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Optimum Choice, Inc.

Company Information

  • Company Providing Plan:United Health Group
  • Address:9700 Health Care Lane, MN017-E900
    Minnetonka, MN 55343
  • Telephone :952-979-7982
  • Website:www.mamsi.com
2016
Number of Enrollees: *10,191
PMPM: *$364
Number of Physicians: *48,611
NCQA Accreditation: Accredited

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


Coverage Areas

Counties

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


Cities

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

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

Administrative Data

2016 2015 2014 2013 2012
*Number of Enrollees 10,191 8,580 8,745 9,963 16,732
PMPM $364 $379 $408 $407 $380
*Medical Cost Ratio 69% 71% 68% 75% 77%
*Administrative Ratio 18% 16% 14% 10% 10%
*Profit/Loss Ratio 14% 13% 19% 16% 14%
*Number of Physicians 48,611 45,388 38,011 36,157 35,400

*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 $38,883,614 $39,486,608 $43,251,038 $48,713,922 $77,735,320
*Income $15,432,754 $15,885,786 $25,624,397 $24,543,390 $22,071,135
*Net Worth $19,902,986 $22,759,287 $54,105,621 $41,048,229 $26,465,803

*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 92.06% 92.81% 92.73% 95.55%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 94.46% 95.78% 95.78% 97.61%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 96.97% 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 92.51% 92.25% 92.83% 95.45%
2014 91.94% 93.10% 92.91% 95.39%
2013 92.50% 93.27% 93.13% 95.56%
2012 92.06% 93.53% 93.40% 95.86%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 2015 95.10% 95.61% 95.90% 97.55%
2014 94.81% 96.03% 95.85% 97.54%
2013 94.74% 95.97% 95.93% 97.60%
2012 94.68% 95.88% 95.84% 97.42%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 2015 97.59% 96.84% 97.32% 96.73%
2014 96.88% 97.56% 97.50% 98.68%
2013 97.60% 97.45% 97.36% 98.63%
2012 96.81% 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 32.75% 35.69% 32.93% 40.24%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 37.50% 40.15% 40.47% 51.96%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 32.65% 35.55% 32.64% 40.33%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 11.84% 12.51% 11.46% 16.72%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 12.50% 11.28% 15.68% 23.73%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 11.83% 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 35.31% 33.04% 33.42% 41.07%
2014 29.54% 32.51% 35.63% 44.19%
2013 34.50% 35.00% 39.01% 50.93%
2012 38.85% 37.48% 40.13% 51.23%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2015 N/A 37.03% 39.62% 50.00%
2014 N/A 37.09% 40.79% 52.00%
2013 N/A 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 35.36% 32.96% 33.20% 40.93%
2014 28.95% 32.16% 35.21% 43.92%
2013 34.42% 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 13.27% 11.61% 12.46% 19.23%
2014 12.66% 10.64% 13.66% 19.19%
2013 13.39% 12.12% 14.64% 21.16%
2012 12.45% 11.95% 14.33% 20.35%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2015 N/A 12.06% 15.42% 22.12%
2014 N/A 13.00% 17.24% 25.29%
2013 N/A 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 13.39% 11.57% 12.34% 18.67%
2014 12.57% 10.33% 13.45% 18.68%
2013 13.65% 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 98.81% 98.34% 98.09% 99.72%
25 month to 6 year old Child Access to Primary Care Practitioners 93.96% 94.33% 92.60% 96.46%
7-11 year old Child Access to Primary Care Practitioners 95.47% 94.38% 93.25% 98.25%
12-19 year old Child Access to Primary Care Practitioners 91.60% 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 98.85% 98.78% 98.03% 99.48%
2014 97.76% 98.49% 97.87% 99.62%
2013 96.42% 97.92% 97.99% 99.48%
2012 96.49% 97.87% 97.94% 99.58%
25 month to 6 year old Child Access to Primary Care Practitioners 2015 93.97% 94.16% 92.67% 96.64%
2014 94.25% 93.85% 92.33% 96.52%
2013 93.03% 93.53% 92.38% 96.50%
2012 93.55% 93.16% 92.31% 96.13%
7-11 year old Child Access to Primary Care Practitioners 2015 94.60% 94.23% 93.23% 97.92%
2014 94.11% 93.78% 93.02% 97.87%
2013 93.15% 93.78% 93.11% 97.89%
2012 94.74% 93.54% 92.93% 97.72%
12-19 year old Child Access to Primary Care Practitioners 2015 92.00% 91.30% 90.66% 96.19%
2014 91.97% 90.84% 90.44% 96.28%
2013 91.58% 90.58% 90.31% 96.28%
2012 90.53% 90.02% 90.01% 95.97%
Info
Prenatal and Postpartum Care 2016 Plan State Avg Nat Avg 90th Pctl.
Postpartum Care 66.92% 74.50% 73.95% 88.85%
Timeliness of Prenatal Care 88.81% 86.71% 85.57% 96.28%
Prenatal and Postpartum Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Postpartum Care 2015 69.42% 73.91% 73.72% 87.50%
2014 73.71% 77.29% 77.64% 88.65%
2013 72.26% 81.38% 91.35% 97.14%
2012 72.26% 81.20% 80.22% 90.25%
Timeliness of Prenatal Care 2015 83.01% 86.80% 84.28% 94.56%
2014 84.00% 86.83% 88.00% 96.23%
2013 87.50% 91.63% 81.00% 90.48%
2012 87.50% 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 70.41% 73.20% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 5-11 60.00% 67.58% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 12-18 63.64% 65.72% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 19-50 67.53% 71.77% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 51-64 79.55% 79.36% N/A N/A
Medication Management for People With Asthma at least 50% Compliance - Ages 65-85 100.00% 82.66% N/A N/A
Medication Management for People With Asthma at least 75% Compliance - Total 52.66% 51.17% 48.54% 56.96%
Medication Management for People With Asthma at least 75% Compliance - Ages 5-11 30.00% 39.03% 37.58% 48.84%
Medication Management for People With Asthma at least 75% Compliance - Ages 12-18 54.55% 35.03% 35.83% 46.97%
Medication Management for People With Asthma at least 75% Compliance - Ages 19-50 48.05% 50.18% 46.16% 55.80%
Medication Management for People With Asthma at least 75% Compliance - Ages 51-64 68.18% 59.39% 57.47% 65.75%
Medication Management for People With Asthma at least 75% Compliance - Ages 65-85 66.67% 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 70.63% 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 N/A 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 N/A 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 69.01% 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 78.85% 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 N/A 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 46.88% 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 N/A 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 N/A 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 40.85% 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 63.46% 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 N/A 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 76.34% 80.60% 78.29% 85.46%
Controller/Total Asthma Medication Ratio - Ages 5-11 100.00% 91.67% 86.40% 93.97%
Controller/Total Asthma Medication Ratio - Ages 12-18 78.26% 81.12% 78.30% 86.34%
Controller/Total Asthma Medication Ratio - Ages 19-50 65.91% 75.24% 73.51% 81.08%
Controller/Total Asthma Medication Ratio - Ages 51-64 81.63% 83.27% 81.70% 88.64%
Controller/Total Asthma Medication Ratio - Ages 65-85 100.00% 88.55% 84.66% 91.94%
Asthma Medication Ratio Year Plan State Avg. Natl. Avg. 90th Pctl.
Controller/Total Asthma Medication Ratio - Total 2015 75.68% 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 N/A 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 N/A 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 64.77% 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 84.21% 85.39% 81.87% 88.89%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Controller/Total Asthma Medication Ratio - Ages 65-85 2015 N/A 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 43.10% 41.91% 38.93% 48.61%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 50.00% 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 41.94% 41.43% 38.13% 50.00%
2014 35.38% 39.00% 38.01% 46.81%
2013 34.74% 35.14% 40.10% 51.06%
2012 37.96% 36.75% 38.72% 48.58%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 2015 N/A 49.06% 46.18% 58.06%
2014 N/A 46.49% 45.70% 57.75%
2013 N/A 41.32% 46.66% 58.62%
2012 N/A 38.87% 45.07% 54.05%
Info
Cardiovascular Disease Management 2016 Plan State Avg Nat Avg 90th Pctl.
Controlling High Blood Pressure 41.94% 56.91% 60.31% 74.43%
Persistence of Beta-Blockers 89.29% 90.70% 83.61% 90.83%
Cardiovascular Disease Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Controlling High Blood Pressure 2015 47.68% 58.35% 58.69% 73.89%
2014 46.74% 59.30% 62.63% 75.63%
2013 53.40% 60.92% 63.30% 74.65%
2012 53.40% 59.78% 61.63% 72.94%
Persistence of Beta-Blockers 2015 88.89% 88.70% 84.68% 91.00%
2014 84.62% 84.03% 83.50% 91.43%
2013 80.00% 83.43% 83.39% 91.72%
2012 N/A 82.94% 83.03% 92.98%
Info
Common Childhood Illnesses 2016 Plan State Avg Nat Avg 90th Pctl.
Appropriate Testing for Children With Pharyngitis 89.60% 90.38% 84.50% 93.75%
Common Childhood Illnesses Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Testing for Children With Pharyngitis 2015 89.57% 90.13% 83.12% 93.11%
2014 89.98% 88.64% 83.29% 91.40%
2013 88.94% 87.54% 81.45% 91.30%
2012 88.90% 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) 55.09% 60.88% 61.06% 78.35%
Comprehensive Diabetes Care-HbA1c control (<8.0%) 51.39% 58.36% 56.62% 66.39%
Comprehensive Diabetes Care-Rate of Eye Exams 44.44% 58.46% 52.96% 72.04%
Comprehensive Diabetes Care-Rate of Medical Attention for Diabetic Nephropathy 89.12% 90.56% 90.03% 92.71%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 37.04% 30.47% 32.15% 20.98%
Comprehensive Diabetes Care-Testing for HbA1c 90.05% 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 54.86% 61.03% 58.80% 75.68%
2014 N/A 63.33% 63.85% 76.00%
2013 N/A 42.35% 64.44% 76.22%
2012 N/A N/A N/A N/A
Comprehensive Diabetes Care-HbA1c control (<8.0%) 2015 57.87% 57.59% 55.81% 66.67%
2014 N/A 59.12% 58.53% 68.61%
2013 N/A 55.47% 58.87% 69.16%
2012 N/A N/A N/A N/A
Comprehensive Diabetes Care-Rate of Eye Exams 2015 44.68% 57.15% 52.47% 70.44%
2014 45.83% 57.54% 54.98% 71.93%
2013 45.83% 56.05% 54.65% 71.53%
2012 45.24% 57.24% 55.70% 74.09%
Comprehensive Diabetes Care-Rate of Medical Attention for Diabetic Nephropathy 2015 88.66% 91.11% 90.10% 93.40%
2014 81.94% 86.26% 84.72% 89.60%
2013 81.94% 84.97% 83.75% 89.19%
2012 84.69% 85.74% 83.70% 89.54%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 2015 30.56% 30.83% 33.90% 20.20%
2014 33.10% 31.37% 30.48% 19.33%
2013 33.10% 34.40% 30.71% 19.46%
2012 26.22% 27.02% 28.85% 18.18%
Comprehensive Diabetes Care-Testing for HbA1c 2015 91.20% 91.13% 90.54% 94.69%
2014 85.19% 89.01% 90.34% 94.86%
2013 85.19% 88.32% 89.62% 94.23%
2012 90.72% 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 89.77% 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 85.07% 89.72% 87.84% 92.86%
2014 81.01% 88.05% 87.86% 93.59%
2013 80.81% 88.24% 87.95% 94.49%
2012 87.04% 88.39% 87.47% 93.70%
Info
Immunizations 2016 Plan State Avg Nat Avg 90th Pctl.
Childhood Immunization for Multiple diseases including Chicken Pox 84.42% 84.29% 78.93% 89.03%
Childhood Immunization for Multiple diseases including pneumovax 83.42% 82.08% 77.04% 87.50%
Flu Vaccinations for Adults Ages 18–64 43.24% 47.13% N/A N/A
Immunizations for Adolescents - Combination 81.34% 77.95% 77.63% 88.81%
Immunizations for Adolescents - Meningococcal 86.19% 79.65% 79.20% 90.02%
Immunizations for Adolescents - Tdap 87.31% 91.29% 87.77% 95.38%
Immunizations Year Plan State Avg. Natl. Avg. 90th Pctl.
Childhood Immunization for Multiple diseases including Chicken Pox 2015 75.80% 81.56% 78.59% 88.08%
2014 58.69% 80.25% 80.18% 88.07%
2013 77.27% 80.24% 78.39% 87.14%
2012 79.62% 82.72% 79.83% 88.00%
Childhood Immunization for Multiple diseases including pneumovax 2015 74.02% 79.45% 76.49% 87.10%
2014 56.76% 78.11% 78.13% 86.26%
2013 N/A 78.73% 76.21% 85.40%
2012 74.26% 78.74% 77.05% 86.00%
Flu Vaccinations for Adults Ages 18–64 2015 0.42% 0.50% 47.85% 58.01%
2014 0.48% 0.52% 49.45% 59.73%
2013 0.41% 0.49% 49.06% 59.59%
2012 N/A N/A N/A N/A
Immunizations for Adolescents - Combination 2015 69.01% 69.50% 74.25% 88.47%
2014 69.07% 67.04% 70.73% 87.34%
2013 N/A 60.89% 66.54% 84.18%
2012 N/A N/A N/A N/A
Immunizations for Adolescents - Meningococcal 2015 0.74% 0.72% 76.12% 89.29%
2014 0.71% 0.69% 72.59% 88.27%
2013 N/A 0.64% 68.70% 85.25%
2012 N/A N/A N/A N/A
Immunizations for Adolescents - Tdap 2015 0.76% 0.85% 86.03% 94.39%
2014 0.81% 0.85% 84.49% 95.15%
2013 N/A 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 70.65% 70.29% 66.56% 74.77%
Antidepressant Medication Management-Continuation Phase Treatment 54.55% 53.51% 50.69% 58.60%
Follow-up After Hospitalization For Mental Illness within 7 days after hospital discharge 50.65% 52.99% 52.06% 67.31%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 74.03% 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 69.36% 67.61% 65.82% 74.06%
2014 70.09% 68.52% 65.88% 75.35%
2013 62.62% 65.67% 63.60% 73.26%
2012 63.97% 69.62% 69.03% 77.57%
Antidepressant Medication Management-Continuation Phase Treatment 2015 49.58% 49.81% 50.15% 57.56%
2014 50.15% 50.31% 49.83% 59.11%
2013 44.39% 48.37% 46.58% 57.12%
2012 49.16% 52.80% 53.51% 61.69%
Follow-up After Hospitalization For Mental Illness within 7 days after hospital discharge 2015 53.19% 47.66% 50.57% 67.57%
2014 45.60% 51.82% 52.21% 70.33%
2013 54.46% 55.07% 53.70% 69.16%
2012 63.16% 61.69% 57.57% 73.88%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 2015 69.15% 71.58% 69.72% 83.80%
2014 75.20% 72.52% 70.72% 85.71%
2013 69.64% 73.03% 72.56% 84.19%
2012 76.69% 77.74% 75.42% 86.45%
Info
Persistent Medications 2016 Plan State Avg Nat Avg 90th Pctl.
Annual Monitoring for Patients on Persistent Medications 83.46% 84.90% 83.34% 87.04%
Persistent Medications Year Plan State Avg. Natl. Avg. 90th Pctl.
Annual Monitoring for Patients on Persistent Medications 2015 82.72% 83.34% 82.94% 86.72%
2014 83.94% 83.28% 82.33% 86.25%
2013 82.87% 83.44% 82.32% 86.12%
2012 83.09% 83.30% 82.11% 86.32%
Info
Pharmacotherapy of COPD Exacerbation 2016 Plan State Avg Nat Avg 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 85.00% 84.12% 76.30% 85.98%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 80.00% 79.54% 70.70% 81.82%
Pharmacotherapy of COPD Exacerbation Year Plan State Avg. Natl. Avg. 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 2015 N/A 78.48% 79.09% 87.10%
2014 76.92% 80.03% 80.14% 86.90%
2013 66.67% 78.88% 79.47% 87.58%
2012 87.50% 80.97% 80.45% 87.50%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 2015 N/A 72.98% 75.30% 84.56%
2014 64.10% 75.53% 75.28% 83.54%
2013 69.23% 73.76% 75.40% 83.33%
2012 59.38% 73.69% 73.65% 81.32%
Info
Preventive Care 2016 Plan State Avg Nat Avg 90th Pctl.
Breast Cancer Screening 63.90% 71.80% 72.90% 80.63%
Chlamydia Screening in Women-all Age groups 45.50% 49.79% 48.98% 63.50%
Colorectal Cancer Screening 53.24% 65.83% 61.71% 74.09%
Preventive Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Breast Cancer Screening 2015 65.23% 72.07% 73.08% 81.53%
2014 67.15% 72.22% 73.52% 81.91%
2013 67.20% 72.82% 73.71% 80.78%
2012 N/A N/A N/A N/A
Chlamydia Screening in Women-all Age groups 2015 49.36% 47.89% 52.32% 64.06%
2014 48.20% 48.07% 51.65% 63.48%
2013 48.66% 47.46% 46.20% 59.63%
2012 47.83% 46.98% 45.16% 57.69%
Colorectal Cancer Screening 2015 56.61% 64.43% 62.32% 73.84%
2014 54.67% 63.41% 64.06% 74.86%
2013 59.26% 65.36% 62.85% 72.75%
2012 60.61% 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 44.29% 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 40.40% 46.31% 42.44% 51.66%
2014 28.99% 42.48% 42.16% 51.85%
2013 39.84% 43.20% 42.08% 50.99%
2012 48.63% 45.42% 43.34% 55.44%
Info
Weight Assessment and Counseling 2016 Plan State Avg Nat Avg 90th Pctl.
Adult BMI Assessment 65.43% 77.87% 76.17% 91.85%
Children/Adolescents BMI Assessment - Total 60.65% 69.07% 65.62% 88.08%
Counseling for Nutrition for Children/Adolescents - Total 59.72% 66.76% 61.76% 83.68%
Counseling for Physical Activity for Children/Adolescents - Total 55.09% 60.41% 55.96% 79.44%
Weight Assessment and Counseling Year Plan State Avg. Natl. Avg. 90th Pctl.
Adult BMI Assessment 2015 68.75% 75.90% 74.19% 91.76%
2014 70.26% 76.28% 75.36% 91.20%
2013 66.82% 72.78% 74.24% 90.00%
2012 62.50% 60.89% N/A N/A
Children/Adolescents BMI Assessment - Total 2015 55.56% 60.49% 60.37% 83.78%
2014 59.49% 61.63% 61.08% 85.37%
2013 44.91% 52.14% 54.90% 83.13%
2012 35.88% 43.29% 49.34% 78.51%
Counseling for Nutrition for Children/Adolescents - Total 2015 59.72% 63.88% 58.94% 80.79%
2014 63.19% 65.02% 60.64% 80.05%
2013 56.25% 61.17% 56.48% 79.32%
2012 51.62% 51.32% 54.19% 75.00%
Counseling for Physical Activity for Children/Adolescents - Total 2015 53.70% 59.53% 54.50% 78.85%
2014 60.19% 62.13% 57.09% 77.30%
2013 51.62% 56.47% 53.16% 74.70%
2012 46.06% 45.42% 49.91% 70.66%
Health Plan Stability/Descriptive
Info
Administrative Data 2016 Plan State Avg Nat Avg 90th Pctl.
Administrative Ratio 0.18 0.15 N/A N/A
Medical Cost Ratio 0.69 0.83 N/A N/A
Number of Enrollees 10,191 136,796 N/A N/A
Number of Physicians 48,611 73,426 N/A N/A
Premium Per Member Per Month $364 $370 N/A N/A
Profit/Loss Ratio 0.14 0.03 N/A N/A
Administrative Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Administrative Ratio 2015 0.16 0.14 N/A N/A
2014 0.14 0.14 N/A N/A
2013 0.10 0.14 N/A N/A
2012 0.10 0.10 N/A N/A
Medical Cost Ratio 2015 0.71 0.82 N/A N/A
2014 0.68 0.81 N/A N/A
2013 0.75 0.83 N/A N/A
2012 0.77 0.84 N/A N/A
Number of Enrollees 2015 8,580 124,097 N/A N/A
2014 8,745 115,428 N/A N/A
2013 9,963 98,253 N/A N/A
2012 16,732 111,525 N/A N/A
Number of Physicians 2015 45,388 90,027 N/A N/A
2014 38,011 63,157 N/A N/A
2013 36,157 64,207 N/A N/A
2012 35,400 62,436 N/A N/A
Premium Per Member Per Month 2015 $379 $375 N/A N/A
2014 $408 $412 N/A N/A
2013 $407 $544 N/A N/A
2012 $380 $378 N/A N/A
Profit/Loss Ratio 2015 0.13 0.04 N/A N/A
2014 0.19 0.06 N/A N/A
2013 0.16 0.03 N/A N/A
2012 0.14 0.07 N/A N/A
Info
Board Certification Rates for Providers 2016 Plan State Avg Nat Avg 90th Pctl.
Board Certification for Geriatricians 66.44% 73.44% N/A N/A
Board Certification for Pediatricians 83.37% 87.02% N/A N/A
Board Certification Rate for Family Medicine Physicians 72.06% 80.32% N/A N/A
Board Certification Rate for Internal Medicine Physicians 75.75% 81.15% N/A N/A
Board Certification Rate for OB/GYN Providers 82.72% 83.36% N/A N/A
Board Certification Rate for Other Specialists 80.54% 83.25% N/A N/A
Board Certification Rates for Providers Year Plan State Avg. Natl. Avg. 90th Pctl.
Board Certification for Geriatricians 2015 65.67% 71.06% N/A N/A
2014 67.23% 74.73% 64.82% 87.50%
2013 65.92% 71.19% 63.29% 83.33%
2012 68.95% 73.37% 65.21% 87.23%
Board Certification for Pediatricians 2015 85.81% 88.14% N/A N/A
2014 87.01% 88.13% 83.89% 91.52%
2013 86.91% 86.01% 81.01% 90.29%
2012 85.56% 86.06% 83.97% 91.65%
Board Certification Rate for Family Medicine Physicians 2015 76.05% 82.53% N/A N/A
2014 78.79% 82.93% 77.41% 89.90%
2013 78.94% 81.36% 76.60% 88.80%
2012 77.82% 81.09% 77.40% 89.19%
Board Certification Rate for Internal Medicine Physicians 2015 77.74% 82.59% N/A N/A
2014 80.24% 83.98% 79.07% 88.73%
2013 79.33% 80.80% 78.18% 87.44%
2012 80.31% 81.93% 79.29% 88.24%
Board Certification Rate for OB/GYN Providers 2015 85.47% 83.51% N/A N/A
2014 85.35% 83.71% 79.30% 88.80%
2013 85.63% 80.44% 76.89% 87.80%
2012 85.18% 80.51% 79.23% 86.38%
Board Certification Rate for Other Specialists 2015 82.04% 82.88% N/A N/A
2014 83.06% 84.44% 78.09% 89.67%
2013 83.61% 79.95% 74.88% 88.36%
2012 81.78% 79.00% 75.49% 87.62%
Info
Financial Data 2016 Plan State Avg Nat Avg 90th Pctl.
Income $15,432,754 $38,212,136 N/A N/A
Net Worth $19,902,986 $267,217,323 N/A N/A
Premiums Earned $38,883,614 $644,862,921 N/A N/A
Financial Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Income 2015 $15,885,786 $19,029,685 N/A N/A
2014 $25,624,397 $50,732,622 N/A N/A
2013 $24,543,390 $44,817,532 N/A N/A
2012 $22,071,135 $57,195,463 N/A N/A
Net Worth 2015 $22,759,287 $237,291,717 N/A N/A
2014 $54,105,621 $250,764,247 N/A N/A
2013 $41,048,229 $222,343,959 N/A N/A
2012 $26,465,803 $232,468,936 N/A N/A
Premiums Earned 2015 $39,486,608 $552,705,214 N/A N/A
2014 $43,251,038 $470,221,984 N/A N/A
2013 $48,713,922 $403,549,832 N/A N/A
2012 $77,735,320 $442,669,442 N/A N/A
Info
Years in Business 2016 Plan State Avg Nat Avg 90th Pctl.
Years in Business 28 34 N/A N/A
Years in Business Year Plan State Avg. Natl. Avg. 90th Pctl.
Years in Business 2015 27 33 N/A N/A
2014 26 32 N/A N/A
2013 25 31 N/A N/A
2012 24 30 N/A N/A
Member Satisfaction
Info
Member Satisfaction 2016 Plan State Avg Nat Avg 90th Pctl.
Getting Care Quickly N/A 85.81% 85.14% 90.00%
Getting Needed Care 80.44% 86.38% 87.25% 91.54%
How Well Doctors Communicate 95.99% 95.22% 95.39% 97.21%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 51.55% 62.47% 62.27% 74.92%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 80.43% 83.44% 84.72% 88.74%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 78.36% 77.49% 77.19% 83.29%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 83.33% 84.65% 84.57% 88.37%
Member Satisfaction Year Plan State Avg. Natl. Avg. 90th Pctl.
Getting Care Quickly 2015 82.59% 85.61% 85.00% 89.71%
2014 80.51% 86.12% 85.79% 90.17%
2013 85.04% 86.65% 86.84% 90.75%
2012 84.52% 85.74% 85.81% 90.18%
Getting Needed Care 2015 79.20% 86.51% 86.79% 91.23%
2014 81.35% 88.34% 87.95% 92.13%
2013 84.34% 87.20% 88.05% 92.37%
2012 84.06% 86.83% 87.88% 91.65%
How Well Doctors Communicate 2015 92.82% 94.90% 95.20% 97.10%
2014 93.98% 95.30% 95.26% 97.16%
2013 91.91% 94.13% 94.94% 96.97%
2012 91.76% 94.08% 94.39% 96.44%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 2015 58.82% 62.71% 62.65% 74.57%
2014 53.91% 58.77% 64.71% 76.75%
2013 54.77% 65.03% 66.21% 78.29%
2012 55.81% 64.01% 63.16% 74.19%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 2015 86.09% 83.49% 83.85% 89.05%
2014 90.52% 85.38% 84.24% 88.27%
2013 80.45% 83.04% 84.52% 89.47%
2012 84.77% 84.35% 83.55% 88.27%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 2015 67.07% 76.25% 76.99% 82.76%
2014 79.89% 79.49% 78.26% 83.66%
2013 71.43% 76.64% 78.14% 84.28%
2012 70.37% 75.50% 76.51% 82.08%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 2015 75.14% 83.85% 84.24% 88.77%
2014 84.54% 84.37% 84.70% 88.96%
2013 78.28% 83.92% 84.96% 89.71%
2012 80.22% 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 52.17% 34.87% 35.80% 45.93%
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 50.00% 61.93% 58.30% 75.00%
Use of Multiple Concurrent Antipsychotics in Children and Adolescents - Ages 1-17 4.76% 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 N/A 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 N/A 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 N/A 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 2.04% 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 0.02% 0.02% 2.40% 0.93%
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
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 78.73% 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 76.16% 74.11% 74.57% 81.25%
2014 75.58% 72.44% 74.82% 81.95%
2013 77.94% 73.66% 74.48% 81.27%
2012 77.67% 72.73% 74.28% 81.82%
Info
Respiratory 2016 Plan State Avg Nat Avg 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 88.30% 88.81% 88.51% 94.80%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 25.43% 27.03% 28.19% 41.72%
Respiratory Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 2015 88.26% 87.71% 88.11% 94.26%
2014 85.94% 87.19% 87.39% 94.57%
2013 86.35% 82.80% 85.30% 92.63%
2012 81.04% 81.66% 84.23% 92.25%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 2015 27.27% 25.68% 26.11% 38.04%
2014 21.42% 25.67% 25.79% 36.11%
2013 19.38% 22.74% 23.86% 30.84%
2012 15.28% 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 0.70 0.79 0.77 0.93
Average number of antibiotic prescriptions per member per year - Ages 0-9 0.90 0.97 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 0.53 0.60 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 0.60 0.69 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 0.67 0.77 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 0.80 0.87 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 0.92 0.99 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 1.15 1.23 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 0.14 0.73 N/A N/A
Days suppplied per antibiotic prescription - Total 9.73 10.09 10.01 11.06
Days suppplied per antibiotic prescription - Ages 0-9 10.41 10.04 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 11.59 12.80 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 9.48 10.07 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 9.41 9.62 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 9.50 9.82 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 9.70 9.93 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 12.12 10.59 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 10.00 9.43 N/A N/A
Prescriptions of concern - Total 0.35 0.38 0.38 0.48
Prescriptions of concern - Ages 0-9 0.39 0.43 N/A N/A
Prescriptions of concern - Ages 10-17 0.24 0.24 N/A N/A
Prescriptions of concern - Ages 18-34 0.28 0.31 N/A N/A
Prescriptions of concern - Ages 35-49 0.36 0.40 N/A N/A
Prescriptions of concern - Ages 50-64 0.44 0.46 N/A N/A
Prescriptions of concern - Ages 65-74 0.45 0.51 N/A N/A
Prescriptions of concern - Ages 75-85 0.65 0.65 N/A N/A
Prescriptions of concern - Ages 85 plus 0.00 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 0.69 0.80 0.81 0.97
2014 0.74 0.75 0.79 0.96
2013 0.80 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 0.80 0.94 N/A N/A
2014 0.85 0.84 N/A N/A
2013 0.92 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 0.56 0.60 N/A N/A
2014 0.58 0.56 N/A N/A
2013 0.62 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 0.61 0.70 N/A N/A
2014 0.66 0.67 N/A N/A
2013 0.72 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 0.68 0.80 N/A N/A
2014 0.73 0.76 N/A N/A
2013 0.79 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 0.78 0.90 N/A N/A
2014 0.83 0.84 N/A N/A
2013 0.89 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 0.99 1.07 N/A N/A
2014 1.03 0.96 N/A N/A
2013 1.06 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 0.95 1.08 N/A N/A
2014 0.89 1.09 N/A N/A
2013 1.22 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 0.15 1.67 N/A N/A
2014 3.55 1.37 N/A N/A
2013 1.91 1.67 N/A N/A
2012 N/A N/A N/A N/A
Days suppplied per antibiotic prescription - Total 2015 10.02 10.26 10.12 11.03
2014 10.40 10.44 10.32 11.18
2013 10.39 10.44 10.45 11.35
2012 N/A N/A N/A N/A
Days suppplied per antibiotic prescription - Ages 0-9 2015 10.30 9.99 N/A N/A
2014 10.49 10.01 N/A N/A
2013 10.27 10.00 N/A N/A
2012 N/A N/A N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 2015 13.19 13.32 N/A N/A
2014 13.49 13.65 N/A N/A
2013 13.77 13.72 N/A N/A
2012 N/A N/A N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 2015 9.80 10.33 N/A N/A
2014 10.29 10.65 N/A N/A
2013 10.24 10.61 N/A N/A
2012 N/A N/A N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 2015 9.56 9.83 N/A N/A
2014 9.83 9.95 N/A N/A
2013 9.74 9.93 N/A N/A
2012 N/A N/A N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 2015 9.61 9.90 N/A N/A
2014 10.19 10.04 N/A N/A
2013 10.20 10.07 N/A N/A
2012 N/A N/A N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 2015 10.73 10.18 N/A N/A
2014 10.31 10.43 N/A N/A
2013 10.68 10.23 N/A N/A
2012 N/A N/A N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 2015 10.95 9.93 N/A N/A
2014 10.24 10.54 N/A N/A
2013 11.43 10.32 N/A N/A
2012 N/A N/A N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 2015 1.00 9.54 N/A N/A
2014 8.14 10.65 N/A N/A
2013 6.15 8.73 N/A N/A
2012 N/A N/A N/A N/A
Prescriptions of concern - Total 2015 0.35 0.40 0.41 0.52
2014 0.38 0.37 0.39 0.49
2013 0.41 0.42 0.41 0.52
2012 N/A N/A N/A N/A
Prescriptions of concern - Ages 0-9 2015 0.34 0.41 N/A N/A
2014 0.37 0.38 N/A N/A
2013 0.42 0.44 N/A N/A
2012 N/A N/A N/A N/A
Prescriptions of concern - Ages 10-17 2015 0.23 0.25 N/A N/A
2014 0.23 0.22 N/A N/A
2013 0.25 0.25 N/A N/A
2012 N/A N/A N/A N/A
Prescriptions of concern - Ages 18-34 2015 0.29 0.32 N/A N/A
2014 0.31 0.30 N/A N/A
2013 0.33 0.34 N/A N/A
2012 N/A N/A N/A N/A
Prescriptions of concern - Ages 35-49 2015 0.36 0.42 N/A N/A
2014 0.40 0.41 N/A N/A
2013 0.44 0.45 N/A N/A
2012 N/A N/A N/A N/A
Prescriptions of concern - Ages 50-64 2015 0.42 0.49 N/A N/A
2014 0.47 0.45 N/A N/A
2013 0.50 0.50 N/A N/A
2012 N/A N/A N/A N/A
Prescriptions of concern - Ages 65-74 2015 0.53 0.57 N/A N/A
2014 0.57 0.51 N/A N/A
2013 0.57 0.56 N/A N/A
2012 N/A N/A N/A N/A
Prescriptions of concern - Ages 75-85 2015 0.63 0.59 N/A N/A
2014 0.47 0.51 N/A N/A
2013 0.67 0.57 N/A N/A
2012 N/A N/A N/A N/A
Prescriptions of concern - Ages 85 plus 2015 0.15 0.82 N/A N/A
2014 0.85 0.55 N/A N/A
2013 0.99 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 83.02% 83.40% 80.76% 90.36%
Well Child Visits in the 3rd - 6th Years 81.51% 82.50% 78.30% 90.11%
Adolescent Well-Care Visits 52.01% 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 84.10% 84.01% 79.35% 89.12%
2014 82.85% 82.63% 79.12% 89.64%
2013 82.52% 83.44% 79.34% 89.83%
2012 80.63% 83.14% 78.67% 91.43%
Well Child Visits in the 3rd - 6th Years 2015 81.28% 80.48% 77.75% 89.74%
2014 80.60% 80.03% 77.37% 88.75%
2013 78.45% 78.43% 75.89% 88.25%
2012 76.56% 76.56% 74.36% 86.52%
Adolescent Well-Care Visits 2015 50.68% 49.34% 48.26% 64.50%
2014 48.67% 48.09% 47.51% 64.76%
2013 47.62% 46.84% 46.27% 63.82%
2012 45.26% 44.66% 44.76% 63.11%
Info
Mental Health Utilization 2016 Plan State Avg Nat Avg 90th Pctl.
Mental Health Utilization - Any service - Total 5.21% 6.65% 6.82% 10.37%
Mental Health Utilization - Any service - Ages 0-12 3.79% 5.25% N/A N/A
Mental Health Utilization - Any service - Ages 13-17 11.08% 12.10% N/A N/A
Mental Health Utilization - Any service - Ages 18-64 5.12% 6.59% N/A N/A
Mental Health Utilization - Any service - Ages 65 plus 1.69% 3.39% N/A N/A
Mental Health Utilization - Inpatient - Total 0.24% 0.25% 0.24% 0.31%
Mental Health Utilization - Inpatient - Ages 0-12 0.06% 0.07% N/A N/A
Mental Health Utilization - Inpatient - Ages 13-17 1.07% 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 0.11% 0.18% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Total 0.13% 0.12% 0.17% 0.35%
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 0-12 0.23% 0.07% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 13-17 0.33% 0.43% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 18-64 0.10% 0.11% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 65 plus 0.00% 0.02% N/A N/A
Mental Health Utilization - Outpatient or ED - Total 5.15% 6.63% 6.77% 10.32%
Mental Health Utilization - Outpatient or ED - Ages 0-12 3.75% 5.26% N/A N/A
Mental Health Utilization - Outpatient or ED - Ages 13-17 10.99% 12.16% N/A N/A
Mental Health Utilization - Outpatient or ED - Ages 18-64 5.07% 6.56% N/A N/A
Mental Health Utilization - Outpatient or ED - Ages 65 plus 1.57% 3.22% N/A N/A
Mental Health Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Mental Health Utilization - Any service - Total 2015 5.48% 6.65% 6.71% 9.72%
2014 5.66% 7.59% 7.15% 10.70%
2013 5.64% 6.78% 7.20% 11.03%
2012 N/A N/A N/A N/A
Mental Health Utilization - Any service - Ages 0-12 2015 3.98% 5.08% N/A N/A
2014 4.36% 5.49% N/A N/A
2013 4.59% 5.17% N/A N/A
2012 N/A N/A N/A N/A
Mental Health Utilization - Any service - Ages 13-17 2015 9.97% 11.13% N/A N/A
2014 10.35% 12.47% N/A N/A
2013 10.49% 10.96% N/A N/A
2012 N/A N/A N/A N/A
Mental Health Utilization - Any service - Ages 18-64 2015 5.49% 6.69% N/A N/A
2014 5.62% 7.72% N/A N/A
2013 5.54% 6.86% N/A N/A
2012 N/A N/A N/A N/A
Mental Health Utilization - Any service - Ages 65 plus 2015 1.72% 3.67% N/A N/A
2014 1.47% 4.08% N/A N/A
2013 2.16% 3.25% N/A N/A
2012 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Total 2015 0.26% 0.25% 0.24% 0.31%
2014 0.33% 0.30% 0.26% 0.35%
2013 0.27% 0.26% 0.26% 0.37%
2012 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 0-12 2015 0.09% 0.07% N/A N/A
2014 0.21% 0.09% N/A N/A
2013 0.12% 0.06% N/A N/A
2012 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 13-17 2015 1.06% 0.77% N/A N/A
2014 1.09% 0.99% N/A N/A
2013 0.92% 0.82% N/A N/A
2012 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 18-64 2015 0.24% 0.24% N/A N/A
2014 0.30% 0.29% N/A N/A
2013 0.25% 0.25% N/A N/A
2012 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 65 plus 2015 0.00% 0.10% N/A N/A
2014 0.09% 0.18% N/A N/A
2013 0.07% 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 0.11% 0.10% 0.16% 0.34%
2014 0.11% 0.11% 0.16% 0.36%
2013 0.13% 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 0.13% 0.05% N/A N/A
2014 0.12% 0.06% N/A N/A
2013 0.16% 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 0.59% 0.37% N/A N/A
2014 0.54% 0.42% N/A N/A
2013 0.57% 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 0.07% 0.09% N/A N/A
2014 0.07% 0.10% N/A N/A
2013 0.09% 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 0.00% 0.02% N/A N/A
2014 0.00% 0.02% N/A N/A
2013 0.00% 0.02% N/A N/A
2012 N/A N/A N/A N/A
Mental Health Utilization - Outpatient or ED - Total 2015 5.43% 6.59% 6.64% 9.70%
2014 5.59% 7.52% 7.07% 10.63%
2013 5.59% 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 3.96% 5.07% N/A N/A
2014 4.31% 5.47% N/A N/A
2013 4.55% 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 9.89% 11.02% N/A N/A
2014 10.29% 12.33% N/A N/A
2013 10.36% 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 5.44% 6.62% N/A N/A
2014 5.56% 7.64% N/A N/A
2013 5.49% 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 1.72% 3.64% N/A N/A
2014 1.47% 3.97% N/A N/A
2013 2.09% 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 0.11% 0.11% N/A N/A
Plan All-Cause Readmissions Total 0.11% 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 0.13% 0.12% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Plan All-Cause Readmissions Ages 45-54 2015 0.12% 0.11% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Plan All-Cause Readmissions Ages 55-64 2015 0.12% 0.11% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A
Plan All-Cause Readmissions Total 2015 0.12% 0.11% N/A N/A
2014 N/A N/A N/A N/A
2013 N/A N/A N/A N/A
2012 N/A N/A N/A N/A