Health Insurance in Virginia

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Optima Health Plan

Company Information

  • Company Providing Plan:Optima Health Plan
  • Address:4417 Corporation Lane
    Virginia Beach, VA 23462
  • Telephone :757-552-7401
  • Website:www.sentara.com
2020
Number of Enrollees: 413,250
PMPM: $593
Number of Physicians: 20,058
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

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

Cities

Bedford, Bristol, Buena Vista, Charlottesville, Chesapeake, Colonial Heights, Covington, Danville, Emporia, Franklin, Fredericksburg, Galax, Hampton, Harrisonburg, Hopewell, Lexington, Lynchburg, Martinsville, Newport News, Norfolk, Norton, Petersburg, Poquoson, Portsmouth, Radford, Richmond, Roanoke, Salem, Staunton, Suffolk, Virginia Beach, Waynesboro, Williamsburg, Winchester

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

Administrative Data

2020 2019 2018 2017 2016
Number of Enrollees 413,250 360,886 347,283 303,866 294,873
PMPM $593 $572 $566 $425 $396
Medical Cost Ratio 88% 93% 85% 90% 91%
Administrative Ratio 10% 10% 10% 9% 8%
Profit/Loss Ratio 4% -1% 6% 1% 1%
Number of Physicians 20,058 18,667 17,219 16,458 15,931

*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 $2,848,363,972 $2,437,500,928 $2,382,336,230 $1,491,595,258 $1,395,696,663
Income $101,286,137 ($34,951,248) $139,305,813 $15,658,596 $9,628,472
Net Worth $367,060,472 $277,918,858 $315,612,837 $244,239,759 $222,565,488

*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 93.73% 93.90% 92.88% 95.71%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 96.45% 96.11% 95.86% 97.54%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 97.36% 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 93.34% 92.78% 92.66% 95.76%
2018 93.74% 92.43% 92.33% 95.45%
2017 93.83% 92.73% 92.45% 95.43%
2016 93.62% 92.81% 92.73% 95.55%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 2019 96.62% 95.78% 95.87% 97.69%
2018 96.58% 95.50% 95.64% 97.49%
2017 96.57% 95.57% 95.61% 97.46%
2016 96.47% 95.78% 95.78% 97.61%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 2019 97.66% 97.13% 97.14% 98.42%
2018 97.95% 97.15% 97.17% 98.45%
2017 97.84% 97.82% 97.07% 98.47%
2016 97.65% 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 34.61% 40.49% 36.39% 45.24%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 43.59% 35.48% 44.95% 59.06%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 34.38% 40.55% 36.18% 45.12%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 10.75% 15.16% 12.46% 17.48%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 17.95% 14.80% 17.76% 27.27%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 10.56% 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 35.57% 39.13% 35.63% 41.36%
2018 35.18% 37.53% 35.68% 42.36%
2017 33.46% 36.14% 36.11% 42.01%
2016 29.88% 35.69% 32.93% 40.24%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2019 55.77% 36.19% 42.41% 54.29%
2018 28.57% 49.35% 40.21% 51.02%
2017 35.42% 40.06% 39.91% 52.54%
2016 17.46% 40.15% 40.47% 51.96%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2019 34.97% 39.20% 35.47% 40.96%
2018 35.31% 37.34% 35.51% 42.35%
2017 33.40% 36.00% 35.97% 41.96%
2016 30.34% 35.55% 32.64% 40.33%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 2019 10.68% 13.47% 12.31% 16.44%
2018 10.20% 14.69% 12.58% 17.04%
2017 11.55% 13.36% 12.65% 17.26%
2016 8.65% 12.51% 11.46% 16.72%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2019 9.62% 10.34% 16.48% 27.14%
2018 3.57% 18.18% 16.91% 25.00%
2017 10.42% 14.40% 14.95% 23.85%
2016 3.17% 11.28% 15.68% 23.73%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2019 10.71% 13.52% 12.20% 16.41%
2018 10.32% 14.58% 12.47% 16.97%
2017 11.59% 13.40% 12.55% 17.38%
2016 8.85% 12.57% 11.32% 16.09%
Info
Prenatal and Postpartum Care 2020 Plan State Avg Nat Avg 90th Pctl.
Postpartum Care 85.40% 74.05% 78.11% 92.47%
Timeliness of Prenatal Care 88.56% 79.76% 81.82% 93.92%
Prenatal and Postpartum Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Postpartum Care 2019 88.80% 78.66% 80.52% 91.97%
2018 88.80% 75.10% 75.89% 88.80%
2017 82.10% 73.45% 75.05% 88.13%
2016 84.35% 74.50% 73.95% 88.85%
Timeliness of Prenatal Care 2019 92.40% 86.76% 85.57% 95.33%
2018 92.40% 88.15% 84.75% 94.17%
2017 92.58% 86.37% 84.34% 94.89%
2016 89.57% 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 64.10% 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 76.46% 77.14% 73.70% 81.07%
Antidepressant Medication Management - Effective Continuation Phase Treatment 61.90% 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 74.42% 73.53% 71.19% 78.79%
2018 71.41% 71.96% 68.64% 77.59%
2017 69.60% 71.12% 67.11% 75.76%
2016 68.70% 70.29% 66.56% 74.77%
Antidepressant Medication Management - Effective Continuation Phase Treatment 2019 59.33% 55.44% 54.90% 62.18%
2018 55.88% 54.22% 53.01% 60.39%
2017 53.81% 54.87% 51.53% 60.24%
2016 52.37% 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 38.99% 45.87% 41.24% 50.34%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 51.92% 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 38.68% 42.67% 40.66% 51.30%
2018 38.35% 42.91% 39.85% 50.42%
2017 35.15% 41.27% 41.13% 50.83%
2016 32.91% 41.91% 38.93% 48.61%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 2019 43.62% 50.69% 47.95% 58.82%
2018 50.00% 40.32% 48.73% 60.57%
2017 40.57% 55.09% 47.07% 58.44%
2016 36.75% 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 10.91% 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 16.97% 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 7.91% 8.56% 11.48% 18.26%
2018 9.94% 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 10.17% 14.74% 15.35% 24.56%
2018 14.29% 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 45.45% 48.22% 47.90% 68.29%
Follow-Up After Emergency Department Visit for Mental Illness within 30 days after hospital discharge 60.23% 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 46.00% 45.64% 48.70% 70.67%
2018 38.92% 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 64.50% 60.35% 62.59% 77.75%
2018 56.65% 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 41.40% 49.46% 49.62% 63.68%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 69.09% 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 43.12% 49.77% 45.66% 58.20%
2018 47.86% 48.09% 44.98% 60.38%
2017 51.23% 52.18% 46.63% 62.81%
2016 58.73% 52.99% 52.06% 67.31%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 2019 73.08% 72.38% 67.81% 80.65%
2018 73.29% 69.84% 66.68% 80.29%
2017 74.19% 69.80% 68.66% 82.58%
2016 80.50% 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 93.60% 93.70% 89.98% 95.00%
Asthma Medication Ratio - Ages 12-18 80.34% 84.76% 81.90% 89.30%
Asthma Medication Ratio - Ages 19-50 80.75% 78.90% 75.62% 84.47%
Asthma Medication Ratio - Ages 51-64 85.90% 85.69% 82.47% 89.38%
Asthma Medication Ratio - Total 84.01% 83.04% 79.76% 85.85%
Asthma Medication Ratio Year Plan State Avg. Natl. Avg. 90th Pctl.
Asthma Medication Ratio - Ages 5-11 2019 89.88% 86.54% 85.94% 93.20%
2018 88.94% 85.26% 87.15% 93.97%
2017 86.36% 86.06% 86.90% 93.55%
2016 92.98% 91.67% 86.40% 93.97%
Asthma Medication Ratio - Ages 12-18 2019 79.59% 84.88% 77.43% 86.25%
2018 80.63% 84.71% 78.77% 84.72%
2017 84.21% 84.80% 76.69% 85.94%
2016 87.10% 81.12% 78.30% 86.34%
Asthma Medication Ratio - Ages 19-50 2019 80.72% 80.50% 74.07% 81.27%
2018 81.22% 82.69% 75.11% 82.84%
2017 80.14% 78.94% 74.23% 81.70%
2016 77.88% 75.24% 73.51% 81.08%
Asthma Medication Ratio - Ages 51-64 2019 88.49% 86.85% 81.27% 88.51%
2018 87.33% 86.11% 82.81% 89.49%
2017 86.99% 89.17% 82.83% 89.28%
2016 85.81% 83.27% 81.70% 88.64%
Asthma Medication Ratio - Total 2019 84.69% 83.92% 78.10% 84.69%
2018 84.35% 84.32% 79.34% 85.18%
2017 83.99% 84.01% 79.04% 85.85%
2016 84.02% 80.60% 78.29% 85.46%
Info
Cardiovascular Disease Management 2020 Plan State Avg Nat Avg 90th Pctl.
Controlling High Blood Pressure 53.53% 43.15% 53.49% 69.10%
Persistence of Beta-Blockers 87.16% 87.06% 87.38% 94.19%
Cardiovascular Disease Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Controlling High Blood Pressure 2019 66.42% 60.96% 61.02% 74.21%
2018 66.42% 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 87.77% 88.62% 85.16% 92.47%
2018 86.78% 83.54% 82.37% 89.29%
2017 87.40% 85.80% 85.18% 93.41%
2016 86.36% 90.70% 83.61% 90.83%
Info
Cervical Cancer Screening 2020 Plan State Avg Nat Avg 90th Pctl.
Cervical Cancer Screening 71.48% 75.44% 75.50% 81.71%
Cervical Cancer Screening Year Plan State Avg. Natl. Avg. 90th Pctl.
Cervical Cancer Screening 2019 76.74% 78.50% 77.40% 83.91%
2018 76.74% 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 91.48% 90.05% 84.77% 92.62%
Common Childhood Illnesses Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Testing for Children With Pharyngitis 2019 90.48% 90.44% 86.62% 93.98%
2018 93.57% 92.74% 87.97% 94.94%
2017 93.55% 92.30% 87.45% 94.64%
2016 90.72% 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) 57.22% 44.59% 55.85% 73.48%
Comprehensive Diabetes Care-HbA1c control (<8.0%) 56.70% 55.20% 55.37% 65.50%
Comprehensive Diabetes Care-Rate of Eye Exams 55.93% 53.44% 50.27% 64.23%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 34.54% 36.05% 34.87% 23.45%
Comprehensive Diabetes Care-Testing for HbA1c 89.43% 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 62.28% 62.53% 63.23% 77.86%
2018 68.23% 63.70% 62.59% 77.37%
2017 63.14% 63.40% 60.82% 76.41%
2016 62.80% 60.88% 61.06% 78.35%
Comprehensive Diabetes Care-HbA1c control (<8.0%) 2019 65.57% 63.81% 58.07% 66.33%
2018 66.15% 62.46% 57.79% 66.33%
2017 64.18% 62.51% 57.48% 67.15%
2016 64.22% 58.36% 56.62% 66.39%
Comprehensive Diabetes Care-Rate of Eye Exams 2019 62.53% 58.32% 55.45% 69.32%
2018 60.16% 56.58% 54.40% 69.68%
2017 71.13% 56.95% 54.06% 70.69%
2016 72.04% 58.46% 52.96% 72.04%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 2019 25.06% 26.09% 30.80% 20.82%
2018 26.82% 27.18% 30.85% 20.62%
2017 26.55% 27.63% 31.91% 21.41%
2016 24.64% 30.47% 32.15% 20.98%
Comprehensive Diabetes Care-Testing for HbA1c 2019 91.90% 92.45% 91.60% 94.71%
2018 91.67% 92.11% 91.29% 94.71%
2017 90.21% 91.52% 90.96% 94.18%
2016 91.00% 90.38% 90.32% 94.83%
Info
Immunizations 2020 Plan State Avg Nat Avg 90th Pctl.
Childhood Immunization for Multiple Diseases Including Chicken Pox 83.25% 76.23% 77.26% 88.52%
Childhood Immunization for Multiple Diseases Including Pneumovax 82.22% 74.94% 75.84% 87.36%
Flu Vaccinations for Adults Ages 18-64 57.92% 57.13% 57.41% 67.88%
Immunizations for Adolescents - Combination 2 33.33% 61.54% N/A N/A
Immunizations for Adolescents - HPV 36.50% 35.09% 31.84% 39.17%
Immunizations for Adolescents - Meningococcal 75.67% 37.80% 33.38% 42.34%
Immunizations for Adolescents - Tdap 94.89% 80.71% 85.83% 93.12%
Immunizations Year Plan State Avg. Natl. Avg. 90th Pctl.
Childhood Immunization for Multiple Diseases Including Chicken Pox 2019 85.44% 82.73% 80.16% 89.29%
2018 85.44% 80.96% 79.32% 88.06%
2017 90.27% 73.55% 79.44% 89.14%
2016 85.38% 75.86% 78.93% 89.03%
Childhood Immunization for Multiple Diseases Including Pneumovax 2019 84.10% 81.30% 78.32% 87.99%
2018 84.10% 79.46% 77.50% 86.62%
2017 89.03% 80.09% 77.67% 87.61%
2016 82.60% 82.08% 77.04% 87.50%
Flu Vaccinations for Adults Ages 18-64 2019 59.83% 59.38% 55.06% 65.24%
2018 58.39% 53.06% 51.93% 61.07%
2017 65.63% 55.21% 49.33% 59.27%
2016 N/A N/A N/A N/A
Immunizations for Adolescents - Combination 2 2019 26.28% 55.69% N/A N/A
2018 72.51% 55.16% N/A N/A
2017 71.53% 47.24% N/A N/A
2016 69.61% N/A N/A N/A
Immunizations for Adolescents - HPV 2019 28.95% 33.16% 29.59% 40.63%
2018 28.95% 79.55% 82.25% 91.52%
2017 22.14% 80.48% 80.23% 89.54%
2016 69.61% 77.95% 77.63% 88.81%
Immunizations for Adolescents - Meningococcal 2019 72.99% 35.43% 31.21% 42.46%
2018 72.99% 32.22% 28.05% 37.23%
2017 71.78% 28.29% 23.98% 32.36%
2016 70.53% 77.95% 77.63% 88.81%
Immunizations for Adolescents - Tdap 2019 96.11% 81.83% 85.01% 92.59%
2018 96.11% 80.66% 83.69% 92.94%
2017 95.86% 82.05% 81.75% 90.27%
2016 94.20% 79.65% 79.20% 90.02%
Info
Pharmacotherapy of COPD Exacerbation 2020 Plan State Avg Nat Avg 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 87.38% 86.03% 81.34% 88.51%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 73.79% 75.06% 74.31% 85.07%
Pharmacotherapy of COPD Exacerbation Year Plan State Avg. Natl. Avg. 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 2019 83.13% 83.91% 80.32% 88.97%
2018 83.23% 85.49% 78.92% 87.88%
2017 78.39% 80.88% 79.87% 87.50%
2016 84.52% 84.12% 76.30% 85.98%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 2019 84.38% 81.14% 76.90% 87.69%
2018 78.88% 76.41% 74.76% 83.55%
2017 77.89% 78.84% 76.26% 84.38%
2016 81.29% 79.54% 70.70% 81.82%
Info
Preventive Care 2020 Plan State Avg Nat Avg 90th Pctl.
Breast Cancer Screening 75.90% 72.56% 72.44% 79.39%
Chlamydia Screening in Women-all Age groups 47.98% 49.80% 48.49% 63.85%
Colorectal Cancer Screening 67.54% 60.99% 63.64% 74.42%
Preventive Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Breast Cancer Screening 2019 77.09% 72.92% 74.81% 81.58%
2018 77.56% 72.13% 73.73% 81.17%
2017 77.61% 71.85% 72.81% 80.91%
2016 77.04% 71.80% 72.90% 80.63%
Chlamydia Screening in Women-all Age groups 2019 48.41% 54.77% 51.86% 67.02%
2018 50.37% 52.91% 51.41% 67.76%
2017 48.28% 51.46% 50.16% 66.08%
2016 48.70% 49.79% 48.98% 63.50%
Colorectal Cancer Screening 2019 76.52% 68.10% 66.15% 77.91%
2018 76.52% 64.94% 64.37% 76.52%
2017 73.77% 65.16% 62.43% 74.72%
2016 67.01% 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 37.69% 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 41.63% 39.81% 42.11% 52.78%
2018 43.74% 44.14% 41.48% 50.95%
2017 45.54% 43.12% 41.90% 50.52%
2016 43.30% 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) 83.71% 85.75% 84.86% 89.67%
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 40–75 years (Female) 80.99% 77.46% 75.69% 81.94%
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - Total 82.92% 83.41% 82.46% 87.85%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 21-75 years (Male) 80.27% 81.24% 81.04% 86.60%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 40–75 years (Female) 75.17% 78.29% 77.58% 86.55%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - Total 78.83% 80.47% 80.55% 86.26%
Statin Therapy for Patients with Diabetes - Received Therapy 66.16% 66.42% 65.49% 71.27%
Statin Therapy for Patients with Diabetes - Statin Adherence 80% 74.42% 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 85.87% 85.53% 84.83% 90.71%
2018 85.22% 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 78.89% 75.96% 74.89% 81.82%
2018 74.53% 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 83.93% 82.97% 82.41% 88.24%
2018 82.11% 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 78.11% 78.19% 78.73% 85.40%
2018 74.58% 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 76.25% 75.98% 73.50% 82.09%
2018 68.73% 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 77.62% 77.63% 77.38% 84.14%
2018 73.03% 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 64.26% 65.53% 64.43% 70.97%
2018 62.38% 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 70.70% 71.84% 71.74% 79.50%
2018 68.28% 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 71.32% 61.27% 70.64% 88.81%
Children/Adolescents BMI Assessment - Ages 3-11 74.88% 64.54% 72.11% 88.89%
Children/Adolescents BMI Assessment - Ages 12-17 67.53% 57.19% 68.80% 87.79%
Counseling for Nutrition for Children/Adolescents - Total 65.09% 56.08% 65.06% 82.43%
Counseling for Nutrition for Children/Adolescents - Ages 3-11 68.12% 59.21% 67.32% 84.32%
Counseling for Nutrition for Children/Adolescents - Ages 12-17 61.86% 52.10% 62.24% 79.49%
Counseling for Physical Activity for Children/Adolescents - Total 57.61% 52.21% 60.81% 80.29%
Counseling for Physical Activity for Children/Adolescents - Ages 3-11 55.07% 52.27% 60.31% 81.14%
Counseling for Physical Activity for Children/Adolescents - Ages 12-17 60.31% 51.96% 61.40% 79.85%
Weight Assessment and Counseling Year Plan State Avg. Natl. Avg. 90th Pctl.
Children/Adolescents BMI Assessment - Total 2019 73.92% 74.97% 74.90% 90.00%
2018 72.86% 73.74% 72.87% 90.00%
2017 72.61% 70.41% 70.59% 88.08%
2016 75.82% 69.07% 65.62% 88.08%
Children/Adolescents BMI Assessment - Ages 3-11 2019 78.64% 78.68% 76.00% 90.91%
2018 73.01% 76.94% 74.00% 90.91%
2017 75.11% 71.37% 71.84% 88.89%
2016 77.87% 70.86% 67.11% 88.19%
Children/Adolescents BMI Assessment - Ages 12-17 2019 68.00% 70.46% 73.46% 89.29%
2018 72.67% 69.73% 71.39% 88.97%
2017 69.36% 68.96% 68.94% 87.82%
2016 72.83% 66.72% 64.28% 87.29%
Counseling for Nutrition for Children/Adolescents - Total 2019 67.09% 72.58% 68.74% 85.24%
2018 66.33% 71.79% 67.72% 85.06%
2017 68.59% 69.47% 65.50% 83.21%
2016 69.01% 66.76% 61.76% 83.68%
Counseling for Nutrition for Children/Adolescents - Ages 3-11 2019 73.18% 77.02% 71.33% 86.49%
2018 70.80% 75.91% 69.85% 86.21%
2017 73.78% 71.63% 68.20% 84.82%
2016 73.12% 69.25% 64.59% 85.48%
Counseling for Nutrition for Children/Adolescents - Ages 12-17 2019 59.43% 66.89% 65.44% 84.29%
2018 60.47% 66.37% 64.92% 84.29%
2017 61.85% 66.54% 61.92% 80.26%
2016 63.01% 63.42% 58.79% 81.87%
Counseling for Physical Activity for Children/Adolescents - Total 2019 58.73% 66.86% 64.24% 82.78%
2018 60.05% 66.42% 63.08% 81.32%
2017 59.55% 64.30% 59.96% 77.32%
2016 59.86% 60.41% 55.96% 79.44%
Counseling for Physical Activity for Children/Adolescents - Ages 3-11 2019 58.64% 66.12% 63.39% 82.53%
2018 57.96% 65.48% 61.70% 80.92%
2017 59.11% 62.31% 58.84% 75.00%
2016 58.10% 58.91% 54.72% 76.52%
Counseling for Physical Activity for Children/Adolescents - Ages 12-17 2019 58.86% 67.67% 65.38% 84.68%
2018 62.79% 67.51% 64.79% 84.03%
2017 60.12% 66.86% 61.40% 79.89%
2016 62.43% 62.44% 58.47% 83.05%
Health Plan Stability/Descriptive
Info
Administrative Data 2020 Plan State Avg Nat Avg 90th Pctl.
Administrative Ratio 0.10 0.13 N/A N/A
Medical Cost Ratio 0.88 0.81 N/A N/A
Number of Enrollees 413,250 170,871 N/A N/A
Number of Physicians 20,058 133,088 N/A N/A
Premium Per Member Per Month $593 $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 0.10 0.12 N/A N/A
2018 0.10 0.14 86.19 92.68
2017 0.09 0.12 86.39 93.13
2016 0.08 0.15 N/A N/A
Medical Cost Ratio 2019 0.93 0.84 N/A N/A
2018 0.85 0.83 92.60 95.85
2017 0.90 0.83 93.13 96.59
2016 0.91 0.83 N/A N/A
Number of Enrollees 2019 360,886 136,748 N/A N/A
2018 347,283 129,656 92 96
2017 303,866 133,992 92 97
2016 294,873 136,796 N/A N/A
Number of Physicians 2019 18,667 105,314 N/A N/A
2018 17,219 86,806 87 95
2017 16,458 81,926 87 95
2016 15,931 73,426 N/A N/A
Premium Per Member Per Month 2019 $572 $511 N/A N/A
2018 $566 $517 N/A N/A
2017 $425 $370 N/A N/A
2016 $396 $370 N/A N/A
Profit/Loss Ratio 2019 -0.01 0.04 N/A N/A
2018 0.06 0.04 N/A N/A
2017 0.01 0.05 N/A N/A
2016 0.01 0.03 N/A N/A
Info
Financial Data 2020 Plan State Avg Nat Avg 90th Pctl.
Income $101,286,137 $117,272,490 N/A N/A
Net Worth $367,060,472 $414,233,312 N/A N/A
Premiums Earned $2,848,363,972 $1,173,200,139 N/A N/A
Financial Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Income 2019 $-34,951,248 $81,234,487 N/A N/A
2018 $139,305,813 $44,046,244 N/A N/A
2017 $15,658,596 $34,422,501 N/A N/A
2016 $9,628,472 $38,212,136 N/A N/A
Net Worth 2019 $277,918,858 $340,553,480 N/A N/A
2018 $315,612,837 $279,558,644 N/A N/A
2017 $244,239,759 $263,890,874 N/A N/A
2016 $222,565,488 $267,217,323 N/A N/A
Premiums Earned 2019 $2,437,500,928 $936,529,722 N/A N/A
2018 $2,382,336,230 $815,577,345 N/A N/A
2017 $1,491,595,258 $645,600,589 N/A N/A
2016 $1,395,696,663 $644,862,921 N/A N/A
Info
Years in Business 2020 Plan State Avg Nat Avg 90th Pctl.
Years in Business 36 38 N/A N/A
Years in Business Year Plan State Avg. Natl. Avg. 90th Pctl.
Years in Business 2019 35 37 N/A N/A
2018 34 36 N/A N/A
2017 33 35 N/A N/A
2016 32 34 N/A N/A
Member Satisfaction
Info
Member Satisfaction 2020 Plan State Avg Nat Avg 90th Pctl.
Getting Care Quickly 79.50% 85.38% 86.32% 91.51%
Getting Needed Care 84.80% 87.88% 88.01% 92.51%
How Well Doctors Communicate 96.18% 95.93% 95.93% 97.98%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 70.40% 65.21% 69.04% 80.59%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 84.46% 86.67% 87.14% 91.18%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 79.80% 79.32% 80.71% 87.04%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 84.68% 85.69% 86.56% 91.30%
Member Satisfaction Year Plan State Avg. Natl. Avg. 90th Pctl.
Getting Care Quickly 2019 90.93% 87.14% 86.32% 90.57%
2018 87.06% 85.27% 85.23% 89.89%
2017 87.80% 87.22% 85.34% 89.83%
2016 87.42% 85.81% 85.14% 90.00%
Getting Needed Care 2019 88.31% 87.88% 87.38% 91.22%
2018 87.60% 85.53% 86.33% 90.45%
2017 88.20% 87.44% 86.71% 90.37%
2016 87.37% 86.38% 87.25% 91.54%
How Well Doctors Communicate 2019 94.47% 94.99% 95.85% 97.38%
2018 95.85% 94.70% 95.31% 97.22%
2017 96.79% 94.74% 95.10% 96.91%
2016 96.20% 95.22% 95.39% 97.21%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 2019 66.00% 69.24% 67.91% 78.57%
2018 64.31% 64.78% 64.53% 76.79%
2017 59.40% 61.26% 62.44% 75.00%
2016 60.24% 62.47% 62.27% 74.92%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 2019 88.75% 88.18% 86.27% 90.20%
2018 88.77% 84.82% 84.41% 88.57%
2017 84.43% 83.86% 84.62% 88.77%
2016 85.93% 83.44% 84.72% 88.74%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 2019 76.34% 79.81% 80.27% 86.36%
2018 79.86% 76.02% 78.17% 83.95%
2017 81.22% 76.98% 77.27% 82.99%
2016 76.81% 77.49% 77.19% 83.29%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 2019 88.68% 87.91% 87.34% 90.94%
2018 83.86% 84.08% 85.14% 89.78%
2017 87.90% 83.95% 84.60% 89.86%
2016 87.45% 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 27.85% 38.77% 31.82% 42.98%
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 43.90% 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 30.26% 42.62% 37.50% 49.28%
2018 33.78% 44.74% 36.17% 47.41%
2017 36.26% 50.55% 36.07% 48.57%
2016 22.11% 34.87% 35.80% 45.93%
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 2019 58.49% 63.47% 61.05% 78.36%
2018 58.18% 57.96% 56.00% 70.54%
2017 55.00% 58.14% 54.52% 68.67%
2016 66.67% 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 0.51% 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 0.51% 0.58% 0.85% 0.24%
2018 0.56% 0.71% 1.05% 0.33%
2017 0.79% 0.94% 1.47% 0.50%
2016 0.96% 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 69.82% 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 70.51% 77.01% 76.69% 83.47%
2018 70.09% 74.77% 75.11% 82.95%
2017 68.47% 73.85% 75.16% 82.29%
2016 68.67% 73.58% 72.67% 80.11%
Info
Respiratory 2020 Plan State Avg Nat Avg 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 91.88% 93.12% 91.57% 95.67%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 38.32% 41.88% 43.24% 59.45%
Respiratory Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 2019 91.64% 91.87% 90.76% 95.51%
2018 91.61% 92.50% 91.22% 95.48%
2017 89.01% 90.92% 89.19% 94.59%
2016 86.33% 88.81% 88.51% 94.80%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 2019 35.92% 38.42% 39.91% 54.09%
2018 31.56% 33.60% 33.16% 48.28%
2017 24.80% 30.67% 30.99% 49.52%
2016 17.28% 27.03% 28.19% 41.72%
Info
Use of Opioids 2020 Plan State Avg Nat Avg 90th Pctl.
Use of Opioids at High Dosage 7.22% 6.49% 5.76% 1.88%
Use of Opioids From Multiple Providers - Multiple Pharmacies 2.52% 2.32% 1.67% 0.62%
Use of Opioids From Multiple Providers - Multiple Prescribers 17.51% 16.62% 13.32% 8.20%
Use of Opioids From Multiple Providers - Multiple Prescribers and Multiple Pharmacies 1.61% 1.28% 0.76% 0.08%
Use of Opioids Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Opioids at High Dosage 2019 5.87% 6.96% 6.08% 1.88%
2018 4.39% 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 4.61% 3.71% 2.79% 0.69%
2018 5.55% 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 17.41% 17.64% 14.51% 9.79%
2018 17.97% 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 2.27% 1.70% 1.24% 0.00%
2018 2.81% 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 22.91% 21.48% 0.72% 0.53%
Acute Hospital Utilization - Surgery 12.96% 11.94% N/A N/A
Acute Hospital Utilization - Total Acute 35.87% 33.42% 0.97% 0.78%
Acute Hospital Utilization Rate Year Plan State Avg. Natl. Avg. 90th Pctl.
Acute Hospital Utilization - Medicine 2019 31.93% 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 17.11% 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 49.04% 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 167 125 N/A N/A
Emergency Department Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Emergency Department Utilization 2019 227 187 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) 4.37% 4.88% 0.58% 0.47%
Plan All-Cause Readmissions Ages 18-44 4.39% 4.26% N/A N/A
Plan All-Cause Readmissions Ages 45-54 4.02% 4.46% N/A N/A
Plan All-Cause Readmissions Ages 55-64 4.57% 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 4.46% 4.32% 0.51% 0.37%
2018 12.57% 11.17% N/A N/A
2017 11.95% 12.19% N/A N/A
2016 0.12% 0.12% N/A N/A
Plan All-Cause Readmissions Ages 18-44 2019 4.60% 4.54% N/A N/A
2018 13.58% 11.41% N/A N/A
2017 13.14% 12.99% N/A N/A
2016 0.13% 0.12% N/A N/A
Plan All-Cause Readmissions Ages 45-54 2019 4.87% 4.35% N/A N/A
2018 12.17% 10.56% N/A N/A
2017 11.58% 11.71% N/A N/A
2016 0.11% 0.12% N/A N/A
Plan All-Cause Readmissions Ages 55-64 2019 4.12% 4.26% N/A N/A
2018 12.09% 11.21% N/A N/A
2017 11.33% 11.93% N/A N/A
2016 0.11% 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 0.65 0.57 0.57 0.71
Average number of antibiotic prescriptions per member per year - Ages 0-9 0.46 0.41 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 0.36 0.33 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 0.63 0.53 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 0.68 0.59 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 0.78 0.70 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 0.86 0.77 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 0.87 0.80 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 0.65 1.56 N/A N/A
Days suppplied per antibiotic prescription - Total 10.020 10.133 10.310 11.480
Days suppplied per antibiotic prescription - Ages 0-9 10.520 10.550 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 13.410 14.369 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 9.400 9.729 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 9.490 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 10.130 9.997 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 10.490 10.119 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 8.200 10.606 N/A N/A
Prescriptions of concern - Total 0.240 0.227 0.240 0.320
Prescriptions of concern - Ages 0-9 0.17 0.15 N/A N/A
Prescriptions of concern - Ages 10-17 0.11 0.11 N/A N/A
Prescriptions of concern - Ages 18-34 0.22 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 0.32 0.31 N/A N/A
Prescriptions of concern - Ages 65-74 0.33 0.33 N/A N/A
Prescriptions of concern - Ages 75-85 0.35 0.34 N/A N/A
Prescriptions of concern - Ages 85 plus 0.45 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 0.82 0.75 0.74 0.90
2018 0.80 0.74 0.71 0.88
2017 0.84 0.77 0.76 0.90
2016 0.87 0.79 0.76 0.90
Average number of antibiotic prescriptions per member per year - Ages 0-9 2019 0.92 0.85 N/A N/A
2018 0.84 0.81 N/A N/A
2017 0.93 0.87 N/A N/A
2016 1.05 0.97 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 2019 0.54 0.52 N/A N/A
2018 0.52 0.52 N/A N/A
2017 0.59 0.57 N/A N/A
2016 0.63 0.60 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 2019 0.73 0.66 N/A N/A
2018 0.73 0.65 N/A N/A
2017 0.76 0.67 N/A N/A
2016 0.78 0.69 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 2019 0.82 0.74 N/A N/A
2018 0.81 0.73 N/A N/A
2017 0.84 0.75 N/A N/A
2016 0.87 0.77 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 2019 0.94 0.85 N/A N/A
2018 0.92 0.84 N/A N/A
2017 0.97 0.88 N/A N/A
2016 0.96 0.87 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 2019 1.08 0.95 N/A N/A
2018 1.01 0.97 N/A N/A
2017 1.07 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 1.30 1.15 N/A N/A
2018 1.37 1.21 N/A N/A
2017 1.31 1.12 N/A N/A
2016 1.16 1.23 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 2019 1.03 0.95 N/A N/A
2018 1.71 1.32 N/A N/A
2017 2.32 1.12 N/A N/A
2016 1.06 0.73 N/A N/A
Days suppplied per antibiotic prescription - Total 2019 9.760 9.888 9.890 10.660
2018 9.770 9.950 9.910 10.890
2017 9.730 10.024 9.880 10.830
2016 9.680 10.090 9.880 10.830
Days suppplied per antibiotic prescription - Ages 0-9 2019 9.990 10.025 N/A N/A
2018 9.930 9.979 N/A N/A
2017 9.830 10.050 N/A N/A
2016 9.730 10.041 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 2019 12.320 12.591 N/A N/A
2018 12.170 12.948 N/A N/A
2017 12.030 12.689 N/A N/A
2016 11.970 12.799 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 2019 9.250 9.695 N/A N/A
2018 9.340 9.731 N/A N/A
2017 9.420 9.836 N/A N/A
2016 9.300 10.074 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 2019 9.400 9.488 N/A N/A
2018 9.430 9.568 N/A N/A
2017 9.260 9.591 N/A N/A
2016 9.210 9.620 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 2019 9.820 9.756 N/A N/A
2018 9.850 9.769 N/A N/A
2017 9.780 9.856 N/A N/A
2016 9.790 9.816 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 2019 9.750 9.766 N/A N/A
2018 9.480 9.830 N/A N/A
2017 9.640 9.850 N/A N/A
2016 9.760 9.929 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 2019 10.880 9.645 N/A N/A
2018 10.990 9.428 N/A N/A
2017 12.090 10.604 N/A N/A
2016 11.940 10.594 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 2019 9.070 9.997 N/A N/A
2018 7.280 9.026 N/A N/A
2017 14.390 9.873 N/A N/A
2016 9.080 9.431 N/A N/A
Prescriptions of concern - Total 2019 0.340 0.339 0.330 0.430
2018 0.340 0.338 0.330 0.430
2017 0.370 0.354 0.360 0.450
2016 0.410 0.383 0.360 0.450
Prescriptions of concern - Ages 0-9 2019 0.35 0.34 N/A N/A
2018 0.32 0.32 N/A N/A
2017 0.35 0.35 N/A N/A
2016 0.45 0.43 N/A N/A
Prescriptions of concern - Ages 10-17 2019 0.19 0.20 N/A N/A
2018 0.18 0.20 N/A N/A
2017 0.21 0.22 N/A N/A
2016 0.25 0.24 N/A N/A
Prescriptions of concern - Ages 18-34 2019 0.29 0.28 N/A N/A
2018 0.29 0.28 N/A N/A
2017 0.31 0.28 N/A N/A
2016 0.35 0.31 N/A N/A
Prescriptions of concern - Ages 35-49 2019 0.36 0.35 N/A N/A
2018 0.36 0.35 N/A N/A
2017 0.39 0.37 N/A N/A
2016 0.44 0.40 N/A N/A
Prescriptions of concern - Ages 50-64 2019 0.43 0.41 N/A N/A
2018 0.43 0.42 N/A N/A
2017 0.46 0.44 N/A N/A
2016 0.49 0.46 N/A N/A
Prescriptions of concern - Ages 65-74 2019 0.48 0.44 N/A N/A
2018 0.46 0.48 N/A N/A
2017 0.51 0.50 N/A N/A
2016 0.53 0.51 N/A N/A
Prescriptions of concern - Ages 75-85 2019 0.42 0.51 N/A N/A
2018 0.54 0.62 N/A N/A
2017 0.42 0.54 N/A N/A
2016 0.51 0.65 N/A N/A
Prescriptions of concern - Ages 85 plus 2019 0.62 0.36 N/A N/A
2018 0.76 0.45 N/A N/A
2017 0.50 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 10.17% 9.13% 9.07% 12.95%
Mental Health Utilization - Any Service - Ages 0-12 7.85% 6.25% N/A N/A
Mental Health Utilization - Any Service - Ages 13-17 17.50% 15.31% N/A N/A
Mental Health Utilization - Any Service - Ages 18-64 10.16% 9.40% N/A N/A
Mental Health Utilization - Any Service - Ages 65 plus 3.73% 3.53% N/A N/A
Mental Health Utilization - ED - Total 0.00% 0.03% 0.06% 0.15%
Mental Health Utilization - ED - Ages 0-12 0.00% 0.01% N/A N/A
Mental Health Utilization - ED - Ages 13-17 0.02% 0.10% N/A N/A
Mental Health Utilization - ED - Ages 18-64 0.00% 0.03% N/A N/A
Mental Health Utilization - ED - Ages 65 plus 0.00% 0.01% N/A N/A
Mental Health Utilization - Inpatient - Total 0.21% 0.22% 0.24% 0.31%
Mental Health Utilization - Inpatient - Ages 0-12 0.07% 0.07% N/A N/A
Mental Health Utilization - Inpatient - Ages 13-17 0.78% 0.79% N/A N/A
Mental Health Utilization - Inpatient - Ages 18-64 0.19% 0.20% N/A N/A
Mental Health Utilization - Inpatient - Ages 65 plus 0.04% 0.06% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Total 0.05% 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 0.18% 0.26% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 18-64 0.04% 0.06% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 65 plus 0.00% 0.01% N/A N/A
Mental Health Utilization - Outpatient - Total 8.17% 7.22% 6.95% 9.99%
Mental Health Utilization - Outpatient - Ages 0-12 6.73% 5.23% N/A N/A
Mental Health Utilization - Outpatient - Ages 13-17 15.12% 12.84% N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 8.00% 7.35% N/A N/A
Mental Health Utilization - Outpatient - Ages 65 plus 3.23% 2.62% N/A N/A
Mental Health Utilization - Telehealth - Total 5.43% 4.92% 5.19% 8.37%
Mental Health Utilization - Telehealth - Ages 0-12 3.61% 3.07% N/A N/A
Mental Health Utilization - Telehealth - Ages 13-17 9.24% 8.30% N/A N/A
Mental Health Utilization - Telehealth - Ages 18-64 5.54% 5.11% N/A N/A
Mental Health Utilization - Telehealth - Ages 65 plus 1.59% 1.80% N/A N/A
Mental Health Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Mental Health Utilization - Any Service - Total 2019 10.21% 8.33% 8.86% 12.67%
2018 9.52% 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 8.66% 6.35% N/A N/A
2018 8.39% 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 18.52% 15.01% N/A N/A
2018 16.95% 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 9.99% 8.45% N/A N/A
2018 9.27% 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 3.78% 3.17% N/A N/A
2018 3.64% 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 0.01% 0.04% 0.08% 0.17%
2018 0.06% 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 0.00% 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 0.03% 0.17% N/A N/A
2018 0.24% 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 0.00% 0.03% N/A N/A
2018 0.05% 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 0.00% 0.07% N/A N/A
2018 0.00% 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 0.27% 0.25% 0.27% 0.34%
2018 0.25% 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 0.12% 0.12% N/A N/A
2018 0.10% 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 0.83% 0.85% N/A N/A
2018 0.72% 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 0.24% 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 0.04% 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 0.07% 0.11% 0.20% 0.40%
2018 0.11% 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 0.18% 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 0.14% 0.35% N/A N/A
2018 0.46% 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 0.06% 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 0.00% 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
Mental Health Utilization - Outpatient - Total 2019 10.14% 8.24% 8.73% 12.61%
2018 9.47% 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 8.64% 6.32% N/A N/A
2018 8.37% 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 18.45% 14.86% N/A N/A
2018 16.85% 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 9.92% 8.36% N/A N/A
2018 9.21% 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 3.76% 3.07% N/A N/A
2018 3.64% 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 0.05% 0.11% 0.11% 0.22%
2018 0.03% 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 0.02% 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 0.02% 0.15% N/A N/A
2018 0.05% 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 0.06% 0.12% N/A N/A
2018 0.04% 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