Health Insurance in Virginia

CareFirst BlueChoice, Inc.

Company Information

  • Company Providing Plan:CareFirst, BlueCross BlueShield
  • Address:10455 Mill Run Circle
    Owings Mills, MD 21117
  • Telephone :410-581-3000
  • Website:www.carefirst.com
2017
Number of Enrollees: *84,851
PMPM: *$404
Number of Physicians: 10,155
NCQA Accreditation: Accredited

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


Coverage Areas

Counties

Arlington, Fairfax (lying east of route 123), Prince William (lying east of route 123)


Cities

Alexandria, Fairfax, Vienna

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

Administrative Data

2017 2016 2015 2014 2013
*Number of Enrollees 84,851 86,893 99,087 104,815 78,778
PMPM $404 $373 $328 $320 $334
*Medical Cost Ratio 82% 79% 77% 78% 80%
*Administrative Ratio 21% 24% 24% 23% 18%
*Profit/Loss Ratio -2% -2% 0% 0% 3%
Number of Physicians 10,155 9,566 9,475 9,015 8,475

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

Financial Data

2017 2016 2015 2014 2013
Premiums Earned $399,660,112 $402,239,015 $395,846,580 $375,372,382 $305,592,725
*Income ($27,820,788) ($46,101,706) ($9,917,801) $22,090,620 $69,214,184
*Net Worth $672,613,635 $697,523,016 $741,104,638 $757,050,329 $733,350,796

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

Performance

Access/Availability of Care
Info
Adult Access To Preventive/Ambulatory Health Services 2017 Plan State Avg Nat Avg 90th Pctl.
Adult Access (Age 20-44) To Preventive/Ambulatory Health Services 95.04% 92.73% 92.45% 95.43%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 96.97% 95.57% 95.61% 97.46%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 97.79% 97.82% 97.07% 98.47%
Adult Access To Preventive/Ambulatory Health Services Year Plan State Avg. Natl. Avg. 90th Pctl.
Adult Access (Age 20-44) To Preventive/Ambulatory Health Services 2016 94.63% 92.81% 92.73% 95.55%
2015 94.92% 92.25% 92.83% 95.45%
2014 94.29% 93.10% 92.91% 95.39%
2013 94.10% 93.27% 93.13% 95.56%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 2016 96.74% 95.78% 95.78% 97.61%
2015 96.94% 95.61% 95.90% 97.55%
2014 96.57% 96.03% 95.85% 97.54%
2013 96.36% 95.97% 95.93% 97.60%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 2016 97.52% 97.30% 97.19% 98.61%
2015 97.58% 96.84% 97.32% 96.73%
2014 96.88% 97.56% 97.50% 98.68%
2013 96.72% 97.45% 97.36% 98.63%
Info
Alcohol and Other Drug Dependence Treatment 2017 Plan State Avg Nat Avg 90th Pctl.
Initiation of Alcohol and Other Drug Dependence Treatment - Total 37.24% 36.14% 36.11% 42.01%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 42.07% 40.06% 39.91% 52.54%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 37.06% 36.00% 35.97% 41.96%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 15.46% 13.36% 12.65% 17.26%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 17.68% 14.40% 14.95% 23.85%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 15.38% 13.40% 12.55% 17.38%
Alcohol and Other Drug Dependence Treatment Year Plan State Avg. Natl. Avg. 90th Pctl.
Initiation of Alcohol and Other Drug Dependence Treatment - Total 2016 36.47% 35.69% 32.93% 40.24%
2015 34.93% 33.04% 33.42% 41.07%
2014 32.38% 32.51% 35.63% 44.19%
2013 31.54% 35.00% 39.01% 50.93%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2016 45.15% 40.15% 40.47% 51.96%
2015 38.64% 37.03% 39.62% 50.00%
2014 38.84% 37.09% 40.79% 52.00%
2013 36.29% 39.67% 41.13% 53.51%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2016 36.17% 35.55% 32.64% 40.33%
2015 34.78% 32.96% 33.20% 40.93%
2014 32.08% 32.16% 35.21% 43.92%
2013 31.30% 34.74% 38.83% 51.61%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 2016 15.57% 12.51% 11.46% 16.72%
2015 14.83% 11.61% 12.46% 19.23%
2014 11.28% 10.64% 13.66% 19.19%
2013 14.23% 12.12% 14.64% 21.16%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2016 24.76% 11.28% 15.68% 23.73%
2015 17.05% 12.06% 15.42% 22.12%
2014 16.07% 13.00% 17.24% 25.29%
2013 18.57% 18.05% 18.23% 27.05%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2016 15.25% 12.57% 11.32% 16.09%
2015 14.74% 11.57% 12.34% 18.67%
2014 11.06% 10.33% 13.45% 18.68%
2013 14.01% 11.84% 14.47% 21.31%
Info
Child Access to Primary Care Practitioners 2017 Plan State Avg Nat Avg 90th Pctl.
Child Access to Primary Care Practitioners Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Prenatal and Postpartum Care 2017 Plan State Avg Nat Avg 90th Pctl.
Timeliness of Prenatal Care 91.48% 87.01% N/A N/A
Prenatal and Postpartum Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Timeliness of Prenatal Care 2016 89.77% 86.52% N/A N/A
2015 86.15% 86.91% N/A N/A
2014 80.09% 85.85% N/A N/A
2013 88.40% 91.58% N/A N/A
Effectiveness of Care
Info
Asthma Medication Management 2017 Plan State Avg Nat Avg 90th Pctl.
Medication Management for People With Asthma at least 50% Compliance - Total 79.49% 76.58% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 5-11 69.40% 66.50% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 12-18 69.91% 68.06% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 19-50 79.38% 75.34% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 51-64 86.95% 84.54% N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Total 61.82% 54.32% 50.48% 57.69%
Medication Management for People With Asthma at least 75% Compliance - Ages 5-11 44.78% 42.35% 40.22% 52.99%
Medication Management for People With Asthma at least 75% Compliance - Ages 12-18 48.65% 41.76% 37.80% 47.11%
Medication Management for People With Asthma at least 75% Compliance - Ages 19-50 62.00% 52.86% 48.60% 57.87%
Medication Management for People With Asthma at least 75% Compliance - Ages 51-64 72.94% 64.50% 59.65% 67.58%
Asthma Medication Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Medication Management for People With Asthma at least 50% Compliance - Total 2016 74.49% 73.20% N/A N/A
2015 67.24% 71.52% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 5-11 2016 63.13% 67.58% N/A N/A
2015 57.30% 64.34% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 12-18 2016 63.75% 65.72% N/A N/A
2015 52.99% 60.17% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 19-50 2016 74.64% 71.77% N/A N/A
2015 67.85% 68.82% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 51-64 2016 82.54% 79.36% N/A N/A
2015 76.15% 78.55% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Total 2016 56.09% 51.17% 48.54% 56.96%
2015 44.77% 48.01% 46.20% 55.00%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Ages 5-11 2016 42.72% 39.03% 37.58% 48.84%
2015 36.56% 36.59% 37.85% 49.09%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Ages 12-18 2016 43.37% 35.03% 35.83% 46.97%
2015 31.16% 35.39% 34.97% 45.26%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Ages 19-50 2016 56.11% 50.18% 46.16% 55.80%
2015 44.74% 45.56% 43.39% 53.13%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Ages 51-64 2016 65.25% 59.39% 57.47% 65.75%
2015 53.86% 58.44% 55.49% 65.28%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Info
Asthma Medication Ratio 2017 Plan State Avg Nat Avg 90th Pctl.
Controller/Total Asthma Medication Ratio - Total 80.35% 84.01% 79.04% 85.85%
Controller/Total Asthma Medication Ratio - Ages 5-11 85.67% 86.06% 86.90% 93.55%
Controller/Total Asthma Medication Ratio - Ages 12-18 78.01% 84.80% 76.69% 85.94%
Controller/Total Asthma Medication Ratio - Ages 19-50 76.64% 78.94% 74.23% 81.70%
Controller/Total Asthma Medication Ratio - Ages 51-64 84.18% 89.17% 82.83% 89.28%
Asthma Medication Ratio Year Plan State Avg. Natl. Avg. 90th Pctl.
Controller/Total Asthma Medication Ratio - Total 2016 80.23% 80.60% 78.29% 85.46%
2015 81.53% 81.09% 77.99% 83.76%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Controller/Total Asthma Medication Ratio - Ages 5-11 2016 84.47% 91.67% 86.40% 93.97%
2015 86.87% 88.49% 86.99% 92.47%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Controller/Total Asthma Medication Ratio - Ages 12-18 2016 74.74% 81.12% 78.30% 86.34%
2015 77.82% 78.19% 77.09% 84.67%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Controller/Total Asthma Medication Ratio - Ages 19-50 2016 77.64% 75.24% 73.51% 81.08%
2015 78.52% 75.16% 72.38% 80.79%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Controller/Total Asthma Medication Ratio - Ages 51-64 2016 83.35% 83.27% 81.70% 88.64%
2015 84.28% 85.39% 81.87% 88.89%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Info
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication 2017 Plan State Avg Nat Avg 90th Pctl.
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Initiation 42.56% 41.27% 41.13% 50.83%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 48.75% 55.09% 47.07% 58.44%
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication Year Plan State Avg. Natl. Avg. 90th Pctl.
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Initiation 2016 36.19% 41.91% 38.93% 48.61%
2015 34.94% 41.43% 38.13% 50.00%
2014 34.37% 39.00% 38.01% 46.81%
2013 34.23% 35.14% 40.10% 51.06%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 2016 38.18% 46.92% 45.82% 56.86%
2015 38.11% 49.06% 46.18% 58.06%
2014 39.34% 46.49% 45.70% 57.75%
2013 40.37% 41.32% 46.66% 58.62%
Info
Cardiovascular Disease Management 2017 Plan State Avg Nat Avg 90th Pctl.
Controlling High Blood Pressure 50.85% 56.61% 59.90% 74.82%
Persistence of Beta-Blockers 86.02% 85.80% 85.18% 93.41%
Cardiovascular Disease Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Controlling High Blood Pressure 2016 56.06% 56.91% 60.31% 74.43%
2015 37.97% 58.35% 58.69% 73.89%
2014 N/A 59.30% 62.63% 75.63%
2013 51.29% 60.92% 63.30% 74.65%
Persistence of Beta-Blockers 2016 88.59% 90.70% 83.61% 90.83%
2015 86.89% 88.70% 84.68% 91.00%
2014 83.62% 84.03% 83.50% 91.43%
2013 78.79% 83.43% 83.39% 91.72%
Info
Common Childhood Illnesses 2017 Plan State Avg Nat Avg 90th Pctl.
Appropriate Testing for Children With Pharyngitis 93.25% 92.01% 87.45% 94.64%
Common Childhood Illnesses Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Testing for Children With Pharyngitis 2016 93.30% 91.84% 84.50% 93.75%
2015 91.85% 91.35% 83.12% 93.11%
2014 91.40% 90.30% 83.29% 91.40%
2013 90.95% 89.15% 81.45% 91.30%
Info
Diabetes Care and Management 2017 Plan State Avg Nat Avg 90th Pctl.
Diabetes Care and Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Drug Therapy in Rheumatoid Arthritis 2017 Plan State Avg Nat Avg 90th Pctl.
Drug Therapy in Rheumatoid Arthritis Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Immunizations 2017 Plan State Avg Nat Avg 90th Pctl.
Immunizations for Adolescents - Combination 85.89% 82.98% N/A N/A
Immunizations Year Plan State Avg. Natl. Avg. 90th Pctl.
Immunizations for Adolescents - Combination 2016 87.15% 79.09% N/A N/A
2015 74.07% 66.99% N/A N/A
2014 68.98% 66.20% N/A N/A
2013 62.96% 51.54% N/A N/A
Info
Mental Health: Care and Follow-up 2017 Plan State Avg Nat Avg 90th Pctl.
Mental Health: Care and Follow-up Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Persistent Medications 2017 Plan State Avg Nat Avg 90th Pctl.
Persistent Medications Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Pharmacotherapy of COPD Exacerbation 2017 Plan State Avg Nat Avg 90th Pctl.
Pharmacotherapy of COPD Exacerbation Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Preventive Care 2017 Plan State Avg Nat Avg 90th Pctl.
Breast Cancer Screening 72.56% 71.85% 72.81% 80.91%
Chlamydia Screening in Women-all Age groups 52.90% 51.46% 50.16% 66.08%
Preventive Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Breast Cancer Screening 2016 72.12% 71.80% 72.90% 80.63%
2015 71.89% 72.07% 73.08% 81.53%
2014 71.60% 72.22% 73.52% 81.91%
2013 71.47% 72.82% 73.71% 80.78%
Chlamydia Screening in Women-all Age groups 2016 51.52% 49.79% 48.98% 63.50%
2015 49.58% 47.89% 52.32% 64.06%
2014 50.98% 48.07% 51.65% 63.48%
2013 50.89% 47.46% 46.20% 59.63%
Info
Spirometry Testing 2017 Plan State Avg Nat Avg 90th Pctl.
Spirometry Testing Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Weight Assessment and Counseling 2017 Plan State Avg Nat Avg 90th Pctl.
Counseling for Physical Activity for Children/Adolescents - Total 58.15% 59.44% N/A N/A
Weight Assessment and Counseling Year Plan State Avg. Natl. Avg. 90th Pctl.
Counseling for Physical Activity for Children/Adolescents - Total 2016 58.02% 54.14% N/A N/A
2015 44.39% 54.38% N/A N/A
2014 62.27% 58.06% N/A N/A
2013 53.94% 52.85% N/A N/A
Health Plan Stability/Descriptive
Info
Administrative Data 2017 Plan State Avg Nat Avg 90th Pctl.
Administrative Ratio 0.21 0.12 86.39 93.13
Medical Cost Ratio 0.82 0.83 93.13 96.59
Number of Enrollees 84,851 133,992 92 97
Number of Physicians 10,155 81,926 87 95
Premium Per Member Per Month $404 $370 N/A N/A
Profit/Loss Ratio -0.02 0.05 79.44 89.14
Administrative Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Administrative Ratio 2016 0.24 0.15 N/A N/A
2015 0.24 0.14 N/A N/A
2014 0.23 0.14 N/A N/A
2013 0.18 0.14 N/A N/A
Medical Cost Ratio 2016 0.79 0.83 N/A N/A
2015 0.77 0.82 N/A N/A
2014 0.78 0.81 N/A N/A
2013 0.80 0.83 N/A N/A
Number of Enrollees 2016 86,893 136,796 N/A N/A
2015 99,087 124,097 N/A N/A
2014 104,815 115,428 N/A N/A
2013 78,778 98,253 N/A N/A
Number of Physicians 2016 9,566 73,426 N/A N/A
2015 9,475 90,027 N/A N/A
2014 9,015 63,157 N/A N/A
2013 8,475 64,207 N/A N/A
Premium Per Member Per Month 2016 $373 $370 N/A N/A
2015 $328 $375 N/A N/A
2014 $320 $412 N/A N/A
2013 $334 $544 N/A N/A
Profit/Loss Ratio 2016 -0.02 0.03 N/A N/A
2015 0.00 0.04 N/A N/A
2014 0.00 0.06 N/A N/A
2013 0.03 0.03 N/A N/A
Info
Board Certification Rates for Providers 2017 Plan State Avg Nat Avg 90th Pctl.
Board Certification for Geriatricians N/A 71.38% N/A N/A
Board Certification for Pediatricians N/A 85.50% N/A N/A
Board Certification Rate for Family Medicine Physicians N/A 81.38% N/A N/A
Board Certification Rate for Internal Medicine Physicians N/A 81.00% N/A N/A
Board Certification Rate for OB/GYN Providers N/A 83.00% N/A N/A
Board Certification Rate for Other Specialists N/A 81.88% N/A N/A
Board Certification Rates for Providers Year Plan State Avg. Natl. Avg. 90th Pctl.
Board Certification for Geriatricians 2016 73.60% 73.44% N/A N/A
2015 74.84% 71.06% N/A N/A
2014 90.00% 74.73% 64.82% 87.50%
2013 78.29% 71.19% 63.29% 83.33%
Board Certification for Pediatricians 2016 84.37% 87.02% N/A N/A
2015 85.39% 88.14% N/A N/A
2014 89.93% 88.13% 83.89% 91.52%
2013 84.01% 86.01% 81.01% 90.29%
Board Certification Rate for Family Medicine Physicians 2016 80.75% 80.32% N/A N/A
2015 87.60% 82.53% N/A N/A
2014 89.87% 82.93% 77.41% 89.90%
2013 80.49% 81.36% 76.60% 88.80%
Board Certification Rate for Internal Medicine Physicians 2016 80.84% 81.15% N/A N/A
2015 82.78% 82.59% N/A N/A
2014 90.02% 83.98% 79.07% 88.73%
2013 84.17% 80.80% 78.18% 87.44%
Board Certification Rate for OB/GYN Providers 2016 75.29% 83.36% N/A N/A
2015 74.55% 83.51% N/A N/A
2014 79.66% 83.71% 79.30% 88.80%
2013 66.44% 80.44% 76.89% 87.80%
Board Certification Rate for Other Specialists 2016 80.34% 83.25% N/A N/A
2015 73.09% 82.88% N/A N/A
2014 85.23% 84.44% 78.09% 89.67%
2013 68.84% 79.95% 74.88% 88.36%
Info
Financial Data 2017 Plan State Avg Nat Avg 90th Pctl.
Financial Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Years in Business 2017 Plan State Avg Nat Avg 90th Pctl.
Years in Business 31 35 N/A N/A
Years in Business Year Plan State Avg. Natl. Avg. 90th Pctl.
Years in Business 2016 30 34 N/A N/A
2015 29 33 N/A N/A
2014 28 32 N/A N/A
2013 27 31 N/A N/A
Member Satisfaction
Info
Member Satisfaction 2017 Plan State Avg Nat Avg 90th Pctl.
Getting Needed Care 89.05% 88.46% N/A N/A
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 83.96% 94.34% 95.10% 96.91%
Member Satisfaction Year Plan State Avg. Natl. Avg. 90th Pctl.
Getting Needed Care 2016 88.53% 87.23% N/A N/A
2015 86.42% 87.33% N/A N/A
2014 87.40% 88.88% N/A N/A
2013 84.33% 87.29% N/A N/A
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 2016 88.15% 94.88% 95.39% 97.21%
2015 82.83% 94.63% 95.20% 97.10%
2014 85.75% 94.87% 95.26% 97.16%
2013 82.48% 93.94% 94.94% 96.97%
Overuse/Appropriateness
Info
Antipsychotics 2017 Plan State Avg Nat Avg 90th Pctl.
Metabolic Monitoring for Children and Adolescents on Antipsychotics - Ages 1-17 40.15% 50.55% 36.07% 48.57%
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 49.80% 58.14% 54.52% 68.67%
Use of Multiple Concurrent Antipsychotics in Children and Adolescents - Ages 1-17 1.43% 2.39% N/A N/A
Antipsychotics Year Plan State Avg. Natl. Avg. 90th Pctl.
Metabolic Monitoring for Children and Adolescents on Antipsychotics - Ages 1-17 2016 40.16% 34.87% 35.80% 45.93%
2015 41.76% 37.02% 33.94% 45.45%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 2016 56.85% 61.93% 58.30% 75.00%
2015 55.02% 61.38% 54.40% 70.49%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Use of Multiple Concurrent Antipsychotics in Children and Adolescents - Ages 1-17 2016 2.21% 2.06% N/A N/A
2015 0.94% 1.70% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
Info
Cervical Cancer Screening in Adolescent Females 2017 Plan State Avg Nat Avg 90th Pctl.
Cervical Cancer Screening in Adolescent Females Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Lower Back Pain 2017 Plan State Avg Nat Avg 90th Pctl.
Lower Back Pain Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Respiratory 2017 Plan State Avg Nat Avg 90th Pctl.
Respiratory Year Plan State Avg. Natl. Avg. 90th Pctl.
Utilization
Info
Antibiotic Utilization 2017 Plan State Avg Nat Avg 90th Pctl.
Average number of antibiotic prescriptions per member per year - Total 0.82 0.77 0.76 0.90
Average number of antibiotic prescriptions per member per year - Ages 0-9 0.93 0.87 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 0.66 0.57 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 0.72 0.67 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 0.79 0.75 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 0.95 0.88 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 1.14 1.00 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 1.25 1.12 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 1.56 1.12 N/A N/A
Days suppplied per antibiotic prescription - Total 10.21 10.02 9.88 10.83
Days suppplied per antibiotic prescription - Ages 0-9 10.00 10.05 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 13.01 12.69 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 10.07 9.84 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 9.76 9.59 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 10.00 9.86 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 10.31 9.85 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 10.43 10.60 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 10.54 9.87 N/A N/A
Prescriptions of concern - Total 0.38 0.35 0.36 0.45
Prescriptions of concern - Ages 0-9 0.37 0.35 N/A N/A
Prescriptions of concern - Ages 10-17 0.26 0.22 N/A N/A
Prescriptions of concern - Ages 18-34 0.31 0.28 N/A N/A
Prescriptions of concern - Ages 35-49 0.40 0.37 N/A N/A
Prescriptions of concern - Ages 50-64 0.49 0.44 N/A N/A
Prescriptions of concern - Ages 65-74 0.56 0.50 N/A N/A
Prescriptions of concern - Ages 75-85 0.61 0.54 N/A N/A
Prescriptions of concern - Ages 85 plus 0.72 0.48 N/A N/A
Antibiotic Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Average number of antibiotic prescriptions per member per year - Total 2016 0.82 0.79 0.76 0.90
2015 0.84 0.80 0.81 0.97
2014 0.47 0.75 0.79 0.96
2013 0.77 0.83 0.81 0.98
Average number of antibiotic prescriptions per member per year - Ages 0-9 2016 0.96 0.97 N/A N/A
2015 0.90 0.94 N/A N/A
2014 0.50 0.84 N/A N/A
2013 0.80 0.93 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 2016 0.66 0.60 N/A N/A
2015 0.65 0.60 N/A N/A
2014 0.33 0.56 N/A N/A
2013 0.57 0.62 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 2016 0.73 0.69 N/A N/A
2015 0.75 0.70 N/A N/A
2014 0.45 0.67 N/A N/A
2013 0.70 0.74 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 2016 0.80 0.77 N/A N/A
2015 0.82 0.80 N/A N/A
2014 0.48 0.76 N/A N/A
2013 0.77 0.83 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 2016 0.94 0.87 N/A N/A
2015 0.97 0.90 N/A N/A
2014 0.52 0.84 N/A N/A
2013 0.90 0.92 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 2016 1.09 0.99 N/A N/A
2015 1.19 1.07 N/A N/A
2014 0.55 0.96 N/A N/A
2013 1.09 1.05 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 2016 1.19 1.23 N/A N/A
2015 1.26 1.08 N/A N/A
2014 0.53 1.09 N/A N/A
2013 1.22 1.11 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 2016 1.37 0.73 N/A N/A
2015 1.21 1.67 N/A N/A
2014 1.47 1.37 N/A N/A
2013 0.92 1.67 N/A N/A
Days suppplied per antibiotic prescription - Total 2016 10.18 10.09 9.88 10.83
2015 10.36 10.26 10.12 11.03
2014 10.26 10.44 10.32 11.18
2013 10.46 10.44 10.45 11.35
Days suppplied per antibiotic prescription - Ages 0-9 2016 9.85 10.04 N/A N/A
2015 9.90 9.99 N/A N/A
2014 9.98 10.01 N/A N/A
2013 9.92 10.00 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 2016 12.93 12.80 N/A N/A
2015 13.44 13.32 N/A N/A
2014 13.28 13.65 N/A N/A
2013 13.44 13.72 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 2016 10.08 10.07 N/A N/A
2015 10.39 10.33 N/A N/A
2014 10.28 10.65 N/A N/A
2013 10.59 10.61 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 2016 9.70 9.62 N/A N/A
2015 9.89 9.83 N/A N/A
2014 9.88 9.95 N/A N/A
2013 10.00 9.93 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 2016 10.03 9.82 N/A N/A
2015 10.13 9.90 N/A N/A
2014 9.91 10.04 N/A N/A
2013 10.22 10.07 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 2016 10.47 9.93 N/A N/A
2015 10.17 10.18 N/A N/A
2014 10.53 10.43 N/A N/A
2013 10.28 10.23 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 2016 10.60 10.59 N/A N/A
2015 10.63 9.93 N/A N/A
2014 10.93 10.54 N/A N/A
2013 10.59 10.32 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 2016 10.57 9.43 N/A N/A
2015 10.86 9.54 N/A N/A
2014 11.64 10.65 N/A N/A
2013 8.36 8.73 N/A N/A
Prescriptions of concern - Total 2016 0.40 0.38 0.36 0.45
2015 0.41 0.40 0.41 0.52
2014 0.23 0.37 0.39 0.49
2013 0.38 0.42 0.41 0.52
Prescriptions of concern - Ages 0-9 2016 0.41 0.43 N/A N/A
2015 0.39 0.41 N/A N/A
2014 0.21 0.38 N/A N/A
2013 0.37 0.44 N/A N/A
Prescriptions of concern - Ages 10-17 2016 0.28 0.24 N/A N/A
2015 0.26 0.25 N/A N/A
2014 0.13 0.22 N/A N/A
2013 0.24 0.25 N/A N/A
Prescriptions of concern - Ages 18-34 2016 0.34 0.31 N/A N/A
2015 0.35 0.32 N/A N/A
2014 0.21 0.30 N/A N/A
2013 0.32 0.34 N/A N/A
Prescriptions of concern - Ages 35-49 2016 0.42 0.40 N/A N/A
2015 0.44 0.42 N/A N/A
2014 0.25 0.41 N/A N/A
2013 0.41 0.45 N/A N/A
Prescriptions of concern - Ages 50-64 2016 0.50 0.46 N/A N/A
2015 0.53 0.49 N/A N/A
2014 0.29 0.45 N/A N/A
2013 0.50 0.50 N/A N/A
Prescriptions of concern - Ages 65-74 2016 0.58 0.51 N/A N/A
2015 0.63 0.57 N/A N/A
2014 0.29 0.51 N/A N/A
2013 0.59 0.56 N/A N/A
Prescriptions of concern - Ages 75-85 2016 0.62 0.65 N/A N/A
2015 0.65 0.59 N/A N/A
2014 0.29 0.51 N/A N/A
2013 0.66 0.57 N/A N/A
Prescriptions of concern - Ages 85 plus 2016 0.64 0.34 N/A N/A
2015 0.59 0.82 N/A N/A
2014 0.74 0.55 N/A N/A
2013 0.62 1.15 N/A N/A
Info
Child and Adolescent Well Child Visits 2017 Plan State Avg Nat Avg 90th Pctl.
Well Child Visits in the First 15 Months of Life 90.85% 85.55% N/A N/A
Well Child Visits in the 3rd - 6th Years 85.71% 83.18% 79.11% 91.03%
Adolescent Well-Care Visits 58.27% 53.24% 50.46% 70.44%
Child and Adolescent Well Child Visits Year Plan State Avg. Natl. Avg. 90th Pctl.
Well Child Visits in the First 15 Months of Life 2016 85.85% 82.77% N/A N/A
2015 85.47% 83.06% N/A N/A
2014 81.55% 81.95% N/A N/A
2013 83.33% 82.08% N/A N/A
Well Child Visits in the 3rd - 6th Years 2016 84.99% 82.50% 78.30% 90.11%
2015 84.30% 80.48% 77.75% 89.74%
2014 82.11% 80.03% 77.37% 88.75%
2013 80.28% 78.43% 75.89% 88.25%
Adolescent Well-Care Visits 2016 57.12% 50.35% 49.68% 67.70%
2015 55.42% 49.34% 48.26% 64.50%
2014 51.99% 48.09% 47.51% 64.76%
2013 50.18% 46.84% 46.27% 63.82%
Info
Mental Health Utilization 2017 Plan State Avg Nat Avg 90th Pctl.
Mental Health Utilization - ED - Ages 0-12 0.03% 0.01% N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 8.90% 0.00% N/A N/A
Mental Health Utilization - Outpatient - Ages 65 plus 4.08% 6.30% N/A N/A
Mental Health Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Mental Health Utilization - ED - Ages 0-12 2016 5.34% 5.26% N/A N/A
2015 4.94% 5.07% N/A N/A
2014 7.05% 5.47% N/A N/A
2013 4.43% 5.15% N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 2016 7.75% 14.81% N/A N/A
2015 7.76% 10.33% N/A N/A
2014 14.95% 10.70% N/A N/A
2013 7.62% 10.29% N/A N/A
Mental Health Utilization - Outpatient - Ages 65 plus 2016 N/A 6.56% N/A N/A
2015 N/A 6.62% N/A N/A
2014 N/A 7.64% N/A N/A
2013 N/A 6.80% N/A N/A
Info
Plan All-Cause Readmissions 2017 Plan State Avg Nat Avg 90th Pctl.
Plan All-Cause Readmissions Year Plan State Avg. Natl. Avg. 90th Pctl.