Health Insurance in Virginia

HMO Profile

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Aetna Health Inc. (a Pennsylvania Corporation)

Company Information

  • Company Providing Plan:Aetna Health, Inc. (a Pennsylvania Corporation)
  • Address:151 Farmingrton Avenue, Rt 21
    Hartford CT 06156
  • Telephone :800-872-3862
  • Website:www.aetna.com
2020
Number of Enrollees: 23,402
PMPM: $713
Number of Physicians: *923,132
NCQA Accreditation: Commendable

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

Coverage Areas

Counties

All Counties in the Commonwealth of Virginia

Cities

All Cities in the Commonwealth of Virginia

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

Administrative Data

2020 2019 2018 2017 2016
Number of Enrollees 23,402 20,671 22,748 50,391 37,605
PMPM $713 $569 $645 $430 $378
*Medical Cost Ratio 78% 83% 80% 81% 82%
*Administrative Ratio 14% 13% 17% 15% 16%
*Profit/Loss Ratio 8% 4% 4% 5% 3%
*Number of Physicians 923,132 795,989 554,080 426,906 370,968

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

Financial Data

2020 2019 2018 2017 2016
Premiums Earned $192,038,222 $141,061,312 $183,812,024 $341,947,599 $174,415,257
*Income $201,700,456 $126,982,751 $96,319,039 $129,475,325 $83,382,290
*Net Worth $562,202,243 $509,963,757 $489,511,836 $525,277,678 $458,205,847

*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 2020 Plan State Avg Nat Avg 90th Pctl.
Adult Access (Age 20-44) To Preventive/Ambulatory Health Services 92.40% 93.90% 92.88% 95.71%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 96.05% 96.11% 95.86% 97.54%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 97.28% 96.79% 96.95% 98.30%
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 2019 92.42% 92.78% 92.66% 95.76%
2018 92.21% 92.43% 92.33% 95.45%
2017 92.23% 92.73% 92.45% 95.43%
2016 92.05% 92.81% 92.73% 95.55%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 2019 96.14% 95.78% 95.87% 97.69%
2018 96.16% 95.50% 95.64% 97.49%
2017 96.03% 95.57% 95.61% 97.46%
2016 95.97% 95.78% 95.78% 97.61%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 2019 97.57% 97.13% 97.14% 98.42%
2018 97.35% 97.15% 97.17% 98.45%
2017 97.35% 97.82% 97.07% 98.47%
2016 97.13% 97.30% 97.19% 98.61%
Info
Alcohol and Other Drug Dependence Treatment 2020 Plan State Avg Nat Avg 90th Pctl.
Initiation of Alcohol and Other Drug Dependence Treatment - Total 34.64% 40.49% 36.39% 45.24%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 42.86% 35.48% 44.95% 59.06%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 34.48% 40.55% 36.18% 45.12%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 12.73% 15.16% 12.46% 17.48%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 14.29% 14.80% 17.76% 27.27%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 12.70% 15.15% 12.33% 17.48%
Alcohol and Other Drug Dependence Treatment Year Plan State Avg. Natl. Avg. 90th Pctl.
Initiation of Alcohol and Other Drug Dependence Treatment - Total 2019 32.43% 39.13% 35.63% 41.36%
2018 32.55% 37.53% 35.68% 42.36%
2017 36.49% 36.14% 36.11% 42.01%
2016 33.37% 35.69% 32.93% 40.24%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2019 27.27% 36.19% 42.41% 54.29%
2018 50.00% 49.35% 40.21% 51.02%
2017 36.54% 40.06% 39.91% 52.54%
2016 33.33% 40.15% 40.47% 51.96%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2019 32.56% 39.20% 35.47% 40.96%
2018 32.20% 37.34% 35.51% 42.35%
2017 36.49% 36.00% 35.97% 41.96%
2016 33.37% 35.55% 32.64% 40.33%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 2019 12.64% 13.47% 12.31% 16.44%
2018 12.99% 14.69% 12.58% 17.04%
2017 13.57% 13.36% 12.65% 17.26%
2016 11.16% 12.51% 11.46% 16.72%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2019 12.12% 10.34% 16.48% 27.14%
2018 36.67% 18.18% 16.91% 25.00%
2017 13.46% 14.40% 14.95% 23.85%
2016 10.42% 11.28% 15.68% 23.73%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2019 12.65% 13.52% 12.20% 16.41%
2018 12.52% 14.58% 12.47% 16.97%
2017 13.57% 13.40% 12.55% 17.38%
2016 11.18% 12.57% 11.32% 16.09%
Info
Prenatal and Postpartum Care 2020 Plan State Avg Nat Avg 90th Pctl.
Postpartum Care 70.32% 74.05% 78.11% 92.47%
Timeliness of Prenatal Care 79.08% 79.76% 81.82% 93.92%
Prenatal and Postpartum Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Postpartum Care 2019 73.24% 78.66% 80.52% 91.97%
2018 62.50% 75.10% 75.89% 88.80%
2017 68.71% 73.45% 75.05% 88.13%
2016 71.68% 74.50% 73.95% 88.85%
Timeliness of Prenatal Care 2019 80.05% 86.76% 85.57% 95.33%
2018 83.06% 88.15% 84.75% 94.17%
2017 81.29% 86.37% 84.34% 94.89%
2016 88.27% 86.71% 85.57% 96.28%
Behavioral Health
Info
Adherence to Antipsychotic Medications for Individuals with Schizophrenia 2020 Plan State Avg Nat Avg 90th Pctl.
Adherence to Antipsychotic Medications for Individuals With Schizophrenia 83.33% 70.63% 69.41% 79.41%
Adherence to Antipsychotic Medications for Individuals with Schizophrenia Year Plan State Avg. Natl. Avg. 90th Pctl.
Adherence to Antipsychotic Medications for Individuals With Schizophrenia 2019 N/A N/A N/A N/A
2018 N/A N/A N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Info
Antidepressant Medication Management 2020 Plan State Avg Nat Avg 90th Pctl.
Antidepressant Medication Management - Effective Acute Phase Treatment 79.16% 77.14% 73.70% 81.07%
Antidepressant Medication Management - Effective Continuation Phase Treatment 64.95% 59.69% 57.32% 64.22%
Antidepressant Medication Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Antidepressant Medication Management - Effective Acute Phase Treatment 2019 76.04% 73.53% 71.19% 78.79%
2018 74.81% 71.96% 68.64% 77.59%
2017 73.35% 71.12% 67.11% 75.76%
2016 73.73% 70.29% 66.56% 74.77%
Antidepressant Medication Management - Effective Continuation Phase Treatment 2019 60.45% 55.44% 54.90% 62.18%
2018 60.99% 54.22% 53.01% 60.39%
2017 58.79% 54.87% 51.53% 60.24%
2016 58.01% 53.51% 50.69% 58.60%
Info
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication 2020 Plan State Avg Nat Avg 90th Pctl.
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Initiation 44.10% 45.87% 41.24% 50.34%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 62.07% 56.56% 48.67% 59.32%
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 2019 38.85% 42.67% 40.66% 51.30%
2018 36.42% 42.91% 39.85% 50.42%
2017 33.90% 41.27% 41.13% 50.83%
2016 37.42% 41.91% 38.93% 48.61%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 2019 44.05% 50.69% 47.95% 58.82%
2018 43.21% 40.32% 48.73% 60.57%
2017 40.85% 55.09% 47.07% 58.44%
2016 47.22% 46.92% 45.82% 56.86%
Info
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence 2020 Plan State Avg Nat Avg 90th Pctl.
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence within 7 days after hospital discharge 5.83% 14.52% 13.45% 21.43%
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence within 30 days after hospital discharge 8.74% 19.84% 18.03% 26.07%
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence Year Plan State Avg. Natl. Avg. 90th Pctl.
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence within 7 days after hospital discharge 2019 10.30% 8.56% 11.48% 18.26%
2018 8.06% 9.96% 10.81% 17.07%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence within 30 days after hospital discharge 2019 13.94% 14.74% 15.35% 24.56%
2018 11.37% 13.52% 14.98% 23.11%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Info
Follow-Up After Emergency Department Visit for Mental Illness 2020 Plan State Avg Nat Avg 90th Pctl.
Follow-Up After Emergency Department Visit for Mental Illness within 7 days after hospital discharge 50.70% 48.22% 47.90% 68.29%
Follow-Up After Emergency Department Visit for Mental Illness within 30 days after hospital discharge 61.97% 59.38% 62.36% 78.77%
Follow-Up After Emergency Department Visit for Mental Illness Year Plan State Avg. Natl. Avg. 90th Pctl.
Follow-Up After Emergency Department Visit for Mental Illness within 7 days after hospital discharge 2019 44.62% 45.64% 48.70% 70.67%
2018 37.73% 38.46% 46.62% 66.57%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Follow-Up After Emergency Department Visit for Mental Illness within 30 days after hospital discharge 2019 55.38% 60.35% 62.59% 77.75%
2018 52.01% 53.38% 60.75% 77.57%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Info
Follow-up After Hospitalization For Mental Illness 2020 Plan State Avg Nat Avg 90th Pctl.
Follow-up After Hospitalization For Mental Illness within 7 days after hospital discharge 41.92% 49.46% 49.62% 63.68%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 62.69% 72.67% 70.00% 79.46%
Follow-up After Hospitalization For Mental Illness Year Plan State Avg. Natl. Avg. 90th Pctl.
Follow-up After Hospitalization For Mental Illness within 7 days after hospital discharge 2019 48.88% 49.77% 45.66% 58.20%
2018 39.52% 48.09% 44.98% 60.38%
2017 46.78% 52.18% 46.63% 62.81%
2016 43.67% 52.99% 52.06% 67.31%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 2019 69.38% 72.38% 67.81% 80.65%
2018 62.14% 69.84% 66.68% 80.29%
2017 68.96% 69.80% 68.66% 82.58%
2016 63.97% 73.85% 71.36% 84.17%
Effectiveness of Care
Info
Asthma Medication Ratio 2020 Plan State Avg Nat Avg 90th Pctl.
Asthma Medication Ratio - Ages 5-11 86.74% 93.70% 89.98% 95.00%
Asthma Medication Ratio - Ages 12-18 80.42% 84.76% 81.90% 89.30%
Asthma Medication Ratio - Ages 19-50 81.79% 78.90% 75.62% 84.47%
Asthma Medication Ratio - Ages 51-64 84.22% 85.69% 82.47% 89.38%
Asthma Medication Ratio - Total 83.05% 83.04% 79.76% 85.85%
Asthma Medication Ratio Year Plan State Avg. Natl. Avg. 90th Pctl.
Asthma Medication Ratio - Ages 5-11 2019 82.85% 86.54% 85.94% 93.20%
2018 85.10% 85.26% 87.15% 93.97%
2017 85.00% 86.06% 86.90% 93.55%
2016 90.24% 91.67% 86.40% 93.97%
Asthma Medication Ratio - Ages 12-18 2019 75.00% 84.88% 77.43% 86.25%
2018 81.25% 84.71% 78.77% 84.72%
2017 77.36% 84.80% 76.69% 85.94%
2016 79.92% 81.12% 78.30% 86.34%
Asthma Medication Ratio - Ages 19-50 2019 79.37% 80.50% 74.07% 81.27%
2018 81.91% 82.69% 75.11% 82.84%
2017 77.97% 78.94% 74.23% 81.70%
2016 80.85% 75.24% 73.51% 81.08%
Asthma Medication Ratio - Ages 51-64 2019 83.46% 86.85% 81.27% 88.51%
2018 87.21% 86.11% 82.81% 89.49%
2017 86.96% 89.17% 82.83% 89.28%
2016 86.59% 83.27% 81.70% 88.64%
Asthma Medication Ratio - Total 2019 80.59% 83.92% 78.10% 84.69%
2018 84.04% 84.32% 79.34% 85.18%
2017 81.88% 84.01% 79.04% 85.85%
2016 83.93% 80.60% 78.29% 85.46%
Info
Cardiovascular Disease Management 2020 Plan State Avg Nat Avg 90th Pctl.
Controlling High Blood Pressure 33.33% 43.15% 53.49% 69.10%
Persistence of Beta-Blockers 93.48% 87.06% 87.38% 94.19%
Cardiovascular Disease Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Controlling High Blood Pressure 2019 41.61% 60.96% 61.02% 74.21%
2018 41.61% 60.55% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Persistence of Beta-Blockers 2019 92.47% 88.62% 85.16% 92.47%
2018 88.79% 83.54% 82.37% 89.29%
2017 90.85% 85.80% 85.18% 93.41%
2016 90.97% 90.70% 83.61% 90.83%
Info
Cervical Cancer Screening 2020 Plan State Avg Nat Avg 90th Pctl.
Cervical Cancer Screening 76.69% 75.44% 75.50% 81.71%
Cervical Cancer Screening Year Plan State Avg. Natl. Avg. 90th Pctl.
Cervical Cancer Screening 2019 77.86% 78.50% 77.40% 83.91%
2018 77.14% 77.90% 76.08% 83.21%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Info
Common Childhood Illnesses 2020 Plan State Avg Nat Avg 90th Pctl.
Appropriate Testing for Children With Pharyngitis 81.78% 90.05% 84.77% 92.62%
Common Childhood Illnesses Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Testing for Children With Pharyngitis 2019 81.31% 90.44% 86.62% 93.98%
2018 92.97% 92.74% 87.97% 94.94%
2017 91.53% 92.30% 87.45% 94.64%
2016 90.44% 90.38% 84.50% 93.75%
Info
Diabetes Care and Management 2020 Plan State Avg Nat Avg 90th Pctl.
Comprehensive Diabetes Care-Blood Pressure Control (<140/90 mm Hg) 42.09% 44.59% 55.85% 73.48%
Comprehensive Diabetes Care-HbA1c control (<8.0%) 53.28% 55.20% 55.37% 65.50%
Comprehensive Diabetes Care-Rate of Eye Exams 56.20% 53.44% 50.27% 64.23%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 39.90% 36.05% 34.87% 23.45%
Comprehensive Diabetes Care-Testing for HbA1c 82.97% 86.71% 87.74% 91.73%
Diabetes Care and Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Comprehensive Diabetes Care-Blood Pressure Control (<140/90 mm Hg) 2019 51.58% 62.53% 63.23% 77.86%
2018 51.58% 63.70% 62.59% 77.37%
2017 47.45% 63.40% 60.82% 76.41%
2016 49.64% 60.88% 61.06% 78.35%
Comprehensive Diabetes Care-HbA1c control (<8.0%) 2019 65.21% 63.81% 58.07% 66.33%
2018 65.21% 62.46% 57.79% 66.33%
2017 55.96% 62.51% 57.48% 67.15%
2016 55.96% 58.36% 56.62% 66.39%
Comprehensive Diabetes Care-Rate of Eye Exams 2019 60.10% 58.32% 55.45% 69.32%
2018 60.10% 56.58% 54.40% 69.68%
2017 59.85% 56.95% 54.06% 70.69%
2016 59.85% 58.46% 52.96% 72.04%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 2019 25.55% 26.09% 30.80% 20.82%
2018 25.55% 27.18% 30.85% 20.62%
2017 34.55% 27.63% 31.91% 21.41%
2016 34.79% 30.47% 32.15% 20.98%
Comprehensive Diabetes Care-Testing for HbA1c 2019 91.73% 92.45% 91.60% 94.71%
2018 91.73% 92.11% 91.29% 94.71%
2017 86.13% 91.52% 90.96% 94.18%
2016 85.64% 90.38% 90.32% 94.83%
Info
Immunizations 2020 Plan State Avg Nat Avg 90th Pctl.
Childhood Immunization for Multiple Diseases Including Chicken Pox 74.94% 76.23% 77.26% 88.52%
Childhood Immunization for Multiple Diseases Including Pneumovax 74.94% 74.94% 75.84% 87.36%
Flu Vaccinations for Adults Ages 18-64 73.71% 57.13% 57.41% 67.88%
Immunizations for Adolescents - Combination 2 59.28% 61.54% N/A N/A
Immunizations for Adolescents - HPV 31.14% 35.09% 31.84% 39.17%
Immunizations for Adolescents - Meningococcal 34.06% 37.80% 33.38% 42.34%
Immunizations for Adolescents - Tdap 84.43% 80.71% 85.83% 93.12%
Immunizations Year Plan State Avg. Natl. Avg. 90th Pctl.
Childhood Immunization for Multiple Diseases Including Chicken Pox 2019 77.22% 82.73% 80.16% 89.29%
2018 77.22% 80.96% 79.32% 88.06%
2017 0.05% 73.55% 79.44% 89.14%
2016 0.03% 75.86% 78.93% 89.03%
Childhood Immunization for Multiple Diseases Including Pneumovax 2019 77.22% 81.30% 78.32% 87.99%
2018 77.22% 79.46% 77.50% 86.62%
2017 83.62% 80.09% 77.67% 87.61%
2016 80.89% 82.08% 77.04% 87.50%
Flu Vaccinations for Adults Ages 18-64 2019 75.19% 59.38% 55.06% 65.24%
2018 75.19% 53.06% 51.93% 61.07%
2017 82.15% 55.21% 49.33% 59.27%
2016 78.91% N/A N/A N/A
Immunizations for Adolescents - Combination 2 2019 61.17% 55.69% N/A N/A
2018 55.61% 55.16% N/A N/A
2017 50.49% 47.24% N/A N/A
2016 N/A N/A N/A N/A
Immunizations for Adolescents - HPV 2019 31.87% 33.16% 29.59% 40.63%
2018 79.08% 79.55% 82.25% 91.52%
2017 78.83% 80.48% 80.23% 89.54%
2016 78.83% 77.95% 77.63% 88.81%
Immunizations for Adolescents - Meningococcal 2019 34.06% 35.43% 31.21% 42.46%
2018 27.49% 32.22% 28.05% 37.23%
2017 22.87% 28.29% 23.98% 32.36%
2016 78.83% 77.95% 77.63% 88.81%
Immunizations for Adolescents - Tdap 2019 84.67% 81.83% 85.01% 92.59%
2018 80.05% 80.66% 83.69% 92.94%
2017 79.81% 82.05% 81.75% 90.27%
2016 81.51% 79.65% 79.20% 90.02%
Info
Pharmacotherapy of COPD Exacerbation 2020 Plan State Avg Nat Avg 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 85.71% 86.03% 81.34% 88.51%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 71.43% 75.06% 74.31% 85.07%
Pharmacotherapy of COPD Exacerbation Year Plan State Avg. Natl. Avg. 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 2019 93.18% 83.91% 80.32% 88.97%
2018 88.51% 85.49% 78.92% 87.88%
2017 81.67% 80.88% 79.87% 87.50%
2016 79.17% 84.12% 76.30% 85.98%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 2019 73.30% 81.14% 76.90% 87.69%
2018 75.86% 76.41% 74.76% 83.55%
2017 75.42% 78.84% 76.26% 84.38%
2016 70.31% 79.54% 70.70% 81.82%
Info
Preventive Care 2020 Plan State Avg Nat Avg 90th Pctl.
Breast Cancer Screening 68.12% 72.56% 72.44% 79.39%
Chlamydia Screening in Women-all Age groups 49.39% 49.80% 48.49% 63.85%
Colorectal Cancer Screening 65.56% 60.99% 63.64% 74.42%
Preventive Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Breast Cancer Screening 2019 70.84% 72.92% 74.81% 81.58%
2018 70.34% 72.13% 73.73% 81.17%
2017 69.17% 71.85% 72.81% 80.91%
2016 67.74% 71.80% 72.90% 80.63%
Chlamydia Screening in Women-all Age groups 2019 53.99% 54.77% 51.86% 67.02%
2018 53.31% 52.91% 51.41% 67.76%
2017 52.43% 51.46% 50.16% 66.08%
2016 51.14% 49.79% 48.98% 63.50%
Colorectal Cancer Screening 2019 68.16% 68.10% 66.15% 77.91%
2018 64.42% 64.94% 64.37% 76.52%
2017 66.49% 65.16% 62.43% 74.72%
2016 62.23% 64.67% 61.71% 74.09%
Info
Spirometry Testing 2020 Plan State Avg Nat Avg 90th Pctl.
Use of Spirometry Testing in the Assessment and diagnosis of COPD 38.90% 37.53% 37.16% 43.86%
Spirometry Testing Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Spirometry Testing in the Assessment and diagnosis of COPD 2019 46.79% 39.81% 42.11% 52.78%
2018 44.40% 44.14% 41.48% 50.95%
2017 43.44% 43.12% 41.90% 50.52%
2016 47.78% 42.48% 42.55% 51.02%
Info
Statin Therapy 2020 Plan State Avg Nat Avg 90th Pctl.
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 21-75 years (Male) 85.37% 85.75% 84.86% 89.67%
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 40–75 years (Female) 75.18% 77.46% 75.69% 81.94%
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - Total 81.78% 83.41% 82.46% 87.85%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 21-75 years (Male) 86.34% 81.24% 81.04% 86.60%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 40–75 years (Female) 83.84% 78.29% 77.58% 86.55%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - Total 85.53% 80.47% 80.55% 86.26%
Statin Therapy for Patients with Diabetes - Received Therapy 66.65% 66.42% 65.49% 71.27%
Statin Therapy for Patients with Diabetes - Statin Adherence 80% 80.92% 73.48% 74.69% 82.04%
Statin Therapy Year Plan State Avg. Natl. Avg. 90th Pctl.
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 21-75 years (Male) 2019 85.33% 85.53% 84.83% 90.71%
2018 81.38% 84.45% 83.64% 89.14%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 40–75 years (Female) 2019 73.25% 75.96% 74.89% 81.82%
2018 69.59% 76.45% 73.26% 81.82%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - Total 2019 81.18% 82.97% 82.41% 88.24%
2018 77.31% 82.21% 81.23% 87.21%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 21-75 years (Male) 2019 85.71% 78.19% 78.73% 85.40%
2018 82.35% 75.19% 77.14% 82.88%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 40–75 years (Female) 2019 82.34% 75.98% 73.50% 82.09%
2018 76.48% 72.78% 72.12% 81.10%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - Total 2019 84.67% 77.63% 77.38% 84.14%
2018 80.53% 74.49% 75.95% 82.83%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Statin Therapy for Patients with Diabetes - Received Therapy 2019 65.25% 65.53% 64.43% 70.97%
2018 63.50% 63.94% 62.57% 70.05%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Statin Therapy for Patients with Diabetes - Statin Adherence 80% 2019 79.71% 71.84% 71.74% 79.50%
2018 75.73% 68.88% 69.52% 78.00%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Info
Weight Assessment and Counseling 2020 Plan State Avg Nat Avg 90th Pctl.
Children/Adolescents BMI Assessment - Total 60.93% 61.27% 70.64% 88.81%
Children/Adolescents BMI Assessment - Ages 3-11 67.13% 64.54% 72.11% 88.89%
Children/Adolescents BMI Assessment - Ages 12-17 53.93% 57.19% 68.80% 87.79%
Counseling for Nutrition for Children/Adolescents - Total 57.74% 56.08% 65.06% 82.43%
Counseling for Nutrition for Children/Adolescents - Ages 3-11 62.04% 59.21% 67.32% 84.32%
Counseling for Nutrition for Children/Adolescents - Ages 12-17 52.88% 52.10% 62.24% 79.49%
Counseling for Physical Activity for Children/Adolescents - Total 54.79% 52.21% 60.81% 80.29%
Counseling for Physical Activity for Children/Adolescents - Ages 3-11 56.48% 52.27% 60.31% 81.14%
Counseling for Physical Activity for Children/Adolescents - Ages 12-17 52.88% 51.96% 61.40% 79.85%
Weight Assessment and Counseling Year Plan State Avg. Natl. Avg. 90th Pctl.
Children/Adolescents BMI Assessment - Total 2019 63.52% 74.97% 74.90% 90.00%
2018 63.52% 73.74% 72.87% 90.00%
2017 65.51% 70.41% 70.59% 88.08%
2016 66.34% 69.07% 65.62% 88.08%
Children/Adolescents BMI Assessment - Ages 3-11 2019 68.37% 78.68% 76.00% 90.91%
2018 68.37% 76.94% 74.00% 90.91%
2017 66.09% 71.37% 71.84% 88.89%
2016 69.53% 70.86% 67.11% 88.19%
Children/Adolescents BMI Assessment - Ages 12-17 2019 57.98% 70.46% 73.46% 89.29%
2018 57.98% 69.73% 71.39% 88.97%
2017 64.71% 68.96% 68.94% 87.82%
2016 62.15% 66.72% 64.28% 87.29%
Counseling for Nutrition for Children/Adolescents - Total 2019 62.53% 72.58% 68.74% 85.24%
2018 62.53% 71.79% 67.72% 85.06%
2017 64.52% 69.47% 65.50% 83.21%
2016 69.02% 66.76% 61.76% 83.68%
Counseling for Nutrition for Children/Adolescents - Ages 3-11 2019 65.12% 77.02% 71.33% 86.49%
2018 65.12% 75.91% 69.85% 86.21%
2017 64.38% 71.63% 68.20% 84.82%
2016 71.67% 69.25% 64.59% 85.48%
Counseling for Nutrition for Children/Adolescents - Ages 12-17 2019 59.57% 66.89% 65.44% 84.29%
2018 59.57% 66.37% 64.92% 84.29%
2017 64.71% 66.54% 61.92% 80.26%
2016 65.54% 63.42% 58.79% 81.87%
Counseling for Physical Activity for Children/Adolescents - Total 2019 57.57% 66.86% 64.24% 82.78%
2018 57.57% 66.42% 63.08% 81.32%
2017 60.55% 64.30% 59.96% 77.32%
2016 59.02% 60.41% 55.96% 79.44%
Counseling for Physical Activity for Children/Adolescents - Ages 3-11 2019 55.35% 66.12% 63.39% 82.53%
2018 55.35% 65.48% 61.70% 80.92%
2017 57.51% 62.31% 58.84% 75.00%
2016 57.94% 58.91% 54.72% 76.52%
Counseling for Physical Activity for Children/Adolescents - Ages 12-17 2019 60.11% 67.67% 65.38% 84.68%
2018 60.11% 67.51% 64.79% 84.03%
2017 64.71% 66.86% 61.40% 79.89%
2016 60.45% 62.44% 58.47% 83.05%
Health Plan Stability/Descriptive
Info
Administrative Data 2020 Plan State Avg Nat Avg 90th Pctl.
Administrative Ratio 0.14 0.13 N/A N/A
Medical Cost Ratio 0.78 0.81 N/A N/A
Number of Enrollees 23,402 170,871 N/A N/A
Number of Physicians 923,132 133,088 N/A N/A
Premium Per Member Per Month $713 $522 N/A N/A
Administrative Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Administrative Ratio 2019 0.13 0.12 N/A N/A
2018 0.17 0.14 86.19 92.68
2017 0.15 0.12 86.39 93.13
2016 0.16 0.15 N/A N/A
Medical Cost Ratio 2019 0.83 0.84 N/A N/A
2018 0.80 0.83 92.60 95.85
2017 0.81 0.83 93.13 96.59
2016 0.82 0.83 N/A N/A
Number of Enrollees 2019 20,671 136,748 N/A N/A
2018 22,748 129,656 92 96
2017 50,391 133,992 92 97
2016 37,605 136,796 N/A N/A
Number of Physicians 2019 795,989 105,314 N/A N/A
2018 554,080 86,806 87 95
2017 426,906 81,926 87 95
2016 370,968 73,426 N/A N/A
Premium Per Member Per Month 2019 $569 $511 N/A N/A
2018 $645 $517 N/A N/A
2017 $430 $370 N/A N/A
2016 $378 $370 N/A N/A
Info
Financial Data 2020 Plan State Avg Nat Avg 90th Pctl.
Income $201,700,456 $117,272,490 N/A N/A
Net Worth $562,202,243 $414,233,312 N/A N/A
Premiums Earned $192,038,222 $1,173,200,139 N/A N/A
Financial Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Income 2019 $126,982,751 $81,234,487 N/A N/A
2018 $96,319,039 $44,046,244 N/A N/A
2017 $129,475,325 $34,422,501 N/A N/A
2016 $83,382,290 $38,212,136 N/A N/A
Net Worth 2019 $509,963,757 $340,553,480 N/A N/A
2018 $489,511,836 $279,558,644 N/A N/A
2017 $525,277,678 $263,890,874 N/A N/A
2016 $458,205,847 $267,217,323 N/A N/A
Premiums Earned 2019 $141,061,312 $936,529,722 N/A N/A
2018 $183,812,024 $815,577,345 N/A N/A
2017 $341,947,599 $645,600,589 N/A N/A
2016 $174,415,257 $644,862,921 N/A N/A
Info
Years in Business 2020 Plan State Avg Nat Avg 90th Pctl.
Years in Business 42 38 N/A N/A
Years in Business Year Plan State Avg. Natl. Avg. 90th Pctl.
Years in Business 2019 41 37 N/A N/A
2018 40 36 N/A N/A
2017 39 35 N/A N/A
2016 38 34 N/A N/A
Member Satisfaction
Info
Member Satisfaction 2020 Plan State Avg Nat Avg 90th Pctl.
Getting Care Quickly 84.25% 85.38% 86.32% 91.51%
Getting Needed Care 89.55% 87.88% 88.01% 92.51%
How Well Doctors Communicate 98.05% 95.93% 95.93% 97.98%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 73.64% 65.21% 69.04% 80.59%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 86.79% 86.67% 87.14% 91.18%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 87.82% 79.32% 80.71% 87.04%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 91.54% 85.69% 86.56% 91.30%
Member Satisfaction Year Plan State Avg. Natl. Avg. 90th Pctl.
Getting Care Quickly 2019 86.96% 87.14% 86.32% 90.57%
2018 88.81% 85.27% 85.23% 89.89%
2017 91.22% 87.22% 85.34% 89.83%
2016 82.72% 85.81% 85.14% 90.00%
Getting Needed Care 2019 90.58% 87.88% 87.38% 91.22%
2018 88.23% 85.53% 86.33% 90.45%
2017 91.67% 87.44% 86.71% 90.37%
2016 89.93% 86.38% 87.25% 91.54%
How Well Doctors Communicate 2019 94.71% 94.99% 95.85% 97.38%
2018 96.57% 94.70% 95.31% 97.22%
2017 97.17% 94.74% 95.10% 96.91%
2016 95.15% 95.22% 95.39% 97.21%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 2019 73.13% 69.24% 67.91% 78.57%
2018 74.12% 64.78% 64.53% 76.79%
2017 70.90% 61.26% 62.44% 75.00%
2016 68.07% 62.47% 62.27% 74.92%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 2019 88.95% 88.18% 86.27% 90.20%
2018 87.71% 84.82% 84.41% 88.57%
2017 89.08% 83.86% 84.62% 88.77%
2016 83.33% 83.44% 84.72% 88.74%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 2019 73.13% 79.81% 80.27% 86.36%
2018 79.20% 76.02% 78.17% 83.95%
2017 82.48% 76.98% 77.27% 82.99%
2016 76.69% 77.49% 77.19% 83.29%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 2019 84.17% 87.91% 87.34% 90.94%
2018 89.45% 84.08% 85.14% 89.78%
2017 83.98% 83.95% 84.60% 89.86%
2016 86.69% 84.65% 84.57% 88.37%
Overuse/Appropriateness
Info
Antipsychotics 2020 Plan State Avg Nat Avg 90th Pctl.
Metabolic Monitoring for Children and Adolescents on Antipsychotics - Ages 1-17 35.54% 38.77% 31.82% 42.98%
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 62.22% 60.42% 62.97% 76.39%
Antipsychotics Year Plan State Avg. Natl. Avg. 90th Pctl.
Metabolic Monitoring for Children and Adolescents on Antipsychotics - Ages 1-17 2019 34.93% 42.62% 37.50% 49.28%
2018 50.36% 44.74% 36.17% 47.41%
2017 38.13% 50.55% 36.07% 48.57%
2016 33.78% 34.87% 35.80% 45.93%
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 2019 65.00% 63.47% 61.05% 78.36%
2018 48.98% 57.96% 56.00% 70.54%
2017 45.83% 58.14% 54.52% 68.67%
2016 50.00% 61.93% 58.30% 75.00%
Info
Cervical Cancer Screening in Adolescent Females 2020 Plan State Avg Nat Avg 90th Pctl.
Non-Recommended Cervical Cancer Screening in Adolescent Females 0.20% 0.46% 0.67% 0.19%
Cervical Cancer Screening in Adolescent Females Year Plan State Avg. Natl. Avg. 90th Pctl.
Non-Recommended Cervical Cancer Screening in Adolescent Females 2019 0.26% 0.58% 0.85% 0.24%
2018 0.33% 0.71% 1.05% 0.33%
2017 0.82% 0.94% 1.47% 0.50%
2016 1.22% 1.60% 1.84% 0.62%
Info
Lower Back Pain 2020 Plan State Avg Nat Avg 90th Pctl.
Use of Imaging for Low Back Pain 75.40% 77.22% 78.53% 85.60%
Lower Back Pain Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Imaging for Low Back Pain 2019 74.15% 77.01% 76.69% 83.47%
2018 71.32% 74.77% 75.11% 82.95%
2017 69.90% 73.85% 75.16% 82.29%
2016 68.56% 73.58% 72.67% 80.11%
Info
Respiratory 2020 Plan State Avg Nat Avg 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 92.12% 93.12% 91.57% 95.67%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 40.17% 41.88% 43.24% 59.45%
Respiratory Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 2019 92.27% 91.87% 90.76% 95.51%
2018 93.81% 92.50% 91.22% 95.48%
2017 90.02% 90.92% 89.19% 94.59%
2016 92.02% 88.81% 88.51% 94.80%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 2019 37.75% 38.42% 39.91% 54.09%
2018 28.31% 33.60% 33.16% 48.28%
2017 27.67% 30.67% 30.99% 49.52%
2016 22.07% 27.03% 28.19% 41.72%
Info
Use of Opioids 2020 Plan State Avg Nat Avg 90th Pctl.
Use of Opioids at High Dosage 7.62% 6.49% 5.76% 1.88%
Use of Opioids From Multiple Providers - Multiple Pharmacies 3.25% 2.32% 1.67% 0.62%
Use of Opioids From Multiple Providers - Multiple Prescribers 16.78% 16.62% 13.32% 8.20%
Use of Opioids From Multiple Providers - Multiple Prescribers and Multiple Pharmacies 1.84% 1.28% 0.76% 0.08%
Use of Opioids Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Opioids at High Dosage 2019 9.82% 6.96% 6.08% 1.88%
2018 3.87% 5.32% 4.54% 1.87%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Use of Opioids From Multiple Providers - Multiple Pharmacies 2019 3.99% 3.71% 2.79% 0.69%
2018 6.65% 5.11% 3.80% 1.40%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Use of Opioids From Multiple Providers - Multiple Prescribers 2019 17.97% 17.64% 14.51% 9.79%
2018 18.33% 18.32% 15.02% 9.64%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Use of Opioids From Multiple Providers - Multiple Prescribers and Multiple Pharmacies 2019 2.00% 1.70% 1.24% 0.00%
2018 2.79% 2.61% 1.76% 0.47%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Risk Adjusted Utilization
Info
Acute Hospital Utilization Rate 2020 Plan State Avg Nat Avg 90th Pctl.
Acute Hospital Utilization - Medicine 28.63% 21.48% 0.72% 0.53%
Acute Hospital Utilization - Surgery 15.41% 11.94% N/A N/A
Acute Hospital Utilization - Total Acute 44.04% 33.42% 0.97% 0.78%
Acute Hospital Utilization Rate Year Plan State Avg. Natl. Avg. 90th Pctl.
Acute Hospital Utilization - Medicine 2019 31.16% 26.50% 0.89% 0.68%
2018 N/A N/A N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Acute Hospital Utilization - Surgery 2019 18.31% 15.92% N/A N/A
2018 N/A N/A N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Acute Hospital Utilization - Total Acute 2019 49.47% 42.42% 1.09% 0.92%
2018 N/A N/A N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Info
Emergency Department Utilization 2020 Plan State Avg Nat Avg 90th Pctl.
Emergency Department Utilization 144 125 N/A N/A
Emergency Department Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Emergency Department Utilization 2019 239 187 1 1
2018 N/A N/A N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Info
Plan All-Cause Readmissions 2020 Plan State Avg Nat Avg 90th Pctl.
Plan All-Cause Readmissions Ages 18-64 (Total) 5.63% 4.88% 0.58% 0.47%
Plan All-Cause Readmissions Ages 18-44 4.77% 4.26% N/A N/A
Plan All-Cause Readmissions Ages 45-54 4.54% 4.46% N/A N/A
Plan All-Cause Readmissions Ages 55-64 6.85% 5.69% N/A N/A
Plan All-Cause Readmissions Year Plan State Avg. Natl. Avg. 90th Pctl.
Plan All-Cause Readmissions Ages 18-64 (Total) 2019 4.34% 4.32% 0.51% 0.37%
2018 13.37% 11.17% N/A N/A
2017 13.26% 12.19% N/A N/A
2016 0.13% 0.12% N/A N/A
Plan All-Cause Readmissions Ages 18-44 2019 4.73% 4.54% N/A N/A
2018 13.33% 11.41% N/A N/A
2017 14.11% 12.99% N/A N/A
2016 0.12% 0.12% N/A N/A
Plan All-Cause Readmissions Ages 45-54 2019 4.40% 4.35% N/A N/A
2018 12.17% 10.56% N/A N/A
2017 12.25% 11.71% N/A N/A
2016 0.12% 0.12% N/A N/A
Plan All-Cause Readmissions Ages 55-64 2019 4.01% 4.26% N/A N/A
2018 14.24% 11.21% N/A N/A
2017 13.40% 11.93% N/A N/A
2016 0.13% 0.11% N/A N/A
Utilization
Info
Antibiotic Utilization 2020 Plan State Avg Nat Avg 90th Pctl.
Average number of antibiotic prescriptions per member per year - Total 0.61 0.57 0.57 0.71
Average number of antibiotic prescriptions per member per year - Ages 0-9 0.38 0.41 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 0.31 0.33 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 0.56 0.53 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 0.63 0.59 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 0.74 0.70 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 0.80 0.77 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 0.88 0.80 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 0.77 1.56 N/A N/A
Days suppplied per antibiotic prescription - Total 9.800 10.133 10.310 11.480
Days suppplied per antibiotic prescription - Ages 0-9 10.110 10.550 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 14.060 14.369 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 9.490 9.729 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 9.550 9.703 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 9.520 10.027 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 9.490 9.997 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 9.850 10.119 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 9.470 10.606 N/A N/A
Prescriptions of concern - Total 0.250 0.227 0.240 0.320
Prescriptions of concern - Ages 0-9 0.14 0.15 N/A N/A
Prescriptions of concern - Ages 10-17 0.10 0.11 N/A N/A
Prescriptions of concern - Ages 18-34 0.21 0.20 N/A N/A
Prescriptions of concern - Ages 35-49 0.27 0.25 N/A N/A
Prescriptions of concern - Ages 50-64 0.34 0.31 N/A N/A
Prescriptions of concern - Ages 65-74 0.35 0.33 N/A N/A
Prescriptions of concern - Ages 75-85 0.41 0.34 N/A N/A
Prescriptions of concern - Ages 85 plus 0.40 0.41 N/A N/A
Antibiotic Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Average number of antibiotic prescriptions per member per year - Total 2019 0.78 0.75 0.74 0.90
2018 0.79 0.74 0.71 0.88
2017 0.80 0.77 0.76 0.90
2016 0.79 0.79 0.76 0.90
Average number of antibiotic prescriptions per member per year - Ages 0-9 2019 0.82 0.85 N/A N/A
2018 0.82 0.81 N/A N/A
2017 0.85 0.87 N/A N/A
2016 0.92 0.97 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 2019 0.49 0.52 N/A N/A
2018 0.50 0.52 N/A N/A
2017 0.55 0.57 N/A N/A
2016 0.55 0.60 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 2019 0.69 0.66 N/A N/A
2018 0.70 0.65 N/A N/A
2017 0.70 0.67 N/A N/A
2016 0.68 0.69 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 2019 0.80 0.74 N/A N/A
2018 0.79 0.73 N/A N/A
2017 0.81 0.75 N/A N/A
2016 0.80 0.77 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 2019 0.88 0.85 N/A N/A
2018 0.91 0.84 N/A N/A
2017 0.91 0.88 N/A N/A
2016 0.89 0.87 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 2019 0.98 0.95 N/A N/A
2018 0.99 0.97 N/A N/A
2017 1.03 1.00 N/A N/A
2016 1.00 0.99 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 2019 1.09 1.15 N/A N/A
2018 1.07 1.21 N/A N/A
2017 1.04 1.12 N/A N/A
2016 0.99 1.23 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 2019 0.93 0.95 N/A N/A
2018 1.06 1.32 N/A N/A
2017 1.18 1.12 N/A N/A
2016 0.91 0.73 N/A N/A
Days suppplied per antibiotic prescription - Total 2019 9.520 9.888 9.890 10.660
2018 9.460 9.950 9.910 10.890
2017 9.560 10.024 9.880 10.830
2016 9.690 10.090 9.880 10.830
Days suppplied per antibiotic prescription - Ages 0-9 2019 9.860 10.025 N/A N/A
2018 9.850 9.979 N/A N/A
2017 9.690 10.050 N/A N/A
2016 9.630 10.041 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 2019 12.230 12.591 N/A N/A
2018 12.530 12.948 N/A N/A
2017 12.090 12.689 N/A N/A
2016 12.350 12.799 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 2019 9.520 9.695 N/A N/A
2018 9.380 9.731 N/A N/A
2017 9.390 9.836 N/A N/A
2016 9.570 10.074 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 2019 9.160 9.488 N/A N/A
2018 9.140 9.568 N/A N/A
2017 9.320 9.591 N/A N/A
2016 9.370 9.620 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 2019 9.220 9.756 N/A N/A
2018 9.070 9.769 N/A N/A
2017 9.230 9.856 N/A N/A
2016 9.350 9.816 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 2019 9.070 9.766 N/A N/A
2018 8.930 9.830 N/A N/A
2017 9.220 9.850 N/A N/A
2016 9.630 9.929 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 2019 9.410 9.645 N/A N/A
2018 9.410 9.428 N/A N/A
2017 9.770 10.604 N/A N/A
2016 10.460 10.594 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 2019 9.000 9.997 N/A N/A
2018 9.200 9.026 N/A N/A
2017 9.820 9.873 N/A N/A
2016 9.320 9.431 N/A N/A
Prescriptions of concern - Total 2019 0.360 0.339 0.330 0.430
2018 0.370 0.338 0.330 0.430
2017 0.380 0.354 0.360 0.450
2016 0.390 0.383 0.360 0.450
Prescriptions of concern - Ages 0-9 2019 0.31 0.34 N/A N/A
2018 0.33 0.32 N/A N/A
2017 0.35 0.35 N/A N/A
2016 0.40 0.43 N/A N/A
Prescriptions of concern - Ages 10-17 2019 0.19 0.20 N/A N/A
2018 0.19 0.20 N/A N/A
2017 0.22 0.22 N/A N/A
2016 0.22 0.24 N/A N/A
Prescriptions of concern - Ages 18-34 2019 0.29 0.28 N/A N/A
2018 0.30 0.28 N/A N/A
2017 0.30 0.28 N/A N/A
2016 0.31 0.31 N/A N/A
Prescriptions of concern - Ages 35-49 2019 0.38 0.35 N/A N/A
2018 0.38 0.35 N/A N/A
2017 0.39 0.37 N/A N/A
2016 0.41 0.40 N/A N/A
Prescriptions of concern - Ages 50-64 2019 0.44 0.41 N/A N/A
2018 0.46 0.42 N/A N/A
2017 0.47 0.44 N/A N/A
2016 0.47 0.46 N/A N/A
Prescriptions of concern - Ages 65-74 2019 0.47 0.44 N/A N/A
2018 0.52 0.48 N/A N/A
2017 0.52 0.50 N/A N/A
2016 0.52 0.51 N/A N/A
Prescriptions of concern - Ages 75-85 2019 0.54 0.51 N/A N/A
2018 0.53 0.62 N/A N/A
2017 0.51 0.54 N/A N/A
2016 0.52 0.65 N/A N/A
Prescriptions of concern - Ages 85 plus 2019 0.53 0.36 N/A N/A
2018 0.57 0.45 N/A N/A
2017 0.64 0.48 N/A N/A
2016 0.44 0.34 N/A N/A
Info
Mental Health Utilization 2020 Plan State Avg Nat Avg 90th Pctl.
Mental Health Utilization - Any Service - Total 7.98% 9.13% 9.07% 12.95%
Mental Health Utilization - Any Service - Ages 0-12 5.43% 6.25% N/A N/A
Mental Health Utilization - Any Service - Ages 13-17 12.19% 15.31% N/A N/A
Mental Health Utilization - Any Service - Ages 18-64 8.56% 9.40% N/A N/A
Mental Health Utilization - Any Service - Ages 65 plus 3.71% 3.53% N/A N/A
Mental Health Utilization - ED - Total 0.09% 0.03% 0.06% 0.15%
Mental Health Utilization - ED - Ages 0-12 0.04% 0.01% N/A N/A
Mental Health Utilization - ED - Ages 13-17 0.20% 0.10% N/A N/A
Mental Health Utilization - ED - Ages 18-64 0.09% 0.03% N/A N/A
Mental Health Utilization - ED - Ages 65 plus 0.05% 0.01% N/A N/A
Mental Health Utilization - Inpatient - Total 0.24% 0.22% 0.24% 0.31%
Mental Health Utilization - Inpatient - Ages 0-12 0.05% 0.07% N/A N/A
Mental Health Utilization - Inpatient - Ages 13-17 0.77% 0.79% N/A N/A
Mental Health Utilization - Inpatient - Ages 18-64 0.23% 0.20% N/A N/A
Mental Health Utilization - Inpatient - Ages 65 plus 0.12% 0.06% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Total 0.10% 0.07% 0.15% 0.30%
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 0-12 0.05% 0.05% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 13-17 0.35% 0.26% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 18-64 0.09% 0.06% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 65 plus 0.01% 0.01% N/A N/A
Mental Health Utilization - Outpatient - Total 6.18% 7.22% 6.95% 9.99%
Mental Health Utilization - Outpatient - Ages 0-12 4.75% 5.23% N/A N/A
Mental Health Utilization - Outpatient - Ages 13-17 10.64% 12.84% N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 6.44% 7.35% N/A N/A
Mental Health Utilization - Outpatient - Ages 65 plus 2.65% 2.62% N/A N/A
Mental Health Utilization - Telehealth - Total 4.81% 4.92% 5.19% 8.37%
Mental Health Utilization - Telehealth - Ages 0-12 3.20% 3.07% N/A N/A
Mental Health Utilization - Telehealth - Ages 13-17 7.32% 8.30% N/A N/A
Mental Health Utilization - Telehealth - Ages 18-64 5.20% 5.11% N/A N/A
Mental Health Utilization - Telehealth - Ages 65 plus 2.00% 1.80% N/A N/A
Mental Health Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Mental Health Utilization - Any Service - Total 2019 7.54% 8.33% 8.86% 12.67%
2018 6.89% 7.63% 7.98% 11.76%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Any Service - Ages 0-12 2019 5.35% 6.35% N/A N/A
2018 5.24% 6.12% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Any Service - Ages 13-17 2019 12.51% 15.01% N/A N/A
2018 11.44% 13.96% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Any Service - Ages 18-64 2019 7.99% 8.45% N/A N/A
2018 7.18% 7.62% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Any Service - Ages 65 plus 2019 2.79% 3.17% N/A N/A
2018 2.53% 3.20% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - ED - Total 2019 0.11% 0.04% 0.08% 0.17%
2018 0.10% 0.09% 0.10% 0.22%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 0-12 2019 0.05% 0.02% N/A N/A
2018 0.07% 0.05% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 13-17 2019 0.44% 0.17% N/A N/A
2018 0.32% 0.28% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 18-64 2019 0.09% 0.03% N/A N/A
2018 0.09% 0.08% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 65 plus 2019 0.05% 0.07% N/A N/A
2018 0.01% 0.02% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Total 2019 0.25% 0.25% 0.27% 0.34%
2018 0.29% 0.27% 0.27% 0.34%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 0-12 2019 0.10% 0.12% N/A N/A
2018 0.14% 0.12% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 13-17 2019 0.86% 0.85% N/A N/A
2018 0.83% 0.95% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 18-64 2019 0.25% 0.24% N/A N/A
2018 0.27% 0.26% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 65 plus 2019 0.08% 0.11% N/A N/A
2018 0.15% 0.06% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Total 2019 0.16% 0.11% 0.20% 0.40%
2018 0.10% 0.12% 0.19% 0.38%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 0-12 2019 0.09% 0.10% N/A N/A
2018 0.08% 0.15% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 13-17 2019 0.59% 0.35% N/A N/A
2018 0.45% 0.49% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 18-64 2019 0.14% 0.09% N/A N/A
2018 0.08% 0.09% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 65 plus 2019 0.04% 0.02% N/A N/A
2018 0.03% 0.02% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Total 2019 7.45% 8.24% 8.73% 12.61%
2018 6.79% 7.53% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Ages 0-12 2019 5.33% 6.32% N/A N/A
2018 5.22% 6.10% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Ages 13-17 2019 12.35% 14.86% N/A N/A
2018 11.26% 13.80% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 2019 7.90% 8.36% N/A N/A
2018 7.08% 7.51% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Ages 65 plus 2019 2.72% 3.07% N/A N/A
2018 2.42% 3.16% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Total 2019 0.10% 0.11% 0.11% 0.22%
2018 0.07% 0.10% 0.05% 0.11%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Ages 0-12 2019 0.01% 0.04% N/A N/A
2018 0.01% 0.03% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Ages 13-17 2019 0.17% 0.15% N/A N/A
2018 0.08% 0.19% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Ages 18-64 2019 0.12% 0.12% N/A N/A
2018 0.08% 0.11% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Ages 65 plus 2019 0.02% 0.02% N/A N/A
2018 0.02% 0.02% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2020 data updated on: 02/08/2022