Health Insurance in Virginia

HMO Profile

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UnitedHealthcare of the Mid-Atlantic, Inc.

Company Information

  • Company Providing Plan:United Healthcare
  • Address:9800 Health Care Lane MN006-W500
    Minnetonka, MN 55343
  • Telephone :866-297-9264
  • Website:www.uhc.com
2020
Number of Enrollees: *188,553
PMPM: *$649
Number of Physicians: *82,569
NCQA Accreditation: Accredited

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

Coverage Areas

Counties

All in Commonwealth of Virginia

Cities

All in Commonwealth of Virginia

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

Administrative Data

2020 2019 2018 2017 2016
*Number of Enrollees 188,553 155,376 88,797 83,174 16,756
PMPM $649 $612 $264 $337 $321
*Medical Cost Ratio 82% 85% 78% 81% 79%
*Administrative Ratio 11% 12% 16% 12% 13%
*Profit/Loss Ratio 8% 3% 7% 7% 10%
*Number of Physicians 82,569 62,910 58,540 68,443 43,435

*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 $1,349,629,148 $1,079,057,557 $241,397,116 $116,588,510 $58,634,436
*Income $120,165,618 $38,898,687 $47,154,871 $39,162,340 $62,387,299
*Net Worth $311,875,402 $196,178,614 $155,676,875 $104,478,161 $139,848,163

*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 93.13% 93.90% 92.88% 95.71%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 95.32% 96.11% 95.86% 97.54%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 94.83% 96.79% 96.95% 98.30%
Adult Access To Preventive/Ambulatory Health Services Year Plan State Avg. Natl. Avg. 90th Pctl.
Adult Access (Age 20-44) To Preventive/Ambulatory Health Services 2019 92.23% 92.78% 92.66% 95.76%
2018 92.64% 92.43% 92.33% 95.45%
2017 94.12% 92.73% 92.45% 95.43%
2016 93.37% 92.81% 92.73% 95.55%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 2019 94.63% 95.78% 95.87% 97.69%
2018 94.55% 95.50% 95.64% 97.49%
2017 95.87% 95.57% 95.61% 97.46%
2016 94.81% 95.78% 95.78% 97.61%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 2019 97.25% 97.13% 97.14% 98.42%
2018 98.06% 97.15% 97.17% 98.45%
2017 98.84% 97.82% 97.07% 98.47%
2016 96.00% 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 36.78% 40.49% 36.39% 45.24%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 0.00% 35.48% 44.95% 59.06%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 37.21% 40.55% 36.18% 45.12%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 10.34% 15.16% 12.46% 17.48%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 0.00% 14.80% 17.76% 27.27%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 10.47% 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 38.61% 39.13% 35.63% 41.36%
2018 36.14% 37.53% 35.68% 42.36%
2017 35.94% 36.14% 36.11% 42.01%
2016 35.56% 35.69% 32.93% 40.24%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2019 50.00% 36.19% 42.41% 54.29%
2018 100.00% 49.35% 40.21% 51.02%
2017 33.33% 40.06% 39.91% 52.54%
2016 50.00% 40.15% 40.47% 51.96%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2019 38.38% 39.20% 35.47% 40.96%
2018 35.37% 37.34% 35.51% 42.35%
2017 36.21% 36.00% 35.97% 41.96%
2016 34.88% 35.55% 32.64% 40.33%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 2019 11.88% 13.47% 12.31% 16.44%
2018 20.48% 14.69% 12.58% 17.04%
2017 10.94% 13.36% 12.65% 17.26%
2016 11.11% 12.51% 11.46% 16.72%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2019 0.00% 10.34% 16.48% 27.14%
2018 0.00% 18.18% 16.91% 25.00%
2017 0.00% 14.40% 14.95% 23.85%
2016 0.00% 11.28% 15.68% 23.73%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2019 12.12% 13.52% 12.20% 16.41%
2018 20.73% 14.58% 12.47% 16.97%
2017 12.07% 13.40% 12.55% 17.38%
2016 11.63% 12.57% 11.32% 16.09%
Info
Prenatal and Postpartum Care 2020 Plan State Avg Nat Avg 90th Pctl.
Postpartum Care 56.52% 74.05% 78.11% 92.47%
Timeliness of Prenatal Care 60.87% 79.76% 81.82% 93.92%
Prenatal and Postpartum Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Postpartum Care 2019 80.11% 78.66% 80.52% 91.97%
2018 80.11% 75.10% 75.89% 88.80%
2017 70.97% 73.45% 75.05% 88.13%
2016 68.24% 74.50% 73.95% 88.85%
Timeliness of Prenatal Care 2019 82.95% 86.76% 85.57% 95.33%
2018 82.95% 88.15% 84.75% 94.17%
2017 80.65% 86.37% 84.34% 94.89%
2016 88.24% 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 50.00% 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 77.11% 77.14% 73.70% 81.07%
Antidepressant Medication Management - Effective Continuation Phase Treatment 60.49% 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 69.17% 73.53% 71.19% 78.79%
2018 66.67% 71.96% 68.64% 77.59%
2017 64.84% 71.12% 67.11% 75.76%
2016 71.23% 70.29% 66.56% 74.77%
Antidepressant Medication Management - Effective Continuation Phase Treatment 2019 52.26% 55.44% 54.90% 62.18%
2018 49.72% 54.22% 53.01% 60.39%
2017 53.85% 54.87% 51.53% 60.24%
2016 56.16% 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 39.02% 45.87% 41.24% 50.34%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 66.67% 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 59.52% 42.67% 40.66% 51.30%
2018 44.44% 42.91% 39.85% 50.42%
2017 22.22% 41.27% 41.13% 50.83%
2016 46.67% 41.91% 38.93% 48.61%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 2019 62.50% 50.69% 47.95% 58.82%
2018 0.00% 40.32% 48.73% 60.57%
2017 100.00% 55.09% 47.07% 58.44%
2016 25.00% 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 25.00% 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 25.00% 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 0.00% 8.56% 11.48% 18.26%
2018 5.56% 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 12.50% 14.74% 15.35% 24.56%
2018 5.56% 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 50.00% 48.22% 47.90% 68.29%
Follow-Up After Emergency Department Visit for Mental Illness within 30 days after hospital discharge 50.00% 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 50.00% 45.64% 48.70% 70.67%
2018 27.27% 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 64.29% 60.35% 62.59% 77.75%
2018 27.27% 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 37.50% 49.46% 49.62% 63.68%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 75.00% 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 52.38% 49.77% 45.66% 58.20%
2018 40.63% 48.09% 44.98% 60.38%
2017 38.89% 52.18% 46.63% 62.81%
2016 61.54% 52.99% 52.06% 67.31%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 2019 71.43% 72.38% 67.81% 80.65%
2018 65.63% 69.84% 66.68% 80.29%
2017 44.44% 69.80% 68.66% 82.58%
2016 84.62% 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 5-11 100.00% 93.70% 89.98% 95.00%
Asthma Medication Ratio - Ages 12-18 93.75% 84.76% 81.90% 89.30%
Asthma Medication Ratio - Ages 19-50 73.17% 78.90% 75.62% 84.47%
Asthma Medication Ratio - Ages 51-64 83.64% 85.69% 82.47% 89.38%
Asthma Medication Ratio - Total 80.12% 83.04% 79.76% 85.85%
Asthma Medication Ratio Year Plan State Avg. Natl. Avg. 90th Pctl.
Asthma Medication Ratio - Ages 5-11 2019 83.33% 86.54% 85.94% 93.20%
2018 78.57% 85.26% 87.15% 93.97%
2017 75.00% 86.06% 86.90% 93.55%
2016 100.00% 91.67% 86.40% 93.97%
Asthma Medication Ratio - Ages 12-18 2019 83.33% 84.88% 77.43% 86.25%
2018 100.00% 84.71% 78.77% 84.72%
2017 100.00% 84.80% 76.69% 85.94%
2016 100.00% 81.12% 78.30% 86.34%
Asthma Medication Ratio - Ages 19-50 2019 77.05% 80.50% 74.07% 81.27%
2018 88.00% 82.69% 75.11% 82.84%
2017 79.17% 78.94% 74.23% 81.70%
2016 70.37% 75.24% 73.51% 81.08%
Asthma Medication Ratio - Ages 51-64 2019 81.40% 86.85% 81.27% 88.51%
2018 78.57% 86.11% 82.81% 89.49%
2017 100.00% 89.17% 82.83% 89.28%
2016 71.43% 83.27% 81.70% 88.64%
Asthma Medication Ratio - Total 2019 79.69% 83.92% 78.10% 84.69%
2018 83.33% 84.32% 79.34% 85.18%
2017 87.27% 84.01% 79.04% 85.85%
2016 76.00% 80.60% 78.29% 85.46%
Info
Cardiovascular Disease Management 2020 Plan State Avg Nat Avg 90th Pctl.
Controlling High Blood Pressure 11.48% 43.15% 53.49% 69.10%
Persistence of Beta-Blockers 82.35% 87.06% 87.38% 94.19%
Cardiovascular Disease Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Controlling High Blood Pressure 2019 63.26% 60.96% 61.02% 74.21%
2018 63.26% 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 80.00% 88.62% 85.16% 92.47%
2018 66.67% 83.54% 82.37% 89.29%
2017 80.00% 85.80% 85.18% 93.41%
2016 100.00% 90.70% 83.61% 90.83%
Info
Cervical Cancer Screening 2020 Plan State Avg Nat Avg 90th Pctl.
Cervical Cancer Screening 69.14% 75.44% 75.50% 81.71%
Cervical Cancer Screening Year Plan State Avg. Natl. Avg. 90th Pctl.
Cervical Cancer Screening 2019 76.89% 78.50% 77.40% 83.91%
2018 76.68% 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 93.13% 90.05% 84.77% 92.62%
Common Childhood Illnesses Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Testing for Children With Pharyngitis 2019 91.01% 90.44% 86.62% 93.98%
2018 90.75% 92.74% 87.97% 94.94%
2017 91.73% 92.30% 87.45% 94.64%
2016 93.75% 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) 12.05% 44.59% 55.85% 73.48%
Comprehensive Diabetes Care-HbA1c control (<8.0%) 39.83% 55.20% 55.37% 65.50%
Comprehensive Diabetes Care-Rate of Eye Exams 38.36% 53.44% 50.27% 64.23%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 52.44% 36.05% 34.87% 23.45%
Comprehensive Diabetes Care-Testing for HbA1c 86.11% 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 63.02% 62.53% 63.23% 77.86%
2018 63.02% 63.70% 62.59% 77.37%
2017 63.25% 63.40% 60.82% 76.41%
2016 54.69% 60.88% 61.06% 78.35%
Comprehensive Diabetes Care-HbA1c control (<8.0%) 2019 54.50% 63.81% 58.07% 66.33%
2018 54.50% 62.46% 57.79% 66.33%
2017 57.76% 62.51% 57.48% 67.15%
2016 51.13% 58.36% 56.62% 66.39%
Comprehensive Diabetes Care-Rate of Eye Exams 2019 37.71% 58.32% 55.45% 69.32%
2018 37.71% 56.58% 54.40% 69.68%
2017 40.81% 56.95% 54.06% 70.69%
2016 47.25% 58.46% 52.96% 72.04%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 2019 34.06% 26.09% 30.80% 20.82%
2018 34.06% 27.18% 30.85% 20.62%
2017 30.31% 27.63% 31.91% 21.41%
2016 37.54% 30.47% 32.15% 20.98%
Comprehensive Diabetes Care-Testing for HbA1c 2019 91.00% 92.45% 91.60% 94.71%
2018 91.00% 92.11% 91.29% 94.71%
2017 92.60% 91.52% 90.96% 94.18%
2016 89.00% 90.38% 90.32% 94.83%
Info
Immunizations 2020 Plan State Avg Nat Avg 90th Pctl.
Childhood Immunization for Multiple Diseases Including Chicken Pox 58.38% 76.23% 77.26% 88.52%
Childhood Immunization for Multiple Diseases Including Pneumovax 55.68% 74.94% 75.84% 87.36%
Flu Vaccinations for Adults Ages 18-64 46.41% 57.13% 57.41% 67.88%
Immunizations for Adolescents - Combination 2 22.08% 61.54% N/A N/A
Immunizations for Adolescents - HPV 24.68% 35.09% 31.84% 39.17%
Immunizations for Adolescents - Meningococcal 69.70% 37.80% 33.38% 42.34%
Immunizations for Adolescents - Tdap 90.04% 80.71% 85.83% 93.12%
Immunizations Year Plan State Avg. Natl. Avg. 90th Pctl.
Childhood Immunization for Multiple Diseases Including Chicken Pox 2019 82.18% 82.73% 80.16% 89.29%
2018 76.60% 80.96% 79.32% 88.06%
2017 80.95% 73.55% 79.44% 89.14%
2016 88.14% 75.86% 78.93% 89.03%
Childhood Immunization for Multiple Diseases Including Pneumovax 2019 78.74% 81.30% 78.32% 87.99%
2018 75.53% 79.46% 77.50% 86.62%
2017 80.95% 80.09% 77.67% 87.61%
2016 84.75% 82.08% 77.04% 87.50%
Flu Vaccinations for Adults Ages 18-64 2019 50.85% 59.38% 55.06% 65.24%
2018 36.00% 53.06% 51.93% 61.07%
2017 44.35% 55.21% 49.33% 59.27%
2016 N/A N/A N/A N/A
Immunizations for Adolescents - Combination 2 2019 20.54% 55.69% N/A N/A
2018 68.75% 55.16% N/A N/A
2017 83.78% 47.24% N/A N/A
2016 78.87% N/A N/A N/A
Immunizations for Adolescents - HPV 2019 24.11% 33.16% 29.59% 40.63%
2018 24.11% 79.55% 82.25% 91.52%
2017 21.62% 80.48% 80.23% 89.54%
2016 78.87% 77.95% 77.63% 88.81%
Immunizations for Adolescents - Meningococcal 2019 70.54% 35.43% 31.21% 42.46%
2018 70.54% 32.22% 28.05% 37.23%
2017 89.19% 28.29% 23.98% 32.36%
2016 80.28% 77.95% 77.63% 88.81%
Immunizations for Adolescents - Tdap 2019 83.93% 81.83% 85.01% 92.59%
2018 83.93% 80.66% 83.69% 92.94%
2017 87.84% 82.05% 81.75% 90.27%
2016 92.96% 79.65% 79.20% 90.02%
Info
Pharmacotherapy of COPD Exacerbation 2020 Plan State Avg Nat Avg 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 86.67% 86.03% 81.34% 88.51%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 73.33% 75.06% 74.31% 85.07%
Pharmacotherapy of COPD Exacerbation Year Plan State Avg. Natl. Avg. 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 2019 66.67% 83.91% 80.32% 88.97%
2018 84.62% 85.49% 78.92% 87.88%
2017 75.00% 80.88% 79.87% 87.50%
2016 100.00% 84.12% 76.30% 85.98%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 2019 91.67% 81.14% 76.90% 87.69%
2018 69.23% 76.41% 74.76% 83.55%
2017 87.50% 78.84% 76.26% 84.38%
2016 100.00% 79.54% 70.70% 81.82%
Info
Preventive Care 2020 Plan State Avg Nat Avg 90th Pctl.
Breast Cancer Screening 67.48% 72.56% 72.44% 79.39%
Chlamydia Screening in Women-all Age groups 48.85% 49.80% 48.49% 63.85%
Colorectal Cancer Screening 39.78% 60.99% 63.64% 74.42%
Preventive Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Breast Cancer Screening 2019 69.48% 72.92% 74.81% 81.58%
2018 70.15% 72.13% 73.73% 81.17%
2017 71.76% 71.85% 72.81% 80.91%
2016 72.76% 71.80% 72.90% 80.63%
Chlamydia Screening in Women-all Age groups 2019 49.61% 54.77% 51.86% 67.02%
2018 48.93% 52.91% 51.41% 67.76%
2017 50.44% 51.46% 50.16% 66.08%
2016 48.86% 49.79% 48.98% 63.50%
Colorectal Cancer Screening 2019 55.53% 68.10% 66.15% 77.91%
2018 55.53% 64.94% 64.37% 76.52%
2017 59.12% 65.16% 62.43% 74.72%
2016 61.57% 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 40.54% 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 20.00% 39.81% 42.11% 52.78%
2018 52.94% 44.14% 41.48% 50.95%
2017 33.33% 43.12% 41.90% 50.52%
2016 31.25% 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) 88.70% 85.75% 84.86% 89.67%
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 40–75 years (Female) 71.79% 77.46% 75.69% 81.94%
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - Total 84.42% 83.41% 82.46% 87.85%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 21-75 years (Male) 83.33% 81.24% 81.04% 86.60%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 40–75 years (Female) 78.57% 78.29% 77.58% 86.55%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - Total 82.31% 80.47% 80.55% 86.26%
Statin Therapy for Patients with Diabetes - Received Therapy 64.43% 66.42% 65.49% 71.27%
Statin Therapy for Patients with Diabetes - Statin Adherence 80% 70.13% 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 84.91% 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 70.37% 75.96% 74.89% 81.82%
2018 75.00% 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 82.35% 82.97% 82.41% 88.24%
2018 82.61% 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 72.15% 78.19% 78.73% 85.40%
2018 57.78% 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 78.95% 75.98% 73.50% 82.09%
2018 66.67% 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 73.47% 77.63% 77.38% 84.14%
2018 59.65% 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 62.02% 65.53% 64.43% 70.97%
2018 62.91% 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 68.75% 71.84% 71.74% 79.50%
2018 56.07% 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 28.64% 61.27% 70.64% 88.81%
Children/Adolescents BMI Assessment - Ages 3-11 30.03% 64.54% 72.11% 88.89%
Children/Adolescents BMI Assessment - Ages 12-17 26.65% 57.19% 68.80% 87.79%
Counseling for Nutrition for Children/Adolescents - Total 18.34% 56.08% 65.06% 82.43%
Counseling for Nutrition for Children/Adolescents - Ages 3-11 19.48% 59.21% 67.32% 84.32%
Counseling for Nutrition for Children/Adolescents - Ages 12-17 16.71% 52.10% 62.24% 79.49%
Counseling for Physical Activity for Children/Adolescents - Total 14.34% 52.21% 60.81% 80.29%
Counseling for Physical Activity for Children/Adolescents - Ages 3-11 14.24% 52.27% 60.31% 81.14%
Counseling for Physical Activity for Children/Adolescents - Ages 12-17 14.48% 51.96% 61.40% 79.85%
Weight Assessment and Counseling Year Plan State Avg. Natl. Avg. 90th Pctl.
Children/Adolescents BMI Assessment - Total 2019 71.90% 74.97% 74.90% 90.00%
2018 71.90% 73.74% 72.87% 90.00%
2017 64.96% 70.41% 70.59% 88.08%
2016 62.04% 69.07% 65.62% 88.08%
Children/Adolescents BMI Assessment - Ages 3-11 2019 74.26% 78.68% 76.00% 90.91%
2018 74.26% 76.94% 74.00% 90.91%
2017 65.32% 71.37% 71.84% 88.89%
2016 64.50% 70.86% 67.11% 88.19%
Children/Adolescents BMI Assessment - Ages 12-17 2019 68.35% 70.46% 73.46% 89.29%
2018 68.35% 69.73% 71.39% 88.97%
2017 64.42% 68.96% 68.94% 87.82%
2016 59.20% 66.72% 64.28% 87.29%
Counseling for Nutrition for Children/Adolescents - Total 2019 69.87% 72.58% 68.74% 85.24%
2018 69.87% 71.79% 67.72% 85.06%
2017 68.61% 69.47% 65.50% 83.21%
2016 62.04% 66.76% 61.76% 83.68%
Counseling for Nutrition for Children/Adolescents - Ages 3-11 2019 75.11% 77.02% 71.33% 86.49%
2018 75.11% 75.91% 69.85% 86.21%
2017 72.58% 71.63% 68.20% 84.82%
2016 66.67% 69.25% 64.59% 85.48%
Counseling for Nutrition for Children/Adolescents - Ages 12-17 2019 62.03% 66.89% 65.44% 84.29%
2018 62.03% 66.37% 64.92% 84.29%
2017 62.58% 66.54% 61.92% 80.26%
2016 56.72% 63.42% 58.79% 81.87%
Counseling for Physical Activity for Children/Adolescents - Total 2019 60.00% 66.86% 64.24% 82.78%
2018 60.00% 66.42% 63.08% 81.32%
2017 60.58% 64.30% 59.96% 77.32%
2016 54.86% 60.41% 55.96% 79.44%
Counseling for Physical Activity for Children/Adolescents - Ages 3-11 2019 58.23% 66.12% 63.39% 82.53%
2018 58.23% 65.48% 61.70% 80.92%
2017 60.48% 62.31% 58.84% 75.00%
2016 54.11% 58.91% 54.72% 76.52%
Counseling for Physical Activity for Children/Adolescents - Ages 12-17 2019 62.66% 67.67% 65.38% 84.68%
2018 62.66% 67.51% 64.79% 84.03%
2017 60.74% 66.86% 61.40% 79.89%
2016 55.72% 62.44% 58.47% 83.05%
Health Plan Stability/Descriptive
Info
Administrative Data 2020 Plan State Avg Nat Avg 90th Pctl.
Administrative Ratio 0.11 0.13 N/A N/A
Medical Cost Ratio 0.82 0.81 N/A N/A
Number of Enrollees 188,553 170,871 N/A N/A
Number of Physicians 82,569 133,088 N/A N/A
Premium Per Member Per Month $649 $522 N/A N/A
Profit/Loss Ratio 0.08 0.06 N/A N/A
Administrative Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Administrative Ratio 2019 0.12 0.12 N/A N/A
2018 0.16 0.14 86.19 92.68
2017 0.12 0.12 86.39 93.13
2016 0.13 0.15 N/A N/A
Medical Cost Ratio 2019 0.85 0.84 N/A N/A
2018 0.78 0.83 92.60 95.85
2017 0.81 0.83 93.13 96.59
2016 0.79 0.83 N/A N/A
Number of Enrollees 2019 155,376 136,748 N/A N/A
2018 88,797 129,656 92 96
2017 83,174 133,992 92 97
2016 16,756 136,796 N/A N/A
Number of Physicians 2019 62,910 105,314 N/A N/A
2018 58,540 86,806 87 95
2017 68,443 81,926 87 95
2016 43,435 73,426 N/A N/A
Premium Per Member Per Month 2019 $612 $511 N/A N/A
2018 $264 $517 N/A N/A
2017 $337 $370 N/A N/A
2016 $321 $370 N/A N/A
Profit/Loss Ratio 2019 0.03 0.04 N/A N/A
2018 0.07 0.04 N/A N/A
2017 0.07 0.05 N/A N/A
2016 0.10 0.03 N/A N/A
Info
Financial Data 2020 Plan State Avg Nat Avg 90th Pctl.
Income $120,165,618 $117,272,490 N/A N/A
Net Worth $311,875,402 $414,233,312 N/A N/A
Premiums Earned $1,349,629,148 $1,173,200,139 N/A N/A
Financial Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Income 2019 $38,898,687 $81,234,487 N/A N/A
2018 $47,154,871 $44,046,244 N/A N/A
2017 $39,162,340 $34,422,501 N/A N/A
2016 $62,387,299 $38,212,136 N/A N/A
Net Worth 2019 $196,178,614 $340,553,480 N/A N/A
2018 $155,676,875 $279,558,644 N/A N/A
2017 $104,478,161 $263,890,874 N/A N/A
2016 $139,848,163 $267,217,323 N/A N/A
Premiums Earned 2019 $1,079,057,557 $936,529,722 N/A N/A
2018 $241,397,116 $815,577,345 N/A N/A
2017 $116,588,510 $645,600,589 N/A N/A
2016 $58,634,436 $644,862,921 N/A N/A
Info
Years in Business 2020 Plan State Avg Nat Avg 90th Pctl.
Years in Business 43 38 N/A N/A
Years in Business Year Plan State Avg. Natl. Avg. 90th Pctl.
Years in Business 2019 42 37 N/A N/A
2018 41 36 N/A N/A
2017 40 35 N/A N/A
2016 39 34 N/A N/A
Member Satisfaction
Info
Member Satisfaction 2020 Plan State Avg Nat Avg 90th Pctl.
Getting Care Quickly N/A 85.38% 86.32% 91.51%
Getting Needed Care 86.38% 87.88% 88.01% 92.51%
How Well Doctors Communicate 95.39% 95.93% 95.93% 97.98%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 56.92% 65.21% 69.04% 80.59%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 85.98% 86.67% 87.14% 91.18%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 71.72% 79.32% 80.71% 87.04%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 82.64% 85.69% 86.56% 91.30%
Member Satisfaction Year Plan State Avg. Natl. Avg. 90th Pctl.
Getting Care Quickly 2019 87.13% 87.14% 86.32% 90.57%
2018 82.23% 85.27% 85.23% 89.89%
2017 82.02% 87.22% 85.34% 89.83%
2016 83.47% 85.81% 85.14% 90.00%
Getting Needed Care 2019 88.60% 87.88% 87.38% 91.22%
2018 80.06% 85.53% 86.33% 90.45%
2017 87.87% 87.44% 86.71% 90.37%
2016 85.23% 86.38% 87.25% 91.54%
How Well Doctors Communicate 2019 96.20% 94.99% 95.85% 97.38%
2018 94.15% 94.70% 95.31% 97.22%
2017 96.89% 94.74% 95.10% 96.91%
2016 94.59% 95.22% 95.39% 97.21%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 2019 53.97% 69.24% 67.91% 78.57%
2018 55.25% 64.78% 64.53% 76.79%
2017 50.00% 61.26% 62.44% 75.00%
2016 54.81% 62.47% 62.27% 74.92%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 2019 88.41% 88.18% 86.27% 90.20%
2018 82.69% 84.82% 84.41% 88.57%
2017 90.27% 83.86% 84.62% 88.77%
2016 76.70% 83.44% 84.72% 88.74%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 2019 78.82% 79.81% 80.27% 86.36%
2018 69.18% 76.02% 78.17% 83.95%
2017 78.13% 76.98% 77.27% 82.99%
2016 75.42% 77.49% 77.19% 83.29%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 2019 87.50% 87.91% 87.34% 90.94%
2018 83.21% 84.08% 85.14% 89.78%
2017 87.83% 83.95% 84.60% 89.86%
2016 85.37% 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 37.50% 38.77% 31.82% 42.98%
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 N/A 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 50.00% 42.62% 37.50% 49.28%
2018 40.00% 44.74% 36.17% 47.41%
2017 100.00% 50.55% 36.07% 48.57%
2016 0.00% 34.87% 35.80% 45.93%
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 2019 N/A 63.47% 61.05% 78.36%
2018 N/A 57.96% 56.00% 70.54%
2017 100.00% 58.14% 54.52% 68.67%
2016 75.00% 61.93% 58.30% 75.00%
Info
Cervical Cancer Screening in Adolescent Females 2020 Plan State Avg Nat Avg 90th Pctl.
Non-Recommended Cervical Cancer Screening in Adolescent Females 0.95% 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 0.70% 0.58% 0.85% 0.24%
2018 0.45% 0.71% 1.05% 0.33%
2017 0.88% 0.94% 1.47% 0.50%
2016 3.37% 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 76.30% 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 76.79% 77.01% 76.69% 83.47%
2018 72.35% 74.77% 75.11% 82.95%
2017 72.84% 73.85% 75.16% 82.29%
2016 69.63% 73.58% 72.67% 80.11%
Info
Respiratory 2020 Plan State Avg Nat Avg 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 93.30% 93.12% 91.57% 95.67%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 38.78% 41.88% 43.24% 59.45%
Respiratory Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 2019 90.40% 91.87% 90.76% 95.51%
2018 91.70% 92.50% 91.22% 95.48%
2017 89.92% 90.92% 89.19% 94.59%
2016 91.67% 88.81% 88.51% 94.80%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 2019 33.27% 38.42% 39.91% 54.09%
2018 25.00% 33.60% 33.16% 48.28%
2017 22.79% 30.67% 30.99% 49.52%
2016 23.57% 27.03% 28.19% 41.72%
Info
Use of Opioids 2020 Plan State Avg Nat Avg 90th Pctl.
Use of Opioids at High Dosage 5.36% 6.49% 5.76% 1.88%
Use of Opioids From Multiple Providers - Multiple Pharmacies 2.38% 2.32% 1.67% 0.62%
Use of Opioids From Multiple Providers - Multiple Prescribers 17.69% 16.62% 13.32% 8.20%
Use of Opioids From Multiple Providers - Multiple Prescribers and Multiple Pharmacies 1.70% 1.28% 0.76% 0.08%
Use of Opioids Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Opioids at High Dosage 2019 6.53% 6.96% 6.08% 1.88%
2018 5.75% 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 4.40% 3.71% 2.79% 0.69%
2018 4.90% 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 19.78% 17.64% 14.51% 9.79%
2018 15.10% 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 1.83% 1.70% 1.24% 0.00%
2018 1.22% 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 20.67% 21.48% 0.72% 0.53%
Acute Hospital Utilization - Surgery 8.83% 11.94% N/A N/A
Acute Hospital Utilization - Total Acute 29.50% 33.42% 0.97% 0.78%
Acute Hospital Utilization Rate Year Plan State Avg. Natl. Avg. 90th Pctl.
Acute Hospital Utilization - Medicine 2019 22.76% 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 12.36% 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 35.11% 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 115 125 N/A N/A
Emergency Department Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Emergency Department Utilization 2019 162 187 1 1
2018 N/A N/A N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Info
Plan All-Cause Readmissions 2020 Plan State Avg Nat Avg 90th Pctl.
Plan All-Cause Readmissions Ages 18-64 (Total) 5.84% 4.88% 0.58% 0.47%
Plan All-Cause Readmissions Ages 18-44 3.16% 4.26% N/A N/A
Plan All-Cause Readmissions Ages 45-54 5.83% 4.46% N/A N/A
Plan All-Cause Readmissions Ages 55-64 8.38% 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 3.03% 4.32% 0.51% 0.37%
2018 8.14% 11.17% N/A N/A
2017 11.66% 12.19% N/A N/A
2016 0.12% 0.12% N/A N/A
Plan All-Cause Readmissions Ages 18-44 2019 3.52% 4.54% N/A N/A
2018 10.43% 11.41% N/A N/A
2017 11.19% 12.99% N/A N/A
2016 0.13% 0.12% N/A N/A
Plan All-Cause Readmissions Ages 45-54 2019 3.77% 4.35% N/A N/A
2018 7.76% 10.56% N/A N/A
2017 13.94% 11.71% N/A N/A
2016 0.12% 0.12% N/A N/A
Plan All-Cause Readmissions Ages 55-64 2019 2.03% 4.26% N/A N/A
2018 6.02% 11.21% N/A N/A
2017 10.26% 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 0.53 0.57 0.57 0.71
Average number of antibiotic prescriptions per member per year - Ages 0-9 0.42 0.41 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 0.34 0.33 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 0.48 0.53 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 0.52 0.59 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 0.68 0.70 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 0.64 0.77 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 0.38 0.80 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 5.88 1.56 N/A N/A
Days suppplied per antibiotic prescription - Total 9.670 10.133 10.310 11.480
Days suppplied per antibiotic prescription - Ages 0-9 9.830 10.550 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 13.650 14.369 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 9.320 9.729 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 9.190 9.703 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 9.610 10.027 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 8.620 9.997 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 11.750 10.119 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 20.420 10.606 N/A N/A
Prescriptions of concern - Total 0.220 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 0.18 0.20 N/A N/A
Prescriptions of concern - Ages 35-49 0.23 0.25 N/A N/A
Prescriptions of concern - Ages 50-64 0.30 0.31 N/A N/A
Prescriptions of concern - Ages 65-74 0.28 0.33 N/A N/A
Prescriptions of concern - Ages 75-85 0.10 0.34 N/A N/A
Prescriptions of concern - Ages 85 plus 0.49 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 0.72 0.75 0.74 0.90
2018 0.70 0.74 0.71 0.88
2017 0.71 0.77 0.76 0.90
2016 0.78 0.79 0.76 0.90
Average number of antibiotic prescriptions per member per year - Ages 0-9 2019 0.89 0.85 N/A N/A
2018 0.87 0.81 N/A N/A
2017 0.86 0.87 N/A N/A
2016 1.01 0.97 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 2019 0.55 0.52 N/A N/A
2018 0.53 0.52 N/A N/A
2017 0.57 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 0.65 0.66 N/A N/A
2018 0.62 0.65 N/A N/A
2017 0.60 0.67 N/A N/A
2016 0.69 0.69 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 2019 0.67 0.74 N/A N/A
2018 0.65 0.73 N/A N/A
2017 0.69 0.75 N/A N/A
2016 0.73 0.77 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 2019 0.82 0.85 N/A N/A
2018 0.80 0.84 N/A N/A
2017 0.82 0.88 N/A N/A
2016 0.86 0.87 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 2019 0.84 0.95 N/A N/A
2018 1.05 0.97 N/A N/A
2017 0.94 1.00 N/A N/A
2016 0.94 0.99 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 2019 1.64 1.15 N/A N/A
2018 2.18 1.21 N/A N/A
2017 1.19 1.12 N/A N/A
2016 2.18 1.23 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 2019 1.00 0.95 N/A N/A
2018 2.00 1.32 N/A N/A
2017 0.00 1.12 N/A N/A
2016 0.00 0.73 N/A N/A
Days suppplied per antibiotic prescription - Total 2019 9.510 9.888 9.890 10.660
2018 9.550 9.950 9.910 10.890
2017 9.520 10.024 9.880 10.830
2016 9.680 10.090 9.880 10.830
Days suppplied per antibiotic prescription - Ages 0-9 2019 9.770 10.025 N/A N/A
2018 9.640 9.979 N/A N/A
2017 10.060 10.050 N/A N/A
2016 10.550 10.041 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 2019 12.190 12.591 N/A N/A
2018 12.540 12.948 N/A N/A
2017 11.140 12.689 N/A N/A
2016 12.260 12.799 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 2019 9.110 9.695 N/A N/A
2018 9.050 9.731 N/A N/A
2017 8.930 9.836 N/A N/A
2016 9.770 10.074 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 2019 9.090 9.488 N/A N/A
2018 9.280 9.568 N/A N/A
2017 9.310 9.591 N/A N/A
2016 8.990 9.620 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 2019 9.460 9.756 N/A N/A
2018 9.520 9.769 N/A N/A
2017 9.720 9.856 N/A N/A
2016 9.240 9.816 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 2019 9.550 9.766 N/A N/A
2018 9.180 9.830 N/A N/A
2017 7.930 9.850 N/A N/A
2016 7.660 9.929 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 2019 8.880 9.645 N/A N/A
2018 7.260 9.428 N/A N/A
2017 8.290 10.604 N/A N/A
2016 7.220 10.594 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 2019 14.670 9.997 N/A N/A
2018 8.330 9.026 N/A N/A
2017 N/A 9.873 N/A N/A
2016 N/A 9.431 N/A N/A
Prescriptions of concern - Total 2019 0.330 0.339 0.330 0.430
2018 0.330 0.338 0.330 0.430
2017 0.340 0.354 0.360 0.450
2016 0.390 0.383 0.360 0.450
Prescriptions of concern - Ages 0-9 2019 0.39 0.34 N/A N/A
2018 0.38 0.32 N/A N/A
2017 0.37 0.35 N/A N/A
2016 0.48 0.43 N/A N/A
Prescriptions of concern - Ages 10-17 2019 0.22 0.20 N/A N/A
2018 0.21 0.20 N/A N/A
2017 0.23 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 0.27 0.28 N/A N/A
2017 0.26 0.28 N/A N/A
2016 0.31 0.31 N/A N/A
Prescriptions of concern - Ages 35-49 2019 0.34 0.35 N/A N/A
2018 0.32 0.35 N/A N/A
2017 0.34 0.37 N/A N/A
2016 0.39 0.40 N/A N/A
Prescriptions of concern - Ages 50-64 2019 0.40 0.41 N/A N/A
2018 0.42 0.42 N/A N/A
2017 0.43 0.44 N/A N/A
2016 0.48 0.46 N/A N/A
Prescriptions of concern - Ages 65-74 2019 0.40 0.44 N/A N/A
2018 0.60 0.48 N/A N/A
2017 0.56 0.50 N/A N/A
2016 0.56 0.51 N/A N/A
Prescriptions of concern - Ages 75-85 2019 0.60 0.51 N/A N/A
2018 1.25 0.62 N/A N/A
2017 0.60 0.54 N/A N/A
2016 1.45 0.65 N/A N/A
Prescriptions of concern - Ages 85 plus 2019 0.00 0.36 N/A N/A
2018 0.00 0.45 N/A N/A
2017 0.00 0.48 N/A N/A
2016 0.00 0.34 N/A N/A
Info
Mental Health Utilization 2020 Plan State Avg Nat Avg 90th Pctl.
Mental Health Utilization - Any Service - Total 7.49% 9.13% 9.07% 12.95%
Mental Health Utilization - Any Service - Ages 0-12 4.73% 6.25% N/A N/A
Mental Health Utilization - Any Service - Ages 13-17 13.92% 15.31% N/A N/A
Mental Health Utilization - Any Service - Ages 18-64 7.66% 9.40% N/A N/A
Mental Health Utilization - Any Service - Ages 65 plus 2.57% 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 0.00% 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 0.23% 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 0.23% 0.20% N/A N/A
Mental Health Utilization - Inpatient - Ages 65 plus 0.00% 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 0.07% 0.05% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 13-17 0.00% 0.26% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 18-64 0.05% 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 5.92% 7.22% 6.95% 9.99%
Mental Health Utilization - Outpatient - Ages 0-12 3.88% 5.23% N/A N/A
Mental Health Utilization - Outpatient - Ages 13-17 10.48% 12.84% N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 6.07% 7.35% N/A N/A
Mental Health Utilization - Outpatient - Ages 65 plus 1.93% 2.62% N/A N/A
Mental Health Utilization - Telehealth - Total 3.68% 4.92% 5.19% 8.37%
Mental Health Utilization - Telehealth - Ages 0-12 2.23% 3.07% N/A N/A
Mental Health Utilization - Telehealth - Ages 13-17 7.19% 8.30% N/A N/A
Mental Health Utilization - Telehealth - Ages 18-64 3.78% 5.11% N/A N/A
Mental Health Utilization - Telehealth - Ages 65 plus 0.64% 1.80% N/A N/A
Mental Health Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Mental Health Utilization - Any Service - Total 2019 7.39% 8.33% 8.86% 12.67%
2018 7.01% 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 4.35% 6.35% N/A N/A
2018 4.84% 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 13.29% 15.01% N/A N/A
2018 13.67% 13.96% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Any Service - Ages 18-64 2019 7.61% 8.45% N/A N/A
2018 6.97% 7.62% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Any Service - Ages 65 plus 2019 2.90% 3.17% N/A N/A
2018 3.49% 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 0.15% 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 0.00% 0.17% N/A N/A
2018 0.16% 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 0.16% 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 0.41% 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 0.26% 0.25% 0.27% 0.34%
2018 0.36% 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 0.23% 0.12% N/A N/A
2018 0.22% 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 1.08% 0.85% N/A N/A
2018 1.63% 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 0.22% 0.24% N/A N/A
2018 0.30% 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 0.00% 0.11% N/A N/A
2018 0.00% 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 0.10% 0.11% 0.20% 0.40%
2018 0.17% 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 0.16% 0.10% N/A N/A
2018 0.29% 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 0.00% 0.35% N/A N/A
2018 0.33% 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 0.10% 0.09% N/A N/A
2018 0.15% 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 0.00% 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 - Outpatient - Total 2019 7.25% 8.24% 8.73% 12.61%
2018 6.85% 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 4.27% 6.32% N/A N/A
2018 4.84% 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 13.11% 14.86% N/A N/A
2018 13.67% 13.80% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 2019 7.47% 8.36% N/A N/A
2018 6.78% 7.51% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Ages 65 plus 2019 2.49% 3.07% N/A N/A
2018 3.49% 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 0.13% 0.11% 0.11% 0.22%
2018 0.14% 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 0.00% 0.04% N/A N/A
2018 0.00% 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 0.18% 0.15% N/A N/A
2018 0.49% 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 0.15% 0.12% N/A N/A
2018 0.14% 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 0.00% 0.02% 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
2020 data updated on: 02/08/2022