Health Insurance in Virginia

HMO Profile

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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
2020
Number of Enrollees: *83,967
PMPM: *$468
Number of Physicians: 12,049
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

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

Cities

Alexandria, Fairfax, Town of Vienna

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

Administrative Data

2020 2019 2018 2017 2016
*Number of Enrollees 83,967 81,960 79,558 84,851 86,893
PMPM $468 $455 $455 $404 $373
*Medical Cost Ratio 75% 74% 77% 82% 79%
*Administrative Ratio 22% 20% 21% 21% 24%
*Profit/Loss Ratio 4% 7% 3% -2% -2%
Number of Physicians 12,049 10,545 10,336 10,155 9,566

*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 $467,505,591 $437,755,166 $449,713,753 $399,660,112 $402,239,015
*Income $97,593,666 $183,552,553 $63,916,927 ($27,820,788) ($46,101,706)
*Net Worth $918,540,455 $916,778,984 $721,055,178 $672,613,635 $697,523,016

*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 95.57% 93.90% 92.88% 95.71%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 97.25% 96.11% 95.86% 97.54%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 97.89% 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 95.17% 92.78% 92.66% 95.76%
2018 95.11% 92.43% 92.33% 95.45%
2017 95.04% 92.73% 92.45% 95.43%
2016 94.63% 92.81% 92.73% 95.55%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 2019 97.08% 95.78% 95.87% 97.69%
2018 97.00% 95.50% 95.64% 97.49%
2017 96.97% 95.57% 95.61% 97.46%
2016 96.74% 95.78% 95.78% 97.61%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 2019 97.84% 97.13% 97.14% 98.42%
2018 97.78% 97.15% 97.17% 98.45%
2017 97.79% 97.82% 97.07% 98.47%
2016 97.52% 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 37.93% 40.49% 36.39% 45.24%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 34.17% 35.48% 44.95% 59.06%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 38.03% 40.55% 36.18% 45.12%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 17.48% 15.16% 12.46% 17.48%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 17.50% 14.80% 17.76% 27.27%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 17.48% 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 34.75% 39.13% 35.63% 41.36%
2018 35.60% 37.53% 35.68% 42.36%
2017 37.24% 36.14% 36.11% 42.01%
2016 36.47% 35.69% 32.93% 40.24%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2019 37.32% 36.19% 42.41% 54.29%
2018 40.69% 49.35% 40.21% 51.02%
2017 42.07% 40.06% 39.91% 52.54%
2016 45.15% 40.15% 40.47% 51.96%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2019 34.66% 39.20% 35.47% 40.96%
2018 35.45% 37.34% 35.51% 42.35%
2017 37.06% 36.00% 35.97% 41.96%
2016 36.17% 35.55% 32.64% 40.33%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 2019 14.89% 13.47% 12.31% 16.44%
2018 15.62% 14.69% 12.58% 17.04%
2017 15.46% 13.36% 12.65% 17.26%
2016 15.57% 12.51% 11.46% 16.72%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2019 17.61% 10.34% 16.48% 27.14%
2018 17.93% 18.18% 16.91% 25.00%
2017 17.68% 14.40% 14.95% 23.85%
2016 24.76% 11.28% 15.68% 23.73%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2019 14.80% 13.52% 12.20% 16.41%
2018 15.55% 14.58% 12.47% 16.97%
2017 15.38% 13.40% 12.55% 17.38%
2016 15.25% 12.57% 11.32% 16.09%
Info
Prenatal and Postpartum Care 2020 Plan State Avg Nat Avg 90th Pctl.
Postpartum Care 77.86% 74.05% 78.11% 92.47%
Timeliness of Prenatal Care 85.89% 79.76% 81.82% 93.92%
Prenatal and Postpartum Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Postpartum Care 2019 78.83% 78.66% 80.52% 91.97%
2018 70.32% 75.10% 75.89% 88.80%
2017 74.45% 73.45% 75.05% 88.13%
2016 66.98% 74.50% 73.95% 88.85%
Timeliness of Prenatal Care 2019 84.18% 86.76% 85.57% 95.33%
2018 90.27% 88.15% 84.75% 94.17%
2017 91.48% 86.37% 84.34% 94.89%
2016 89.77% 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 74.46% 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 79.33% 77.14% 73.70% 81.07%
Antidepressant Medication Management - Effective Continuation Phase Treatment 63.58% 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 77.09% 73.53% 71.19% 78.79%
2018 78.67% 71.96% 68.64% 77.59%
2017 77.04% 71.12% 67.11% 75.76%
2016 74.34% 70.29% 66.56% 74.77%
Antidepressant Medication Management - Effective Continuation Phase Treatment 2019 60.60% 55.44% 54.90% 62.18%
2018 64.17% 54.22% 53.01% 60.39%
2017 61.67% 54.87% 51.53% 60.24%
2016 59.94% 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 43.63% 45.87% 41.24% 50.34%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 51.00% 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 38.29% 42.67% 40.66% 51.30%
2018 40.81% 42.91% 39.85% 50.42%
2017 42.56% 41.27% 41.13% 50.83%
2016 36.19% 41.91% 38.93% 48.61%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 2019 46.09% 50.69% 47.95% 58.82%
2018 44.53% 40.32% 48.73% 60.57%
2017 48.75% 55.09% 47.07% 58.44%
2016 38.18% 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 11.90% 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 16.39% 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 9.50% 8.56% 11.48% 18.26%
2018 10.02% 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 13.50% 14.74% 15.35% 24.56%
2018 13.36% 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 50.96% 48.22% 47.90% 68.29%
Follow-Up After Emergency Department Visit for Mental Illness within 30 days after hospital discharge 66.27% 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 54.50% 45.64% 48.70% 70.67%
2018 51.76% 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 69.61% 60.35% 62.59% 77.75%
2018 66.37% 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 56.60% 49.46% 49.62% 63.68%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 76.53% 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 51.67% 49.77% 45.66% 58.20%
2018 55.04% 48.09% 44.98% 60.38%
2017 55.31% 52.18% 46.63% 62.81%
2016 52.23% 52.99% 52.06% 67.31%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 2019 74.87% 72.38% 67.81% 80.65%
2018 73.95% 69.84% 66.68% 80.29%
2017 74.08% 69.80% 68.66% 82.58%
2016 72.61% 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 92.10% 93.70% 89.98% 95.00%
Asthma Medication Ratio - Ages 12-18 82.92% 84.76% 81.90% 89.30%
Asthma Medication Ratio - Ages 19-50 82.13% 78.90% 75.62% 84.47%
Asthma Medication Ratio - Ages 51-64 86.30% 85.69% 82.47% 89.38%
Asthma Medication Ratio - Total 84.54% 83.04% 79.76% 85.85%
Asthma Medication Ratio Year Plan State Avg. Natl. Avg. 90th Pctl.
Asthma Medication Ratio - Ages 5-11 2019 90.33% 86.54% 85.94% 93.20%
2018 86.27% 85.26% 87.15% 93.97%
2017 85.67% 86.06% 86.90% 93.55%
2016 84.47% 91.67% 86.40% 93.97%
Asthma Medication Ratio - Ages 12-18 2019 76.95% 84.88% 77.43% 86.25%
2018 77.49% 84.71% 78.77% 84.72%
2017 78.01% 84.80% 76.69% 85.94%
2016 74.74% 81.12% 78.30% 86.34%
Asthma Medication Ratio - Ages 19-50 2019 79.97% 80.50% 74.07% 81.27%
2018 79.34% 82.69% 75.11% 82.84%
2017 76.64% 78.94% 74.23% 81.70%
2016 77.64% 75.24% 73.51% 81.08%
Asthma Medication Ratio - Ages 51-64 2019 85.36% 86.85% 81.27% 88.51%
2018 84.52% 86.11% 82.81% 89.49%
2017 84.18% 89.17% 82.83% 89.28%
2016 83.35% 83.27% 81.70% 88.64%
Asthma Medication Ratio - Total 2019 82.72% 83.92% 78.10% 84.69%
2018 81.66% 84.32% 79.34% 85.18%
2017 80.35% 84.01% 79.04% 85.85%
2016 80.23% 80.60% 78.29% 85.46%
Info
Cardiovascular Disease Management 2020 Plan State Avg Nat Avg 90th Pctl.
Controlling High Blood Pressure 61.56% 43.15% 53.49% 69.10%
Persistence of Beta-Blockers 86.23% 87.06% 87.38% 94.19%
Cardiovascular Disease Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Controlling High Blood Pressure 2019 56.05% 60.96% 61.02% 74.21%
2018 56.20% 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 88.08% 88.62% 85.16% 92.47%
2018 85.76% 83.54% 82.37% 89.29%
2017 86.02% 85.80% 85.18% 93.41%
2016 88.59% 90.70% 83.61% 90.83%
Info
Cervical Cancer Screening 2020 Plan State Avg Nat Avg 90th Pctl.
Cervical Cancer Screening 77.78% 75.44% 75.50% 81.71%
Cervical Cancer Screening Year Plan State Avg. Natl. Avg. 90th Pctl.
Cervical Cancer Screening 2019 79.32% 78.50% 77.40% 83.91%
2018 79.32% 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 91.11% 90.05% 84.77% 92.62%
Common Childhood Illnesses Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Testing for Children With Pharyngitis 2019 91.63% 90.44% 86.62% 93.98%
2018 93.29% 92.74% 87.97% 94.94%
2017 93.25% 92.30% 87.45% 94.64%
2016 93.30% 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) 58.19% 44.59% 55.85% 73.48%
Comprehensive Diabetes Care-HbA1c control (<8.0%) 57.46% 55.20% 55.37% 65.50%
Comprehensive Diabetes Care-Rate of Eye Exams 47.19% 53.44% 50.27% 64.23%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 33.74% 36.05% 34.87% 23.45%
Comprehensive Diabetes Care-Testing for HbA1c 83.86% 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 63.75% 62.53% 63.23% 77.86%
2018 58.39% 63.70% 62.59% 77.37%
2017 61.31% 63.40% 60.82% 76.41%
2016 54.14% 60.88% 61.06% 78.35%
Comprehensive Diabetes Care-HbA1c control (<8.0%) 2019 61.07% 63.81% 58.07% 66.33%
2018 57.12% 62.46% 57.79% 66.33%
2017 65.69% 62.51% 57.48% 67.15%
2016 56.61% 58.36% 56.62% 66.39%
Comprehensive Diabetes Care-Rate of Eye Exams 2019 54.01% 58.32% 55.45% 69.32%
2018 54.56% 56.58% 54.40% 69.68%
2017 49.88% 56.95% 54.06% 70.69%
2016 49.03% 58.46% 52.96% 72.04%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 2019 32.36% 26.09% 30.80% 20.82%
2018 32.12% 27.18% 30.85% 20.62%
2017 23.60% 27.63% 31.91% 21.41%
2016 34.39% 30.47% 32.15% 20.98%
Comprehensive Diabetes Care-Testing for HbA1c 2019 89.29% 92.45% 91.60% 94.71%
2018 89.60% 92.11% 91.29% 94.71%
2017 92.21% 91.52% 90.96% 94.18%
2016 87.48% 90.38% 90.32% 94.83%
Info
Immunizations 2020 Plan State Avg Nat Avg 90th Pctl.
Childhood Immunization for Multiple Diseases Including Chicken Pox 83.33% 76.23% 77.26% 88.52%
Childhood Immunization for Multiple Diseases Including Pneumovax 82.81% 74.94% 75.84% 87.36%
Flu Vaccinations for Adults Ages 18-64 58.45% 57.13% 57.41% 67.88%
Immunizations for Adolescents - Combination 2 31.87% 61.54% N/A N/A
Immunizations for Adolescents - HPV 34.06% 35.09% 31.84% 39.17%
Immunizations for Adolescents - Meningococcal 89.54% 37.80% 33.38% 42.34%
Immunizations for Adolescents - Tdap 93.19% 80.71% 85.83% 93.12%
Immunizations Year Plan State Avg. Natl. Avg. 90th Pctl.
Childhood Immunization for Multiple Diseases Including Chicken Pox 2019 77.32% 82.73% 80.16% 89.29%
2018 85.40% 80.96% 79.32% 88.06%
2017 77.37% 73.55% 79.44% 89.14%
2016 80.65% 75.86% 78.93% 89.03%
Childhood Immunization for Multiple Diseases Including Pneumovax 2019 76.29% 81.30% 78.32% 87.99%
2018 83.70% 79.46% 77.50% 86.62%
2017 75.91% 80.09% 77.67% 87.61%
2016 79.95% 82.08% 77.04% 87.50%
Flu Vaccinations for Adults Ages 18-64 2019 58.60% 59.38% 55.06% 65.24%
2018 49.40% 53.06% 51.93% 61.07%
2017 51.23% 55.21% 49.33% 59.27%
2016 N/A N/A N/A N/A
Immunizations for Adolescents - Combination 2 2019 29.44% 55.69% N/A N/A
2018 83.21% 55.16% N/A N/A
2017 85.89% 47.24% N/A N/A
2016 87.15% N/A N/A N/A
Immunizations for Adolescents - HPV 2019 30.90% 33.16% 29.59% 40.63%
2018 30.41% 79.55% 82.25% 91.52%
2017 26.03% 80.48% 80.23% 89.54%
2016 87.15% 77.95% 77.63% 88.81%
Immunizations for Adolescents - Meningococcal 2019 88.32% 35.43% 31.21% 42.46%
2018 84.91% 32.22% 28.05% 37.23%
2017 87.35% 28.29% 23.98% 32.36%
2016 88.55% 77.95% 77.63% 88.81%
Immunizations for Adolescents - Tdap 2019 94.16% 81.83% 85.01% 92.59%
2018 90.27% 80.66% 83.69% 92.94%
2017 91.24% 82.05% 81.75% 90.27%
2016 92.06% 79.65% 79.20% 90.02%
Info
Pharmacotherapy of COPD Exacerbation 2020 Plan State Avg Nat Avg 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 81.99% 86.03% 81.34% 88.51%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 77.02% 75.06% 74.31% 85.07%
Pharmacotherapy of COPD Exacerbation Year Plan State Avg. Natl. Avg. 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 2019 84.73% 83.91% 80.32% 88.97%
2018 86.62% 85.49% 78.92% 87.88%
2017 83.17% 80.88% 79.87% 87.50%
2016 87.21% 84.12% 76.30% 85.98%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 2019 77.09% 81.14% 76.90% 87.69%
2018 78.03% 76.41% 74.76% 83.55%
2017 74.26% 78.84% 76.26% 84.38%
2016 80.98% 79.54% 70.70% 81.82%
Info
Preventive Care 2020 Plan State Avg Nat Avg 90th Pctl.
Breast Cancer Screening 72.72% 72.56% 72.44% 79.39%
Chlamydia Screening in Women-all Age groups 50.75% 49.80% 48.49% 63.85%
Colorectal Cancer Screening 62.80% 60.99% 63.64% 74.42%
Preventive Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Breast Cancer Screening 2019 74.45% 72.92% 74.81% 81.58%
2018 73.66% 72.13% 73.73% 81.17%
2017 72.56% 71.85% 72.81% 80.91%
2016 72.12% 71.80% 72.90% 80.63%
Chlamydia Screening in Women-all Age groups 2019 55.20% 54.77% 51.86% 67.02%
2018 54.26% 52.91% 51.41% 67.76%
2017 52.90% 51.46% 50.16% 66.08%
2016 51.52% 49.79% 48.98% 63.50%
Colorectal Cancer Screening 2019 66.85% 68.10% 66.15% 77.91%
2018 66.67% 64.94% 64.37% 76.52%
2017 61.56% 65.16% 62.43% 74.72%
2016 63.70% 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 40.66% 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 42.44% 39.81% 42.11% 52.78%
2018 43.31% 44.14% 41.48% 50.95%
2017 44.36% 43.12% 41.90% 50.52%
2016 45.86% 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) 84.92% 85.75% 84.86% 89.67%
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 40–75 years (Female) 75.09% 77.46% 75.69% 81.94%
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - Total 82.35% 83.41% 82.46% 87.85%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 21-75 years (Male) 83.54% 81.24% 81.04% 86.60%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 40–75 years (Female) 79.95% 78.29% 77.58% 86.55%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - Total 82.68% 80.47% 80.55% 86.26%
Statin Therapy for Patients with Diabetes - Received Therapy 64.27% 66.42% 65.49% 71.27%
Statin Therapy for Patients with Diabetes - Statin Adherence 80% 77.21% 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 86.22% 85.53% 84.83% 90.71%
2018 84.98% 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 71.56% 75.96% 74.89% 81.82%
2018 69.38% 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 82.30% 82.97% 82.41% 88.24%
2018 80.82% 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 80.37% 78.19% 78.73% 85.40%
2018 81.29% 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 76.52% 75.98% 73.50% 82.09%
2018 77.50% 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 79.47% 77.63% 77.38% 84.14%
2018 80.42% 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 63.16% 65.53% 64.43% 70.97%
2018 62.17% 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 74.65% 71.84% 71.74% 79.50%
2018 74.65% 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 67.78% 61.27% 70.64% 88.81%
Children/Adolescents BMI Assessment - Ages 3-11 70.70% 64.54% 72.11% 88.89%
Children/Adolescents BMI Assessment - Ages 12-17 63.45% 57.19% 68.80% 87.79%
Counseling for Nutrition for Children/Adolescents - Total 65.28% 56.08% 65.06% 82.43%
Counseling for Nutrition for Children/Adolescents - Ages 3-11 70.70% 59.21% 67.32% 84.32%
Counseling for Nutrition for Children/Adolescents - Ages 12-17 57.24% 52.10% 62.24% 79.49%
Counseling for Physical Activity for Children/Adolescents - Total 63.61% 52.21% 60.81% 80.29%
Counseling for Physical Activity for Children/Adolescents - Ages 3-11 66.51% 52.27% 60.31% 81.14%
Counseling for Physical Activity for Children/Adolescents - Ages 12-17 59.31% 51.96% 61.40% 79.85%
Weight Assessment and Counseling Year Plan State Avg. Natl. Avg. 90th Pctl.
Children/Adolescents BMI Assessment - Total 2019 75.91% 74.97% 74.90% 90.00%
2018 75.91% 73.74% 72.87% 90.00%
2017 65.94% 70.41% 70.59% 88.08%
2016 66.51% 69.07% 65.62% 88.08%
Children/Adolescents BMI Assessment - Ages 3-11 2019 77.35% 78.68% 76.00% 90.91%
2018 77.35% 76.94% 74.00% 90.91%
2017 66.92% 71.37% 71.84% 88.89%
2016 68.00% 70.86% 67.11% 88.19%
Children/Adolescents BMI Assessment - Ages 12-17 2019 74.01% 70.46% 73.46% 89.29%
2018 74.01% 69.73% 71.39% 88.97%
2017 64.24% 68.96% 68.94% 87.82%
2016 64.37% 66.72% 64.28% 87.29%
Counseling for Nutrition for Children/Adolescents - Total 2019 75.18% 72.58% 68.74% 85.24%
2018 75.18% 71.79% 67.72% 85.06%
2017 63.99% 69.47% 65.50% 83.21%
2016 66.04% 66.76% 61.76% 83.68%
Counseling for Nutrition for Children/Adolescents - Ages 3-11 2019 79.06% 77.02% 71.33% 86.49%
2018 79.06% 75.91% 69.85% 86.21%
2017 65.38% 71.63% 68.20% 84.82%
2016 68.40% 69.25% 64.59% 85.48%
Counseling for Nutrition for Children/Adolescents - Ages 12-17 2019 70.06% 66.89% 65.44% 84.29%
2018 70.06% 66.37% 64.92% 84.29%
2017 61.59% 66.54% 61.92% 80.26%
2016 62.64% 63.42% 58.79% 81.87%
Counseling for Physical Activity for Children/Adolescents - Total 2019 68.37% 66.86% 64.24% 82.78%
2018 68.37% 66.42% 63.08% 81.32%
2017 58.15% 64.30% 59.96% 77.32%
2016 58.02% 60.41% 55.96% 79.44%
Counseling for Physical Activity for Children/Adolescents - Ages 3-11 2019 65.38% 66.12% 63.39% 82.53%
2018 65.38% 65.48% 61.70% 80.92%
2017 56.15% 62.31% 58.84% 75.00%
2016 56.00% 58.91% 54.72% 76.52%
Counseling for Physical Activity for Children/Adolescents - Ages 12-17 2019 72.32% 67.67% 65.38% 84.68%
2018 72.32% 67.51% 64.79% 84.03%
2017 61.59% 66.86% 61.40% 79.89%
2016 60.92% 62.44% 58.47% 83.05%
Health Plan Stability/Descriptive
Info
Administrative Data 2020 Plan State Avg Nat Avg 90th Pctl.
Administrative Ratio 0.22 0.13 N/A N/A
Medical Cost Ratio 0.75 0.81 N/A N/A
Number of Enrollees 83,967 170,871 N/A N/A
Number of Physicians 54,488 133,088 N/A N/A
Premium Per Member Per Month $468 $522 N/A N/A
Profit/Loss Ratio 0.04 0.06 N/A N/A
Administrative Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Administrative Ratio 2019 0.20 0.12 N/A N/A
2018 0.21 0.14 86.19 92.68
2017 0.21 0.12 86.39 93.13
2016 0.24 0.15 N/A N/A
Medical Cost Ratio 2019 0.74 0.84 N/A N/A
2018 0.77 0.83 92.60 95.85
2017 0.82 0.83 93.13 96.59
2016 0.79 0.83 N/A N/A
Number of Enrollees 2019 81,960 136,748 N/A N/A
2018 79,558 129,656 92 96
2017 84,851 133,992 92 97
2016 86,893 136,796 N/A N/A
Number of Physicians 2019 10,545 105,314 N/A N/A
2018 10,336 86,806 87 95
2017 10,155 81,926 87 95
2016 9,566 73,426 N/A N/A
Premium Per Member Per Month 2019 $455 $511 N/A N/A
2018 $455 $517 N/A N/A
2017 $404 $370 N/A N/A
2016 $373 $370 N/A N/A
Profit/Loss Ratio 2019 0.07 0.04 N/A N/A
2018 0.03 0.04 N/A N/A
2017 -0.02 0.05 N/A N/A
2016 -0.02 0.03 N/A N/A
Info
Financial Data 2020 Plan State Avg Nat Avg 90th Pctl.
Income $97,593,666 $117,272,490 N/A N/A
Net Worth $918,540,455 $414,233,312 N/A N/A
Premiums Earned $467,505,591 $1,173,200,139 N/A N/A
Financial Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Income 2019 $183,552,553 $81,234,487 N/A N/A
2018 $63,916,927 $44,046,244 N/A N/A
2017 $-27,820,788 $34,422,501 N/A N/A
2016 $-46,101,706 $38,212,136 N/A N/A
Net Worth 2019 $916,778,984 $340,553,480 N/A N/A
2018 $721,055,178 $279,558,644 N/A N/A
2017 $672,613,635 $263,890,874 N/A N/A
2016 $697,523,016 $267,217,323 N/A N/A
Premiums Earned 2019 $437,755,166 $936,529,722 N/A N/A
2018 $449,713,753 $815,577,345 N/A N/A
2017 $399,660,112 $645,600,589 N/A N/A
2016 $402,239,015 $644,862,921 N/A N/A
Info
Years in Business 2020 Plan State Avg Nat Avg 90th Pctl.
Years in Business 34 38 N/A N/A
Years in Business Year Plan State Avg. Natl. Avg. 90th Pctl.
Years in Business 2019 33 37 N/A N/A
2018 32 36 N/A N/A
2017 31 35 N/A N/A
2016 30 34 N/A N/A
Member Satisfaction
Info
Member Satisfaction 2020 Plan State Avg Nat Avg 90th Pctl.
Getting Care Quickly 90.72% 85.38% 86.32% 91.51%
Getting Needed Care 88.67% 87.88% 88.01% 92.51%
How Well Doctors Communicate 96.99% 95.93% 95.93% 97.98%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 73.13% 65.21% 69.04% 80.59%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 88.97% 86.67% 87.14% 91.18%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 85.64% 79.32% 80.71% 87.04%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 88.83% 85.69% 86.56% 91.30%
Member Satisfaction Year Plan State Avg. Natl. Avg. 90th Pctl.
Getting Care Quickly 2019 90.57% 87.14% 86.32% 90.57%
2018 84.64% 85.27% 85.23% 89.89%
2017 89.38% 87.22% 85.34% 89.83%
2016 85.94% 85.81% 85.14% 90.00%
Getting Needed Care 2019 89.16% 87.88% 87.38% 91.22%
2018 87.75% 85.53% 86.33% 90.45%
2017 89.05% 87.44% 86.71% 90.37%
2016 88.53% 86.38% 87.25% 91.54%
How Well Doctors Communicate 2019 95.73% 94.99% 95.85% 97.38%
2018 93.21% 94.70% 95.31% 97.22%
2017 94.93% 94.74% 95.10% 96.91%
2016 95.54% 95.22% 95.39% 97.21%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 2019 74.89% 69.24% 67.91% 78.57%
2018 69.03% 64.78% 64.53% 76.79%
2017 68.08% 61.26% 62.44% 75.00%
2016 68.16% 62.47% 62.27% 74.92%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 2019 87.07% 88.18% 86.27% 90.20%
2018 85.71% 84.82% 84.41% 88.57%
2017 83.96% 83.86% 84.62% 88.77%
2016 88.15% 83.44% 84.72% 88.74%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 2019 83.92% 79.81% 80.27% 86.36%
2018 76.09% 76.02% 78.17% 83.95%
2017 76.92% 76.98% 77.27% 82.99%
2016 77.09% 77.49% 77.19% 83.29%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 2019 87.25% 87.91% 87.34% 90.94%
2018 80.97% 84.08% 85.14% 89.78%
2017 81.70% 83.95% 84.60% 89.86%
2016 80.11% 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 32.89% 38.77% 31.82% 42.98%
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 60.32% 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 38.22% 42.62% 37.50% 49.28%
2018 39.90% 44.74% 36.17% 47.41%
2017 40.15% 50.55% 36.07% 48.57%
2016 40.16% 34.87% 35.80% 45.93%
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 2019 72.20% 63.47% 61.05% 78.36%
2018 62.41% 57.96% 56.00% 70.54%
2017 49.80% 58.14% 54.52% 68.67%
2016 56.85% 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 0.68% 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 0.90% 0.58% 0.85% 0.24%
2018 1.31% 0.71% 1.05% 0.33%
2017 1.59% 0.94% 1.47% 0.50%
2016 2.28% 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 76.01% 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 74.74% 77.01% 76.69% 83.47%
2018 72.94% 74.77% 75.11% 82.95%
2017 72.73% 73.85% 75.16% 82.29%
2016 70.27% 73.58% 72.67% 80.11%
Info
Respiratory 2020 Plan State Avg Nat Avg 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 93.12% 93.12% 91.57% 95.67%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 39.45% 41.88% 43.24% 59.45%
Respiratory Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 2019 92.25% 91.87% 90.76% 95.51%
2018 92.27% 92.50% 91.22% 95.48%
2017 91.29% 90.92% 89.19% 94.59%
2016 89.89% 88.81% 88.51% 94.80%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 2019 37.58% 38.42% 39.91% 54.09%
2018 31.66% 33.60% 33.16% 48.28%
2017 28.10% 30.67% 30.99% 49.52%
2016 23.59% 27.03% 28.19% 41.72%
Info
Use of Opioids 2020 Plan State Avg Nat Avg 90th Pctl.
Use of Opioids at High Dosage 11.64% 6.49% 5.76% 1.88%
Use of Opioids From Multiple Providers - Multiple Pharmacies 2.68% 2.32% 1.67% 0.62%
Use of Opioids From Multiple Providers - Multiple Prescribers 17.55% 16.62% 13.32% 8.20%
Use of Opioids From Multiple Providers - Multiple Prescribers and Multiple Pharmacies 1.36% 1.28% 0.76% 0.08%
Use of Opioids Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Opioids at High Dosage 2019 10.26% 6.96% 6.08% 1.88%
2018 9.02% 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 4.30% 3.71% 2.79% 0.69%
2018 9.14% 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 19.81% 17.64% 14.51% 9.79%
2018 26.52% 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 2.44% 1.70% 1.24% 0.00%
2018 5.93% 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 17.25% 21.48% 0.72% 0.53%
Acute Hospital Utilization - Surgery 11.54% 11.94% N/A N/A
Acute Hospital Utilization - Total Acute 28.80% 33.42% 0.97% 0.78%
Acute Hospital Utilization Rate Year Plan State Avg. Natl. Avg. 90th Pctl.
Acute Hospital Utilization - Medicine 2019 18.34% 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 14.37% 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 32.71% 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 126 125 N/A N/A
Emergency Department Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Emergency Department Utilization 2019 190 187 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) 4.42% 4.88% 0.58% 0.47%
Plan All-Cause Readmissions Ages 18-44 4.24% 4.26% N/A N/A
Plan All-Cause Readmissions Ages 45-54 4.19% 4.46% N/A N/A
Plan All-Cause Readmissions Ages 55-64 4.76% 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 3.82% 4.32% 0.51% 0.37%
2018 11.69% 11.17% N/A N/A
2017 11.13% 12.19% N/A N/A
2016 0.11% 0.12% N/A N/A
Plan All-Cause Readmissions Ages 18-44 2019 3.32% 4.54% N/A N/A
2018 12.20% 11.41% N/A N/A
2017 11.92% 12.99% N/A N/A
2016 0.12% 0.12% N/A N/A
Plan All-Cause Readmissions Ages 45-54 2019 4.12% 4.35% N/A N/A
2018 11.07% 10.56% N/A N/A
2017 10.59% 11.71% N/A N/A
2016 0.10% 0.12% N/A N/A
Plan All-Cause Readmissions Ages 55-64 2019 4.03% 4.26% N/A N/A
2018 11.67% 11.21% N/A N/A
2017 10.78% 11.93% N/A N/A
2016 0.10% 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 0.59 0.57 0.57 0.71
Average number of antibiotic prescriptions per member per year - Ages 0-9 0.41 0.41 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 0.37 0.33 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 0.55 0.53 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 0.61 0.59 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 0.76 0.70 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 0.88 0.77 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 1.02 0.80 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 0.75 1.56 N/A N/A
Days suppplied per antibiotic prescription - Total 10.460 10.133 10.310 11.480
Days suppplied per antibiotic prescription - Ages 0-9 10.480 10.550 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 14.860 14.369 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 10.080 9.729 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 10.030 9.703 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 10.230 10.027 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 10.590 9.997 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 10.680 10.119 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 8.920 10.606 N/A N/A
Prescriptions of concern - Total 0.240 0.227 0.240 0.320
Prescriptions of concern - Ages 0-9 0.15 0.15 N/A N/A
Prescriptions of concern - Ages 10-17 0.12 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 0.26 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 0.39 0.33 N/A N/A
Prescriptions of concern - Ages 75-85 0.44 0.34 N/A N/A
Prescriptions of concern - Ages 85 plus 0.38 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 0.79 0.75 0.74 0.90
2018 0.80 0.74 0.71 0.88
2017 0.82 0.77 0.76 0.90
2016 0.82 0.79 0.76 0.90
Average number of antibiotic prescriptions per member per year - Ages 0-9 2019 0.86 0.85 N/A N/A
2018 0.87 0.81 N/A N/A
2017 0.93 0.87 N/A N/A
2016 0.96 0.97 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 2019 0.59 0.52 N/A N/A
2018 0.61 0.52 N/A N/A
2017 0.66 0.57 N/A N/A
2016 0.66 0.60 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 2019 0.71 0.66 N/A N/A
2018 0.71 0.65 N/A N/A
2017 0.72 0.67 N/A N/A
2016 0.73 0.69 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 2019 0.78 0.74 N/A N/A
2018 0.78 0.73 N/A N/A
2017 0.79 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 0.93 0.85 N/A N/A
2018 0.94 0.84 N/A N/A
2017 0.95 0.88 N/A N/A
2016 0.94 0.87 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 2019 1.12 0.95 N/A N/A
2018 1.11 0.97 N/A N/A
2017 1.14 1.00 N/A N/A
2016 1.09 0.99 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 2019 1.19 1.15 N/A N/A
2018 1.15 1.21 N/A N/A
2017 1.25 1.12 N/A N/A
2016 1.19 1.23 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 2019 1.81 0.95 N/A N/A
2018 1.75 1.32 N/A N/A
2017 1.56 1.12 N/A N/A
2016 1.37 0.73 N/A N/A
Days suppplied per antibiotic prescription - Total 2019 10.050 9.888 9.890 10.660
2018 10.120 9.950 9.910 10.890
2017 10.210 10.024 9.880 10.830
2016 10.180 10.090 9.880 10.830
Days suppplied per antibiotic prescription - Ages 0-9 2019 10.050 10.025 N/A N/A
2018 9.970 9.979 N/A N/A
2017 10.000 10.050 N/A N/A
2016 9.850 10.041 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 2019 12.940 12.591 N/A N/A
2018 13.110 12.948 N/A N/A
2017 13.010 12.689 N/A N/A
2016 12.930 12.799 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 2019 9.900 9.695 N/A N/A
2018 10.010 9.731 N/A N/A
2017 10.070 9.836 N/A N/A
2016 10.080 10.074 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 2019 9.610 9.488 N/A N/A
2018 9.670 9.568 N/A N/A
2017 9.760 9.591 N/A N/A
2016 9.700 9.620 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 2019 9.820 9.756 N/A N/A
2018 9.870 9.769 N/A N/A
2017 10.000 9.856 N/A N/A
2016 10.030 9.816 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 2019 10.070 9.766 N/A N/A
2018 10.110 9.830 N/A N/A
2017 10.310 9.850 N/A N/A
2016 10.470 9.929 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 2019 10.400 9.645 N/A N/A
2018 10.200 9.428 N/A N/A
2017 10.430 10.604 N/A N/A
2016 10.600 10.594 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 2019 12.020 9.997 N/A N/A
2018 12.840 9.026 N/A N/A
2017 10.540 9.873 N/A N/A
2016 10.570 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 0.400 0.383 0.360 0.450
Prescriptions of concern - Ages 0-9 2019 0.33 0.34 N/A N/A
2018 0.34 0.32 N/A N/A
2017 0.37 0.35 N/A N/A
2016 0.41 0.43 N/A N/A
Prescriptions of concern - Ages 10-17 2019 0.23 0.20 N/A N/A
2018 0.23 0.20 N/A N/A
2017 0.26 0.22 N/A N/A
2016 0.28 0.24 N/A N/A
Prescriptions of concern - Ages 18-34 2019 0.30 0.28 N/A N/A
2018 0.31 0.28 N/A N/A
2017 0.31 0.28 N/A N/A
2016 0.34 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 0.40 0.37 N/A N/A
2016 0.42 0.40 N/A N/A
Prescriptions of concern - Ages 50-64 2019 0.46 0.41 N/A N/A
2018 0.48 0.42 N/A N/A
2017 0.49 0.44 N/A N/A
2016 0.50 0.46 N/A N/A
Prescriptions of concern - Ages 65-74 2019 0.54 0.44 N/A N/A
2018 0.54 0.48 N/A N/A
2017 0.56 0.50 N/A N/A
2016 0.58 0.51 N/A N/A
Prescriptions of concern - Ages 75-85 2019 0.60 0.51 N/A N/A
2018 0.56 0.62 N/A N/A
2017 0.61 0.54 N/A N/A
2016 0.62 0.65 N/A N/A
Prescriptions of concern - Ages 85 plus 2019 0.73 0.36 N/A N/A
2018 0.67 0.45 N/A N/A
2017 0.72 0.48 N/A N/A
2016 0.64 0.34 N/A N/A
Info
Mental Health Utilization 2020 Plan State Avg Nat Avg 90th Pctl.
Mental Health Utilization - Any Service - Total 12.11% 9.13% 9.07% 12.95%
Mental Health Utilization - Any Service - Ages 0-12 7.58% 6.25% N/A N/A
Mental Health Utilization - Any Service - Ages 13-17 19.22% 15.31% N/A N/A
Mental Health Utilization - Any Service - Ages 18-64 12.60% 9.40% N/A N/A
Mental Health Utilization - Any Service - Ages 65 plus 4.83% 3.53% N/A N/A
Mental Health Utilization - ED - Total 0.04% 0.03% 0.06% 0.15%
Mental Health Utilization - ED - Ages 0-12 0.02% 0.01% N/A N/A
Mental Health Utilization - ED - Ages 13-17 0.15% 0.10% N/A N/A
Mental Health Utilization - ED - Ages 18-64 0.04% 0.03% N/A N/A
Mental Health Utilization - ED - Ages 65 plus 0.02% 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 0.08% 0.07% N/A N/A
Mental Health Utilization - Inpatient - Ages 13-17 0.86% 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 0.07% 0.06% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Total 0.12% 0.07% 0.15% 0.30%
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 0-12 0.04% 0.05% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 13-17 0.52% 0.26% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 18-64 0.11% 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 9.27% 7.22% 6.95% 9.99%
Mental Health Utilization - Outpatient - Ages 0-12 5.99% 5.23% N/A N/A
Mental Health Utilization - Outpatient - Ages 13-17 15.75% 12.84% N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 9.51% 7.35% N/A N/A
Mental Health Utilization - Outpatient - Ages 65 plus 3.85% 2.62% N/A N/A
Mental Health Utilization - Telehealth - Total 7.69% 4.92% 5.19% 8.37%
Mental Health Utilization - Telehealth - Ages 0-12 4.57% 3.07% N/A N/A
Mental Health Utilization - Telehealth - Ages 13-17 11.78% 8.30% N/A N/A
Mental Health Utilization - Telehealth - Ages 18-64 8.10% 5.11% N/A N/A
Mental Health Utilization - Telehealth - Ages 65 plus 2.64% 1.80% N/A N/A
Mental Health Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Mental Health Utilization - Any Service - Total 2019 11.77% 8.33% 8.86% 12.67%
2018 10.40% 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 7.75% 6.35% N/A N/A
2018 7.05% 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 19.28% 15.01% N/A N/A
2018 17.29% 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 12.12% 8.45% N/A N/A
2018 10.63% 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 4.68% 3.17% N/A N/A
2018 4.67% 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 0.06% 0.04% 0.08% 0.17%
2018 0.17% 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 0.03% 0.02% N/A N/A
2018 0.08% 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 0.25% 0.17% N/A N/A
2018 0.57% 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 0.05% 0.03% N/A N/A
2018 0.16% 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 0.02% 0.07% N/A N/A
2018 0.06% 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 0.28% 0.25% 0.27% 0.34%
2018 0.28% 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 0.09% 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 0.99% 0.85% N/A N/A
2018 1.03% 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 0.26% 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 0.10% 0.11% N/A N/A
2018 0.05% 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 0.18% 0.11% 0.20% 0.40%
2018 0.16% 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 0.79% 0.35% N/A N/A
2018 0.72% 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 0.15% 0.09% N/A N/A
2018 0.14% 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 11.66% 8.24% 8.73% 12.61%
2018 10.28% 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 7.73% 6.32% N/A N/A
2018 7.03% 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 19.10% 14.86% N/A N/A
2018 17.08% 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 12.00% 8.36% N/A N/A
2018 10.50% 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 4.63% 3.07% N/A N/A
2018 4.62% 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 0.31% 0.11% 0.11% 0.22%
2018 0.13% 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 0.07% 0.04% N/A N/A
2018 0.02% 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 0.45% 0.15% N/A N/A
2018 0.25% 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 0.35% 0.12% N/A N/A
2018 0.15% 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 0.05% 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
2020 data updated on: 02/08/2022