients on Persistent Medications 2015 88.01% 83.34% 82.94% 86.72%
2014 88.12% 83.28% 82.33% 86.25%
2013 89.85% 83.44% 82.32% 86.12%
2012 86.03% 83.30% 82.11% 86.32%
Info
Pharmacotherapy of COPD Exacerbation 2016 Plan State Avg Nat Avg 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 91.59% 84.12% 76.30% 85.98%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 83.18% 79.54% 70.70% 81.82%
Pharmacotherapy of COPD Exacerbation Year Plan State Avg. Natl. Avg. 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 2015 90.64% 78.48% 79.09% 87.10%
2014 89.23% 80.03% 80.14% 86.90%
2013 79.19% 78.88% 79.47% 87.58%
2012 78.01% 80.97% 80.45% 87.50%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 2015 73.89% 72.98% 75.30% 84.56%
2014 75.38% 75.53% 75.28% 83.54%
2013 66.50% 73.76% 75.40% 83.33%
2012 67.38% 73.69% 73.65% 81.32%
Info
Preventive Care 2016 Plan State Avg Nat Avg 90th Pctl.
Breast Cancer Screening 87.98% 71.80% 72.90% 80.63%
Chlamydia Screening in Women-all Age groups 69.30% 49.79% 48.98% 63.50%
Colorectal Cancer Screening 83.45% 65.83% 61.71% 74.09%
Preventive Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Breast Cancer Screening 2015 88.23% 72.07% 73.08% 81.53%
2014 89.63% 72.22% 73.52% 81.91%
2013 88.84% 72.82% 73.71% 80.78%
2012 N/A N/A N/A N/A
Chlamydia Screening in Women-all Age groups 2015 65.76% 47.89% 52.32% 64.06%
2014 66.77% 48.07% 51.65% 63.48%
2013 71.05% 47.46% 46.20% 59.63%
2012 69.88% 46.98% 45.16% 57.69%
Colorectal Cancer Screening 2015 82.80% 64.43% 62.32% 73.84%
2014 71.30% 63.41% 64.06% 74.86%
2013 83.94% 65.36% 62.85% 72.75%
2012 76.24% 64.80% 62.63% 73.86%
Info
Spirometry Testing 2016 Plan State Avg Nat Avg 90th Pctl.
Use of Spirometry Testing in the Assessment and diagnosis of COPD 54.10% 42.48% 42.55% 51.02%
Spirometry Testing Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Spirometry Testing in the Assessment and diagnosis of COPD 2015 71.39% 46.31% 42.44% 51.66%
2014 76.52% 42.48% 42.16% 51.85%
2013 71.97% 43.20% 42.08% 50.99%
2012 59.46% 45.42% 43.34% 55.44%
Info
Weight Assessment and Counseling 2016 Plan State Avg Nat Avg 90th Pctl.
Adult BMI Assessment 98.11% 77.87% 76.17% 91.85%
Children/Adolescents BMI Assessment - Total 100.00% 69.07% 65.62% 88.08%
Counseling for Nutrition for Children/Adolescents - Total 98.51% 66.76% 61.76% 83.68%
Counseling for Physical Activity for Children/Adolescents - Total 100.00% 60.41% 55.96% 79.44%
Weight Assessment and Counseling Year Plan State Avg. Natl. Avg. 90th Pctl.
Adult BMI Assessment 2015 99.00% 75.90% 74.19% 91.76%
2014 96.35% 76.28% 75.36% 91.20%
2013 95.13% 72.78% 74.24% 90.00%
2012 93.91% 60.89% N/A N/A
Children/Adolescents BMI Assessment - Total 2015 99.00% 60.49% 60.37% 83.78%
2014 97.17% 61.63% 61.08% 85.37%
2013 96.12% 52.14% 54.90% 83.13%
2012 91.97% 43.29% 49.34% 78.51%
Counseling for Nutrition for Children/Adolescents - Total 2015 95.00% 63.88% 58.94% 80.79%
2014 96.23% 65.02% 60.64% 80.05%
2013 95.82% 61.17% 56.48% 79.32%
2012 74.94% 51.32% 54.19% 75.00%
Counseling for Physical Activity for Children/Adolescents - Total 2015 95.00% 59.53% 54.50% 78.85%
2014 96.23% 62.13% 57.09% 77.30%
2013 95.52% 56.47% 53.16% 74.70%
2012 74.52% 45.42% 49.91% 70.66%
Health Plan Stability/Descriptive
Info
Administrative Data 2016 Plan State Avg Nat Avg 90th Pctl.
Administrative Ratio 0.10 0.15 N/A N/A
Medical Cost Ratio 0.89 0.83 N/A N/A
Number of Enrollees 180,359 136,796 N/A N/A
Number of Physicians 20,507 73,426 N/A N/A
Premium Per Member Per Month $350 $370 N/A N/A
Profit/Loss Ratio 0.01 0.03 N/A N/A
Administrative Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Administrative Ratio 2015 0.11 0.14 N/A N/A
2014 0.11 0.14 N/A N/A
2013 0.09 0.14 N/A N/A
2012 0.08 0.10 N/A N/A
Medical Cost Ratio 2015 0.89 0.82 N/A N/A
2014 0.89 0.81 N/A N/A
2013 0.91 0.83 N/A N/A
2012 0.93 0.84 N/A N/A
Number of Enrollees 2015 171,883 124,097 N/A N/A
2014 138,673 115,428 N/A N/A
2013 114,001 98,253 N/A N/A
2012 113,161 111,525 N/A N/A
Number of Physicians 2015 19,970 90,027 N/A N/A
2014 19,950 63,157 N/A N/A
2013 19,358 64,207 N/A N/A
2012 18,697 62,436 N/A N/A
Premium Per Member Per Month 2015 $362 $375 N/A N/A
2014 $388 $412 N/A N/A
2013 $385 $544 N/A N/A
2012 $370 $378 N/A N/A
Profit/Loss Ratio 2015 -0.00 0.04 N/A N/A
2014 -0.00 0.06 N/A N/A
2013 -0.01 0.03 N/A N/A
2012 -0.01 0.07 N/A N/A
Info
Board Certification Rates for Providers 2016 Plan State Avg Nat Avg 90th Pctl.
Board Certification for Geriatricians 91.18% 73.44% N/A N/A
Board Certification for Pediatricians 97.18% 87.02% N/A N/A
Board Certification Rate for Family Medicine Physicians 95.31% 80.32% N/A N/A
Board Certification Rate for Internal Medicine Physicians 95.66% 81.15% N/A N/A
Board Certification Rate for OB/GYN Providers 90.16% 83.36% N/A N/A
Board Certification Rate for Other Specialists 95.46% 83.25% N/A N/A
Board Certification Rates for Providers Year Plan State Avg. Natl. Avg. 90th Pctl.
Board Certification for Geriatricians 2015 96.88% 71.06% N/A N/A
2014 96.67% 74.73% 64.82% 87.50%
2013 96.83% 71.19% 63.29% 83.33%
2012 82.42% 73.37% 65.21% 87.23%
Board Certification for Pediatricians 2015 96.96% 88.14% N/A N/A
2014 97.14% 88.13% 83.89% 91.52%
2013 92.19% 86.01% 81.01% 90.29%
2012 91.48% 86.06% 83.97% 91.65%
Board Certification Rate for Family Medicine Physicians 2015 97.21% 82.53% N/A N/A
2014 95.20% 82.93% 77.41% 89.90%
2013 90.14% 81.36% 76.60% 88.80%
2012 89.74% 81.09% 77.40% 89.19%
Board Certification Rate for Internal Medicine Physicians 2015 96.66% 82.59% N/A N/A
2014 94.89% 83.98% 79.07% 88.73%
2013 83.85% 80.80% 78.18% 87.44%
2012 85.31% 81.93% 79.29% 88.24%
Board Certification Rate for OB/GYN Providers 2015 90.45% 83.51% N/A N/A
2014 90.51% 83.71% 79.30% 88.80%
2013 82.77% 80.44% 76.89% 87.80%
2012 80.67% 80.51% 79.23% 86.38%
Board Certification Rate for Other Specialists 2015 96.25% 82.88% N/A N/A
2014 94.40% 84.44% 78.09% 89.67%
2013 87.59% 79.95% 74.88% 88.36%
2012 78.32% 79.00% 75.49% 87.62%
Info
Financial Data 2016 Plan State Avg Nat Avg 90th Pctl.
Income $16,827,995 $38,212,136 N/A N/A
Net Worth $198,655,393 $267,217,323 N/A N/A
Premiums Earned $761,639,141 $644,862,921 N/A N/A
Financial Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Income 2015 $-5,078,117 $19,029,685 N/A N/A
2014 $-12,335,831 $50,732,622 N/A N/A
2013 $-19,378,215 $44,817,532 N/A N/A
2012 $-21,298,698 $57,195,463 N/A N/A
Net Worth 2015 $209,174,462 $237,291,717 N/A N/A
2014 $147,191,831 $250,764,247 N/A N/A
2013 $176,010,947 $222,343,959 N/A N/A
2012 $182,339,451 $232,468,936 N/A N/A
Premiums Earned 2015 $733,571,440 $552,705,214 N/A N/A
2014 $610,846,468 $470,221,984 N/A N/A
2013 $529,390,905 $403,549,832 N/A N/A
2012 $510,062,148 $442,669,442 N/A N/A
Info
Years in Business 2016 Plan State Avg Nat Avg 90th Pctl.
Years in Business 37 34 N/A N/A
Years in Business Year Plan State Avg. Natl. Avg. 90th Pctl.
Years in Business 2015 36 33 N/A N/A
2014 35 32 N/A N/A
2013 34 31 N/A N/A
2012 33 30 N/A N/A
Member Satisfaction
Info
Member Satisfaction 2016 Plan State Avg Nat Avg 90th Pctl.
Getting Care Quickly 83.76% 85.81% 85.14% 90.00%
Getting Needed Care 81.78% 86.38% 87.25% 91.54%
How Well Doctors Communicate 91.95% 95.22% 95.39% 97.21%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 73.84% 62.47% 62.27% 74.92%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 82.97% 83.44% 84.72% 88.74%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 75.99% 77.49% 77.19% 83.29%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 82.73% 84.65% 84.57% 88.37%
Member Satisfaction Year Plan State Avg. Natl. Avg. 90th Pctl.
Getting Care Quickly 2015 84.47% 85.61% 85.00% 89.71%
2014 83.24% 86.12% 85.79% 90.17%
2013 85.80% 86.65% 86.84% 90.75%
2012 83.05% 85.74% 85.81% 90.18%
Getting Needed Care 2015 88.20% 86.51% 86.79% 91.23%
2014 84.98% 88.34% 87.95% 92.13%
2013 86.54% 87.20% 88.05% 92.37%
2012 86.68% 86.83% 87.88% 91.65%
How Well Doctors Communicate 2015 94.31% 94.90% 95.20% 97.10%
2014 92.75% 95.30% 95.26% 97.16%
2013 94.62% 94.13% 94.94% 96.97%
2012 92.65% 94.08% 94.39% 96.44%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 2015 75.06% 62.71% 62.65% 74.57%
2014 68.00% 58.77% 64.71% 76.75%
2013 84.29% 65.03% 66.21% 78.29%
2012 83.01% 64.01% 63.16% 74.19%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 2015 86.64% 83.49% 83.85% 89.05%
2014 85.79% 85.38% 84.24% 88.27%
2013 86.05% 83.04% 84.52% 89.47%
2012 86.22% 84.35% 83.55% 88.27%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 2015 82.95% 76.25% 76.99% 82.76%
2014 84.82% 79.49% 78.26% 83.66%
2013 83.89% 76.64% 78.14% 84.28%
2012 81.36% 75.50% 76.51% 82.08%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 2015 82.08% 83.85% 84.24% 88.77%
2014 88.04% 84.37% 84.70% 88.96%
2013 90.05% 83.92% 84.96% 89.71%
2012 89.42% 84.23% 83.62% 87.92%
Overuse/Appropriateness
Info
Antipsychotics 2016 Plan State Avg Nat Avg 90th Pctl.
Metabolic Monitoring for Children and Adolescents on Antipsychotics - Ages 1-17 75.00% 34.87% 35.80% 45.93%
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 73.08% 61.93% 58.30% 75.00%
Use of Multiple Concurrent Antipsychotics in Children and Adolescents - Ages 1-17 0.00% 2.06% N/A N/A
Antipsychotics Year Plan State Avg. Natl. Avg. 90th Pctl.
Metabolic Monitoring for Children and Adolescents on Antipsychotics - Ages 1-17 2015 49.55% 37.02% 33.94% 45.45%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 2015 58.78% 61.38% 54.40% 70.49%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Use of Multiple Concurrent Antipsychotics in Children and Adolescents - Ages 1-17 2015 0.51% 1.70% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Info
Cervical Cancer Screening in Adolescent Females 2016 Plan State Avg Nat Avg 90th Pctl.
Non-Recommended Cervical Cancer Screening in Adolescent Females 0.13% 1.60% 1.84% 0.62%
Cervical Cancer Screening in Adolescent Females Year Plan State Avg. Natl. Avg. 90th Pctl.
Non-Recommended Cervical Cancer Screening in Adolescent Females 2015 0.00% 0.02% 2.40% 0.93%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Info
Lower Back Pain 2016 Plan State Avg Nat Avg 90th Pctl.
Use of Imaging for Low Back Pain 81.56% 73.58% 72.67% 80.11%
Lower Back Pain Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Imaging for Low Back Pain 2015 83.15% 74.11% 74.57% 81.25%
2014 83.00% 72.44% 74.82% 81.95%
2013 81.66% 73.66% 74.48% 81.27%
2012 81.61% 72.73% 74.28% 81.82%
Info
Respiratory 2016 Plan State Avg Nat Avg 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 95.19% 88.81% 88.51% 94.80%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 70.95% 27.03% 28.19% 41.72%
Respiratory Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 2015 95.12% 87.71% 88.11% 94.26%
2014 99.96% 87.19% 87.39% 94.57%
2013 99.50% 82.80% 85.30% 92.63%
2012 98.63% 81.66% 84.23% 92.25%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 2015 71.99% 25.68% 26.11% 38.04%
2014 74.38% 25.67% 25.79% 36.11%
2013 62.45% 22.74% 23.86% 30.84%
2012 67.30% 20.78% 22.26% 32.00%
Utilization
Info
Antibiotic Utilization 2016 Plan State Avg Nat Avg 90th Pctl.
Average number of antibiotic prescriptions per member per year - Total 0.56 0.79 0.77 0.93
Average number of antibiotic prescriptions per member per year - Ages 0-9 0.56 0.97 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 0.31 0.60 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 0.52 0.69 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 0.60 0.77 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 0.65 0.87 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 0.70 0.99 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 0.70 1.23 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 0.80 0.73 N/A N/A
Days suppplied per antibiotic prescription - Total 10.94 10.09 10.01 11.06
Days suppplied per antibiotic prescription - Ages 0-9 10.34 10.04 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 15.77 12.80 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 11.23 10.07 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 10.41 9.62 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 10.41 9.82 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 10.97 9.93 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 11.23 10.59 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 10.64 9.43 N/A N/A
Prescriptions of concern - Total 0.25 0.38 0.38 0.48
Prescriptions of concern - Ages 0-9 0.21 0.43 N/A N/A
Prescriptions of concern - Ages 10-17 0.12 0.24 N/A N/A
Prescriptions of concern - Ages 18-34 0.21 0.31 N/A N/A
Prescriptions of concern - Ages 35-49 0.28 0.40 N/A N/A
Prescriptions of concern - Ages 50-64 0.33 0.46 N/A N/A
Prescriptions of concern - Ages 65-74 0.33 0.51 N/A N/A
Prescriptions of concern - Ages 75-85 0.34 0.65 N/A N/A
Prescriptions of concern - Ages 85 plus 0.39 0.34 N/A N/A
Antibiotic Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Average number of antibiotic prescriptions per member per year - Total 2015 0.58 0.80 0.81 0.97
2014 0.60 0.75 0.79 0.96
2013 0.62 0.83 0.81 0.98
2012 N/A N/A N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 0-9 2015 0.60 0.94 N/A N/A
2014 0.59 0.84 N/A N/A
2013 0.63 0.93 N/A N/A
2012 N/A N/A N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 2015 0.32 0.60 N/A N/A
2014 0.33 0.56 N/A N/A
2013 0.34 0.62 N/A N/A
2012 N/A N/A N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 2015 0.53 0.70 N/A N/A
2014 0.56 0.67 N/A N/A
2013 0.58 0.74 N/A N/A
2012 N/A N/A N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 2015 0.61 0.80 N/A N/A
2014 0.65 0.76 N/A N/A
2013 0.66 0.83 N/A N/A
2012 N/A N/A N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 2015 0.67 0.90 N/A N/A
2014 0.69 0.84 N/A N/A
2013 0.70 0.92 N/A N/A
2012 N/A N/A N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 2015 0.71 1.07 N/A N/A
2014 0.66 0.96 N/A N/A
2013 0.72 1.05 N/A N/A
2012 N/A N/A N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 2015 0.76 1.08 N/A N/A
2014 0.73 1.09 N/A N/A
2013 0.74 1.11 N/A N/A
2012 N/A N/A N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 2015 0.79 1.67 N/A N/A
2014 0.70 1.37 N/A N/A
2013 0.81 1.67 N/A N/A
2012 N/A N/A N/A N/A
Days suppplied per antibiotic prescription - Total 2015 11.06 10.26 10.12 11.03
2014 11.15 10.44 10.32 11.18
2013 10.90 10.44 10.45 11.35
2012 N/A N/A N/A N/A
Days suppplied per antibiotic prescription - Ages 0-9 2015 10.43 9.99 N/A N/A
2014 10.24 10.01 N/A N/A
2013 10.14 10.00 N/A N/A
2012 N/A N/A N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 2015 16.14 13.32 N/A N/A
2014 16.28 13.65 N/A N/A
2013 15.92 13.72 N/A N/A
2012 N/A N/A N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 2015 11.45 10.33 N/A N/A
2014 11.61 10.65 N/A N/A
2013 11.18 10.61 N/A N/A
2012 N/A N/A N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 2015 10.46 9.83 N/A N/A
2014 10.44 9.95 N/A N/A
2013 10.29 9.93 N/A N/A
2012 N/A N/A N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 2015 10.46 9.90 N/A N/A
2014 10.51 10.04 N/A N/A
2013 10.46 10.07 N/A N/A
2012 N/A N/A N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 2015 11.19 10.18 N/A N/A
2014 12.31 10.43 N/A N/A
2013 10.95 10.23 N/A N/A
2012 N/A N/A N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 2015 10.93 9.93 N/A N/A
2014 11.00 10.54 N/A N/A
2013 10.10 10.32 N/A N/A
2012 N/A N/A N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 2015 11.60 9.54 N/A N/A
2014 13.46 10.65 N/A N/A
2013 13.37 8.73 N/A N/A
2012 N/A N/A N/A N/A
Prescriptions of concern - Total 2015 0.27 0.40 0.41 0.52
2014 0.28 0.37 0.39 0.49
2013 0.30 0.42 0.41 0.52
2012 N/A N/A N/A N/A
Prescriptions of concern - Ages 0-9 2015 0.23 0.41 N/A N/A
2014 0.22 0.38 N/A N/A
2013 0.26 0.44 N/A N/A
2012 N/A N/A N/A N/A
Prescriptions of concern - Ages 10-17 2015 0.16 0.25 N/A N/A
2014 0.12 0.22 N/A N/A
2013 0.13 0.25 N/A N/A
2012 N/A N/A N/A N/A
Prescriptions of concern - Ages 18-34 2015 0.22 0.32 N/A N/A
2014 0.23 0.30 N/A N/A
2013 0.24 0.34 N/A N/A
2012 N/A N/A N/A N/A
Prescriptions of concern - Ages 35-49 2015 0.29 0.42 N/A N/A
2014 0.32 0.41 N/A N/A
2013 0.33 0.45 N/A N/A
2012 N/A N/A N/A N/A
Prescriptions of concern - Ages 50-64 2015 0.35 0.49 N/A N/A
2014 0.37 0.45 N/A N/A
2013 0.38 0.50 N/A N/A
2012 N/A N/A N/A N/A
Prescriptions of concern - Ages 65-74 2015 0.36 0.57 N/A N/A
2014 0.38 0.51 N/A N/A
2013 0.40 0.56 N/A N/A
2012 N/A N/A N/A N/A
Prescriptions of concern - Ages 75-85 2015 0.39 0.59 N/A N/A
2014 0.38 0.51 N/A N/A
2013 0.42 0.57 N/A N/A
2012 N/A N/A N/A N/A
Prescriptions of concern - Ages 85 plus 2015 0.38 0.82 N/A N/A
2014 0.37 0.55 N/A N/A
2013 0.48 1.15 N/A N/A
2012 N/A N/A N/A N/A
Info
Child and Adolescent Well Child Visits 2016 Plan State Avg Nat Avg 90th Pctl.
Well Child Visits in the First 15 Months of Life 83.33% 83.40% 80.76% 90.36%
Well Child Visits in the 3rd - 6th Years 89.81% 82.50% 78.30% 90.11%
Adolescent Well-Care Visits 54.78% 50.35% 49.68% 67.70%
Child and Adolescent Well Child Visits Year Plan State Avg. Natl. Avg. 90th Pctl.
Well Child Visits in the First 15 Months of Life 2015 81.25% 84.01% 79.35% 89.12%
2014 84.84% 82.63% 79.12% 89.64%
2013 84.07% 83.44% 79.34% 89.83%
2012 84.71% 83.14% 78.67% 91.43%
Well Child Visits in the 3rd - 6th Years 2015 84.05% 80.48% 77.75% 89.74%
2014 82.79% 80.03% 77.37% 88.75%
2013 78.47% 78.43% 75.89% 88.25%
2012 78.47% 76.56% 74.36% 86.52%
Adolescent Well-Care Visits 2015 52.68% 49.34% 48.26% 64.50%
2014 51.73% 48.09% 47.51% 64.76%
2013 49.36% 46.84% 46.27% 63.82%
2012 48.86% 44.66% 44.76% 63.11%
Info
Mental Health Utilization 2016 Plan State Avg Nat Avg 90th Pctl.
Mental Health Utilization - Any service - Total 5.58% 6.65% 6.82% 10.37%
Mental Health Utilization - Any service - Ages 0-12 4.56% 5.25% N/A N/A
Mental Health Utilization - Any service - Ages 13-17 9.59% 12.10% N/A N/A
Mental Health Utilization - Any service - Ages 18-64 5.62% 6.59% N/A N/A
Mental Health Utilization - Any service - Ages 65 plus 2.82% 3.39% N/A N/A
Mental Health Utilization - Inpatient - Total 0.22% 0.25% 0.24% 0.31%
Mental Health Utilization - Inpatient - Ages 0-12 0.04% 0.07% N/A N/A
Mental Health Utilization - Inpatient - Ages 13-17 0.74% 0.79% N/A N/A
Mental Health Utilization - Inpatient - Ages 18-64 0.21% 0.25% N/A N/A
Mental Health Utilization - Inpatient - Ages 65 plus 0.12% 0.18% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Total 0.19% 0.12% 0.17% 0.35%
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 0-12 0.03% 0.07% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 13-17 0.55% 0.43% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 18-64 0.20% 0.11% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 65 plus 0.04% 0.02% N/A N/A
Mental Health Utilization - Outpatient or ED - Total 5.88% 6.63% 6.77% 10.32%
Mental Health Utilization - Outpatient or ED - Ages 0-12 4.77% 5.26% N/A N/A
Mental Health Utilization - Outpatient or ED - Ages 13-17 11.15% 12.16% N/A N/A
Mental Health Utilization - Outpatient or ED - Ages 18-64 5.88% 6.56% N/A N/A
Mental Health Utilization - Outpatient or ED - Ages 65 plus 2.52% 3.22% N/A N/A
Mental Health Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Mental Health Utilization - Any service - Total 2015 6.16% 6.65% 6.71% 9.72%
2014 6.14% 7.59% 7.15% 10.70%
2013 6.27% 6.78% 7.20% 11.03%
2012 N/A N/A N/A N/A
Mental Health Utilization - Any service - Ages 0-12 2015 5.26% 5.08% N/A N/A
2014 4.82% 5.49% N/A N/A
2013 4.52% 5.17% N/A N/A
2012 N/A N/A N/A N/A
Mental Health Utilization - Any service - Ages 13-17 2015 9.84% 11.13% N/A N/A
2014 10.92% 12.47% N/A N/A
2013 10.04% 10.96% N/A N/A
2012 N/A N/A N/A N/A
Mental Health Utilization - Any service - Ages 18-64 2015 6.16% 6.69% N/A N/A
2014 6.16% 7.72% N/A N/A
2013 6.43% 6.86% N/A N/A
2012 N/A N/A N/A N/A
Mental Health Utilization - Any service - Ages 65 plus 2015 3.03% 3.67% N/A N/A
2014 3.05% 4.08% N/A N/A
2013 3.33% 3.25% N/A N/A
2012 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Total 2015 0.23% 0.25% 0.24% 0.31%
2014 0.24% 0.30% 0.26% 0.35%
2013 0.26% 0.26% 0.26% 0.37%
2012 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 0-12 2015 0.06% 0.07% N/A N/A
2014 0.07% 0.09% N/A N/A
2013 0.06% 0.06% N/A N/A
2012 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 13-17 2015 0.66% 0.77% N/A N/A
2014 0.72% 0.99% N/A N/A
2013 0.75% 0.82% N/A N/A
2012 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 18-64 2015 0.22% 0.24% N/A N/A
2014 0.24% 0.29% N/A N/A
2013 0.26% 0.25% N/A N/A
2012 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 65 plus 2015 0.13% 0.10% N/A N/A
2014 0.17% 0.18% N/A N/A
2013 0.16% 0.18% N/A N/A
2012 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Total 2015 0.19% 0.10% 0.16% 0.34%
2014 0.20% 0.11% 0.16% 0.36%
2013 0.20% 0.09% 0.14% 0.28%
2012 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 0-12 2015 0.04% 0.05% N/A N/A
2014 0.03% 0.06% N/A N/A
2013 0.04% 0.05% N/A N/A
2012 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 13-17 2015 0.51% 0.37% N/A N/A
2014 0.62% 0.42% N/A N/A
2013 0.60% 0.34% N/A N/A
2012 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 18-64 2015 0.19% 0.09% N/A N/A
2014 0.21% 0.10% N/A N/A
2013 0.20% 0.08% N/A N/A
2012 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 65 plus 2015 0.04% 0.02% N/A N/A
2014 0.05% 0.02% N/A N/A
2013 0.03% 0.02% N/A N/A
2012 N/A N/A N/A N/A
Mental Health Utilization - Outpatient or ED - Total 2015 6.07% 6.59% 6.64% 9.70%
2014 6.03% 7.52% 7.07% 10.63%
2013 6.16% 6.72% 7.12% 10.93%
2012 N/A N/A N/A N/A
Mental Health Utilization - Outpatient or ED - Ages 0-12 2015 5.24% 5.07% N/A N/A
2014 4.80% 5.47% N/A N/A
2013 4.50% 5.15% N/A N/A
2012 N/A N/A N/A N/A
Mental Health Utilization - Outpatient or ED - Ages 13-17 2015 9.60% 11.02% N/A N/A
2014 10.63% 12.33% N/A N/A
2013 9.78% 10.84% N/A N/A
2012 N/A N/A N/A N/A
Mental Health Utilization - Outpatient or ED - Ages 18-64 2015 6.07% 6.62% N/A N/A
2014 6.06% 7.64% N/A N/A
2013 6.33% 6.80% N/A N/A
2012 N/A N/A N/A N/A
Mental Health Utilization - Outpatient or ED - Ages 65 plus 2015 2.97% 3.64% N/A N/A
2014 2.94% 3.97% N/A N/A
2013 3.23% 3.17% N/A N/A
2012 N/A N/A N/A N/A
Info
Plan All-Cause Readmissions 2016 Plan State Avg Nat Avg 90th Pctl.
Plan All-Cause Readmissions Ages 18-44 0.11% 0.12% N/A N/A
Plan All-Cause Readmissions Ages 45-54 0.11% 0.12% N/A N/A
Plan All-Cause Readmissions Ages 55-64 0.12% 0.11% N/A N/A
Plan All-Cause Readmissions Total 0.12% 0.12% N/A N/A
Plan All-Cause Readmissions Year Plan State Avg. Natl. Avg. 90th Pctl.
Plan All-Cause Readmissions Ages 18-44 2015 0.10% 0.12% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Plan All-Cause Readmissions Ages 45-54 2015 0.08% 0.11% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Plan All-Cause Readmissions Ages 55-64 2015 0.09% 0.11% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Plan All-Cause Readmissions Total 2015 0.09% 0.11% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A