Health Insurance in Virginia

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HEALTHKEEPERS, INC.

Company Information

  • Company Providing Plan:Elevance Health Insurance Group
  • Address:2015 STAPLES MILL ROAD
    RICHMOND VA 23230
  • Telephone :804-354-7000
  • Website:WWW.ELEVANCEHEALTH.COM
2021
Number of Enrollees: 869,626
PMPM: $585
Number of Physicians: 45,799
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

STATE OF VIRGINIA EXCEPT FOR THE CITY OF FAIRFAX, THE TOWN OF VIENNA, AND THE AREA EAST OF STATE ROUTE 123

Cities

Commonwealth of Virginia Except City of Fairfax, Town of Vienna and Area East of State Route 123

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

Administrative Data

2021 2020 2019 2018 2017
Number of Enrollees 869,626 758,061 649,455 532,548 669,975
PMPM $585 $579 $590 $532 $435
Medical Cost Ratio 82% 81% 81% 83% 82%
Administrative Ratio 10% 12% 10% 11% 10%
Profit/Loss Ratio 9% 7% 10% 6% 8%
Number of Physicians 45,799 40,310 33,561 29,248 28,352

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

Financial Data

2021 2020 2019 2018 2017
Premiums Earned $5,861,278,122 $5,028,447,884 $4,536,680,481 $3,496,135,978 $3,474,182,105
Income $488,291,833 $333,253,034 $395,505,743 $146,778,850 $183,916,865
Net Worth $1,302,629,884 $888,682,148 $904,301,049 $566,871,633 $595,066,070

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

Performance

  • Healthkeepers is the product for
    HealthKeepers, Inc, Peninsula Health Care, Inc. and Priority Health Care, Inc.
Access/Availability of Care
Info
Adult Access To Preventive/Ambulatory Health Services 2021 Plan State Avg Nat Avg 90th Pctl.
Adult Access (Age 20-44) To Preventive/Ambulatory Health Services 95.98% 94.34% 93.47% 96.29%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 97.28% 96.22% 96.12% 97.63%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 98.29% 96.96% 96.96% 98.35%
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 2020 95.47% 93.90% 92.88% 95.71%
2019 95.08% 92.78% 92.66% 95.76%
2018 94.45% 92.43% 92.33% 95.45%
2017 94.19% 92.73% 92.45% 95.43%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 2020 97.08% 96.11% 95.86% 97.54%
2019 97.03% 95.78% 95.87% 97.69%
2018 96.65% 95.50% 95.64% 97.49%
2017 96.37% 95.57% 95.61% 97.46%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 2020 98.13% 96.79% 96.95% 98.30%
2019 97.92% 97.13% 97.14% 98.42%
2018 97.85% 97.15% 97.17% 98.45%
2017 97.58% 97.82% 97.07% 98.47%
Info
Alcohol and Other Drug Dependence Treatment 2021 Plan State Avg Nat Avg 90th Pctl.
Initiation of Alcohol and Other Drug Dependence Treatment - Total 32.13% 38.29% 34.72% 43.21%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 47.06% 45.84% 41.60% 52.08%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 31.91% 38.22% 34.53% 43.21%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 12.07% 14.66% 11.91% 15.33%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 17.65% 16.85% 15.29% 22.05%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 11.99% 14.60% 11.85% 15.56%
Alcohol and Other Drug Dependence Treatment Year Plan State Avg. Natl. Avg. 90th Pctl.
Initiation of Alcohol and Other Drug Dependence Treatment - Total 2020 34.27% 40.49% 36.39% 45.24%
2019 38.81% 39.13% 35.63% 41.36%
2018 38.67% 37.53% 35.68% 42.36%
2017 35.39% 36.14% 36.11% 42.01%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2020 42.22% 35.48% 44.95% 59.06%
2019 45.16% 36.19% 42.41% 54.29%
2018 56.90% 49.35% 40.21% 51.02%
2017 43.43% 40.06% 39.91% 52.54%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2020 34.10% 40.55% 36.18% 45.12%
2019 38.64% 39.20% 35.47% 40.96%
2018 38.17% 37.34% 35.51% 42.35%
2017 35.11% 36.00% 35.97% 41.96%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 2020 13.95% 15.16% 12.46% 17.48%
2019 13.21% 13.47% 12.31% 16.44%
2018 15.08% 14.69% 12.58% 17.04%
2017 13.47% 13.36% 12.65% 17.26%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2020 11.11% 14.80% 17.76% 27.27%
2019 12.90% 10.34% 16.48% 27.14%
2018 18.97% 18.18% 16.91% 25.00%
2017 16.16% 14.40% 14.95% 23.85%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2020 14.01% 15.15% 12.33% 17.48%
2019 13.21% 13.52% 12.20% 16.41%
2018 14.98% 14.58% 12.47% 16.97%
2017 13.38% 13.40% 12.55% 17.38%
Info
Prenatal and Postpartum Care 2021 Plan State Avg Nat Avg 90th Pctl.
Postpartum Care 82.92% 80.79% 81.70% 93.89%
Timeliness of Prenatal Care 85.42% 86.12% 83.24% 94.16%
Prenatal and Postpartum Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Postpartum Care 2020 83.45% 74.05% 78.11% 92.47%
2019 75.20% 78.66% 80.52% 91.97%
2018 75.20% 75.10% 75.89% 88.80%
2017 82.29% 73.45% 75.05% 88.13%
Timeliness of Prenatal Care 2020 88.81% 79.76% 81.82% 93.92%
2019 86.40% 86.76% 85.57% 95.33%
2018 86.40% 88.15% 84.75% 94.17%
2017 85.76% 86.37% 84.34% 94.89%
Behavioral Health
Info
Adherence to Antipsychotic Medications for Individuals with Schizophrenia 2021 Plan State Avg Nat Avg 90th Pctl.
Adherence to Antipsychotic Medications for Individuals With Schizophrenia 67.03% 67.45% 68.64% 79.03%
Adherence to Antipsychotic Medications for Individuals with Schizophrenia Year Plan State Avg. Natl. Avg. 90th Pctl.
Adherence to Antipsychotic Medications for Individuals With Schizophrenia 2020 64.22% 70.63% 69.41% 79.41%
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
Info
Antidepressant Medication Management 2021 Plan State Avg Nat Avg 90th Pctl.
Antidepressant Medication Management - Effective Acute Phase Treatment 76.48% 79.35% 76.18% 83.11%
Antidepressant Medication Management - Effective Continuation Phase Treatment 59.06% 61.51% 59.75% 67.55%
Antidepressant Medication Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Antidepressant Medication Management - Effective Acute Phase Treatment 2020 73.99% 77.14% 73.70% 81.07%
2019 70.65% 73.53% 71.19% 78.79%
2018 66.62% 71.96% 68.64% 77.59%
2017 66.05% 71.12% 67.11% 75.76%
Antidepressant Medication Management - Effective Continuation Phase Treatment 2020 56.86% 59.69% 57.32% 64.22%
2019 50.95% 55.44% 54.90% 62.18%
2018 50.70% 54.22% 53.01% 60.39%
2017 49.17% 54.87% 51.53% 60.24%
Info
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication 2021 Plan State Avg Nat Avg 90th Pctl.
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Initiation 33.22% 41.24% 36.60% 48.10%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 39.85% 45.63% 45.94% 60.34%
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 2020 37.00% 45.87% 41.24% 50.34%
2019 40.22% 42.67% 40.66% 51.30%
2018 35.77% 42.91% 39.85% 50.42%
2017 37.48% 41.27% 41.13% 50.83%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 2020 42.59% 56.56% 48.67% 59.32%
2019 45.86% 50.69% 47.95% 58.82%
2018 46.26% 40.32% 48.73% 60.57%
2017 49.47% 55.09% 47.07% 58.44%
Info
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence 2021 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 8.58% 12.52% 12.71% 21.05%
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence within 30 days after hospital discharge 12.88% 16.65% 17.10% 27.59%
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 2020 12.81% 14.52% 13.45% 21.43%
2019 10.71% 8.56% 11.48% 18.26%
2018 13.82% 9.96% 10.81% 17.07%
2017 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 2020 20.20% 19.84% 18.03% 26.07%
2019 15.87% 14.74% 15.35% 24.56%
2018 18.29% 13.52% 14.98% 23.11%
2017 N/A N/A N/A N/A
Info
Follow-Up After Emergency Department Visit for Mental Illness 2021 Plan State Avg Nat Avg 90th Pctl.
Follow-Up After Emergency Department Visit for Mental Illness within 7 days after hospital discharge 49.24% 44.60% 50.67% 70.54%
Follow-Up After Emergency Department Visit for Mental Illness within 30 days after hospital discharge 67.18% 61.91% 64.91% 82.58%
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 2020 50.56% 48.22% 47.90% 68.29%
2019 48.01% 45.64% 48.70% 70.67%
2018 42.03% 38.46% 46.62% 66.57%
2017 N/A N/A N/A N/A
Follow-Up After Emergency Department Visit for Mental Illness within 30 days after hospital discharge 2020 63.67% 59.38% 62.36% 78.77%
2019 60.26% 60.35% 62.59% 77.75%
2018 60.58% 53.38% 60.75% 77.57%
2017 N/A N/A N/A N/A
Info
Follow-up After Hospitalization For Mental Illness 2021 Plan State Avg Nat Avg 90th Pctl.
Follow-up After Hospitalization For Mental Illness within 7 days after hospital discharge 45.20% 49.75% 48.70% 63.60%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 69.93% 73.29% 71.44% 82.61%
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 2020 48.82% 49.46% 49.62% 63.68%
2019 47.35% 49.77% 45.66% 58.20%
2018 47.21% 48.09% 44.98% 60.38%
2017 49.52% 52.18% 46.63% 62.81%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 2020 71.40% 72.67% 70.00% 79.46%
2019 72.86% 72.38% 67.81% 80.65%
2018 71.52% 69.84% 66.68% 80.29%
2017 72.74% 69.80% 68.66% 82.58%
Effectiveness of Care
Info
Asthma Medication Ratio 2021 Plan State Avg Nat Avg 90th Pctl.
Asthma Medication Ratio - Ages 5-11 96.03% 92.78% 89.65% 96.23%
Asthma Medication Ratio - Ages 12-18 90.21% 85.93% 83.38% 90.21%
Asthma Medication Ratio - Ages 19-50 82.40% 82.29% 78.35% 87.18%
Asthma Medication Ratio - Ages 51-64 85.26% 86.60% 83.59% 90.22%
Asthma Medication Ratio - Total 84.95% 85.07% 81.23% 87.41%
Asthma Medication Ratio Year Plan State Avg. Natl. Avg. 90th Pctl.
Asthma Medication Ratio - Ages 5-11 2020 92.27% 93.70% 89.98% 95.00%
2019 86.59% 86.54% 85.94% 93.20%
2018 93.55% 85.26% 87.15% 93.97%
2017 92.58% 86.06% 86.90% 93.55%
Asthma Medication Ratio - Ages 12-18 2020 83.08% 84.76% 81.90% 89.30%
2019 89.87% 84.88% 77.43% 86.25%
2018 86.06% 84.71% 78.77% 84.72%
2017 88.85% 84.80% 76.69% 85.94%
Asthma Medication Ratio - Ages 19-50 2020 83.13% 78.90% 75.62% 84.47%
2019 82.10% 80.50% 74.07% 81.27%
2018 82.37% 82.69% 75.11% 82.84%
2017 81.70% 78.94% 74.23% 81.70%
Asthma Medication Ratio - Ages 51-64 2020 87.42% 85.69% 82.47% 89.38%
2019 87.38% 86.85% 81.27% 88.51%
2018 85.75% 86.11% 82.81% 89.49%
2017 88.30% 89.17% 82.83% 89.28%
Asthma Medication Ratio - Total 2020 85.42% 83.04% 79.76% 85.85%
2019 85.19% 83.92% 78.10% 84.69%
2018 85.09% 84.32% 79.34% 85.18%
2017 85.85% 84.01% 79.04% 85.85%
Info
Cardiovascular Disease Management 2021 Plan State Avg Nat Avg 90th Pctl.
Controlling High Blood Pressure 61.31% 60.64% 59.95% 73.24%
Persistence of Beta-Blockers 87.04% 88.98% 86.08% 93.62%
Cardiovascular Disease Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Controlling High Blood Pressure 2020 59.12% 43.15% 53.49% 69.10%
2019 55.72% 60.96% 61.02% 74.21%
2018 55.72% 60.55% N/A N/A
2017 N/A N/A N/A N/A
Persistence of Beta-Blockers 2020 89.03% 87.06% 87.38% 94.19%
2019 84.83% 88.62% 85.16% 92.47%
2018 89.36% 83.54% 82.37% 89.29%
2017 84.97% 85.80% 85.18% 93.41%
Info
Cervical Cancer Screening 2021 Plan State Avg Nat Avg 90th Pctl.
Cervical Cancer Screening 78.36% 76.66% 75.48% 81.94%
Cervical Cancer Screening Year Plan State Avg. Natl. Avg. 90th Pctl.
Cervical Cancer Screening 2020 76.72% 75.44% 75.50% 81.71%
2019 76.64% 78.50% 77.40% 83.91%
2018 75.91% 77.90% 76.08% 83.21%
2017 N/A N/A N/A N/A
Info
Common Childhood Illnesses 2021 Plan State Avg Nat Avg 90th Pctl.
Appropriate Testing for Children With Pharyngitis 88.50% 82.09% 79.49% 89.15%
Common Childhood Illnesses Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Testing for Children With Pharyngitis 2020 93.11% 90.05% 84.77% 92.62%
2019 92.62% 90.44% 86.62% 93.98%
2018 93.12% 92.74% 87.97% 94.94%
2017 92.11% 92.30% 87.45% 94.64%
Info
Diabetes Care and Management 2021 Plan State Avg Nat Avg 90th Pctl.
Comprehensive Diabetes Care-Blood Pressure Control (<140/90 mm Hg) 62.04% 59.77% 62.09% 75.43%
Comprehensive Diabetes Care-HbA1c control (<8.0%) 63.26% 61.24% 59.64% 67.11%
Comprehensive Diabetes Care-Rate of Eye Exams 61.07% 57.17% 52.65% 64.30%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 27.25% 28.15% 29.94% 21.90%
Comprehensive Diabetes Care-Testing for HbA1c 91.48% 91.18% 90.81% 93.92%
Diabetes Care and Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Comprehensive Diabetes Care-Blood Pressure Control (<140/90 mm Hg) 2020 60.76% 44.59% 55.85% 73.48%
2019 64.48% 62.53% 63.23% 77.86%
2018 64.48% 63.70% 62.59% 77.37%
2017 63.26% 63.40% 60.82% 76.41%
Comprehensive Diabetes Care-HbA1c control (<8.0%) 2020 63.04% 55.20% 55.37% 65.50%
2019 65.45% 63.81% 58.07% 66.33%
2018 65.45% 62.46% 57.79% 66.33%
2017 59.37% 62.51% 57.48% 67.15%
Comprehensive Diabetes Care-Rate of Eye Exams 2020 51.39% 53.44% 50.27% 64.23%
2019 60.83% 58.32% 55.45% 69.32%
2018 60.83% 56.58% 54.40% 69.68%
2017 53.53% 56.95% 54.06% 70.69%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 2020 26.33% 36.05% 34.87% 23.45%
2019 21.41% 26.09% 30.80% 20.82%
2018 21.41% 27.18% 30.85% 20.62%
2017 26.28% 27.63% 31.91% 21.41%
Comprehensive Diabetes Care-Testing for HbA1c 2020 87.59% 86.71% 87.74% 91.73%
2019 93.67% 92.45% 91.60% 94.71%
2018 93.67% 92.11% 91.29% 94.71%
2017 90.27% 91.52% 90.96% 94.18%
Info
Immunizations 2021 Plan State Avg Nat Avg 90th Pctl.
Childhood Immunization for Multiple Diseases (Combo 10) 66.94% 66.38% 60.60% 73.21%
Childhood Immunization for Multiple Diseases Including Pneumovax 82.24% 82.74% 78.15% 88.27%
Immunizations for Adolescents - Combination 2 34.79% 59.29% 55.31% 65.85%
Immunizations for Adolescents - HPV 37.23% 39.82% 34.09% 44.04%
Immunizations for Adolescents - Meningococcal 82.48% 41.73% 35.37% 46.00%
Immunizations for Adolescents - Tdap 95.62% 86.88% 85.91% 93.19%
Immunizations Year Plan State Avg. Natl. Avg. 90th Pctl.
Childhood Immunization for Multiple Diseases (Combo 10) 2020 N/A N/A N/A N/A
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
Childhood Immunization for Multiple Diseases Including Pneumovax 2020 83.80% 74.94% 75.84% 87.36%
2019 82.14% 81.30% 78.32% 87.99%
2018 82.14% 79.46% 77.50% 86.62%
2017 81.51% 80.09% 77.67% 87.61%
Immunizations for Adolescents - Combination 2 2020 31.14% 57.13% 57.41% 67.88%
2019 25.30% 59.38% 55.06% 65.24%
2018 73.24% 53.06% 51.93% 61.07%
2017 67.40% 55.21% 49.33% 59.27%
Immunizations for Adolescents - HPV 2020 34.79% 35.09% 31.84% 39.17%
2019 28.47% 33.16% 29.59% 40.63%
2018 23.84% 79.55% 82.25% 91.52%
2017 25.79% 80.48% 80.23% 89.54%
Immunizations for Adolescents - Meningococcal 2020 75.18% 37.80% 33.38% 42.34%
2019 72.99% 35.43% 31.21% 42.46%
2018 73.48% 32.22% 28.05% 37.23%
2017 68.13% 28.29% 23.98% 32.36%
Immunizations for Adolescents - Tdap 2020 95.13% 80.71% 85.83% 93.12%
2019 93.67% 81.83% 85.01% 92.59%
2018 93.67% 80.66% 83.69% 92.94%
2017 94.65% 82.05% 81.75% 90.27%
Info
Pharmacotherapy of COPD Exacerbation 2021 Plan State Avg Nat Avg 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 78.95% 86.14% 81.56% 89.58%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 86.32% 80.22% 74.79% 84.78%
Pharmacotherapy of COPD Exacerbation Year Plan State Avg. Natl. Avg. 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 2020 78.18% 86.03% 81.34% 88.51%
2019 80.00% 83.91% 80.32% 88.97%
2018 73.96% 85.49% 78.92% 87.88%
2017 78.76% 80.88% 79.87% 87.50%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 2020 69.09% 75.06% 74.31% 85.07%
2019 76.97% 81.14% 76.90% 87.69%
2018 75.15% 76.41% 74.76% 83.55%
2017 77.61% 78.84% 76.26% 84.38%
Info
Preventive Care 2021 Plan State Avg Nat Avg 90th Pctl.
Breast Cancer Screening 74.67% 72.93% 72.44% 79.62%
Chlamydia Screening in Women-all Age groups 42.35% 51.90% 48.47% 62.71%
Colorectal Cancer Screening 62.30% 63.99% 64.90% 76.16%
Preventive Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Breast Cancer Screening 2020 74.82% 72.56% 72.44% 79.39%
2019 76.68% 72.92% 74.81% 81.58%
2018 74.26% 72.13% 73.73% 81.17%
2017 73.79% 71.85% 72.81% 80.91%
Chlamydia Screening in Women-all Age groups 2020 45.32% 49.80% 48.49% 63.85%
2019 47.12% 54.77% 51.86% 67.02%
2018 46.26% 52.91% 51.41% 67.76%
2017 44.40% 51.46% 50.16% 66.08%
Colorectal Cancer Screening 2020 67.21% 60.99% 63.64% 74.42%
2019 67.12% 68.10% 66.15% 77.91%
2018 67.12% 64.94% 64.37% 76.52%
2017 66.58% 65.16% 62.43% 74.72%
Info
Spirometry Testing 2021 Plan State Avg Nat Avg 90th Pctl.
Use of Spirometry Testing in the Assessment and diagnosis of COPD 35.02% 34.87% 36.29% 45.50%
Spirometry Testing Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Spirometry Testing in the Assessment and diagnosis of COPD 2020 34.54% 37.53% 37.16% 43.86%
2019 40.07% 39.81% 42.11% 52.78%
2018 38.81% 44.14% 41.48% 50.95%
2017 38.54% 43.12% 41.90% 50.52%
Info
Statin Therapy 2021 Plan State Avg Nat Avg 90th Pctl.
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 21-75 years (Male) 82.92% 86.25% 84.99% 90.85%
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 40–75 years (Female) 73.96% 74.86% 76.91% 83.87%
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - Total 80.30% 83.06% 82.86% 88.32%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 21-75 years (Male) 74.92% 78.10% 80.36% 87.04%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 40–75 years (Female) 73.36% 77.02% 76.97% 85.47%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - Total 74.50% 77.77% 79.53% 86.44%
Statin Therapy for Patients with Diabetes - Received Therapy 63.69% 66.92% 66.45% 72.23%
Statin Therapy for Patients with Diabetes - Statin Adherence 80% 72.11% 74.32% 73.74% 81.61%
Statin Therapy Year Plan State Avg. Natl. Avg. 90th Pctl.
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 21-75 years (Male) 2020 82.40% 85.75% 84.86% 89.67%
2019 84.13% 85.53% 84.83% 90.71%
2018 84.50% 84.45% 83.64% 89.14%
2017 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 40–75 years (Female) 2020 75.49% 77.46% 75.69% 81.94%
2019 76.02% 75.96% 74.89% 81.82%
2018 74.65% 76.45% 73.26% 81.82%
2017 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - Total 2020 80.32% 83.41% 82.46% 87.85%
2019 82.01% 82.97% 82.41% 88.24%
2018 81.96% 82.21% 81.23% 87.21%
2017 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 21-75 years (Male) 2020 78.55% 81.24% 81.04% 86.60%
2019 73.17% 78.19% 78.73% 85.40%
2018 74.71% 75.19% 77.14% 82.88%
2017 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 40–75 years (Female) 2020 80.52% 78.29% 77.58% 86.55%
2019 71.25% 75.98% 73.50% 82.09%
2018 67.65% 72.78% 72.12% 81.10%
2017 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - Total 2020 79.11% 80.47% 80.55% 86.26%
2019 72.70% 77.63% 77.38% 84.14%
2018 73.06% 74.49% 75.95% 82.83%
2017 N/A N/A N/A N/A
Statin Therapy for Patients with Diabetes - Received Therapy 2020 63.20% 66.42% 65.49% 71.27%
2019 61.75% 65.53% 64.43% 70.97%
2018 61.44% 63.94% 62.57% 70.05%
2017 N/A N/A N/A N/A
Statin Therapy for Patients with Diabetes - Statin Adherence 80% 2020 71.98% 73.48% 74.69% 82.04%
2019 66.11% 71.84% 71.74% 79.50%
2018 65.57% 68.88% 69.52% 78.00%
2017 N/A N/A N/A N/A
Info
Weight Assessment and Counseling 2021 Plan State Avg Nat Avg 90th Pctl.
Children/Adolescents BMI Assessment - Total 77.87% 77.31% 75.21% 89.14%
Children/Adolescents BMI Assessment - Ages 3-11 81.73% 78.77% 76.73% 90.56%
Children/Adolescents BMI Assessment - Ages 12-17 72.78% 75.37% 73.29% 87.42%
Counseling for Nutrition for Children/Adolescents - Total 74.59% 74.98% 69.95% 83.70%
Counseling for Nutrition for Children/Adolescents - Ages 3-11 78.37% 77.08% 72.50% 86.18%
Counseling for Nutrition for Children/Adolescents - Ages 12-17 69.62% 72.13% 66.75% 82.14%
Counseling for Physical Activity for Children/Adolescents - Total 69.13% 71.34% 66.55% 80.86%
Counseling for Physical Activity for Children/Adolescents - Ages 3-11 65.38% 69.93% 66.24% 81.08%
Counseling for Physical Activity for Children/Adolescents - Ages 12-17 74.05% 73.30% 66.87% 83.09%
Weight Assessment and Counseling Year Plan State Avg. Natl. Avg. 90th Pctl.
Children/Adolescents BMI Assessment - Total 2020 78.30% 61.27% 70.64% 88.81%
2019 66.07% 74.97% 74.90% 90.00%
2018 66.07% 73.74% 72.87% 90.00%
2017 68.84% 70.41% 70.59% 88.08%
Children/Adolescents BMI Assessment - Ages 3-11 2020 83.56% 64.54% 72.11% 88.89%
2019 74.89% 78.68% 76.00% 90.91%
2018 74.89% 76.94% 74.00% 90.91%
2017 71.14% 71.37% 71.84% 88.89%
Children/Adolescents BMI Assessment - Ages 12-17 2020 71.98% 57.19% 68.80% 87.79%
2019 53.94% 70.46% 73.46% 89.29%
2018 53.94% 69.73% 71.39% 88.97%
2017 65.13% 68.96% 68.94% 87.82%
Counseling for Nutrition for Children/Adolescents - Total 2020 73.82% 56.08% 65.06% 82.43%
2019 64.54% 72.58% 68.74% 85.24%
2018 64.54% 71.79% 67.72% 85.06%
2017 66.58% 69.47% 65.50% 83.21%
Counseling for Nutrition for Children/Adolescents - Ages 3-11 2020 79.45% 59.21% 67.32% 84.32%
2019 74.01% 77.02% 71.33% 86.49%
2018 74.01% 75.91% 69.85% 86.21%
2017 68.29% 71.63% 68.20% 84.82%
Counseling for Nutrition for Children/Adolescents - Ages 12-17 2020 67.03% 52.10% 62.24% 79.49%
2019 51.52% 66.89% 65.44% 84.29%
2018 51.52% 66.37% 64.92% 84.29%
2017 63.82% 66.54% 61.92% 80.26%
Counseling for Physical Activity for Children/Adolescents - Total 2020 67.83% 52.21% 60.81% 80.29%
2019 58.67% 66.86% 64.24% 82.78%
2018 58.67% 66.42% 63.08% 81.32%
2017 61.56% 64.30% 59.96% 77.32%
Counseling for Physical Activity for Children/Adolescents - Ages 3-11 2020 65.30% 52.27% 60.31% 81.14%
2019 61.23% 66.12% 63.39% 82.53%
2018 61.23% 65.48% 61.70% 80.92%
2017 60.57% 62.31% 58.84% 75.00%
Counseling for Physical Activity for Children/Adolescents - Ages 12-17 2020 70.88% 51.96% 61.40% 79.85%
2019 55.15% 67.67% 65.38% 84.68%
2018 55.15% 67.51% 64.79% 84.03%
2017 63.16% 66.86% 61.40% 79.89%
Health Plan Stability/Descriptive
Info
Administrative Data 2021 Plan State Avg Nat Avg 90th Pctl.
Administrative Ratio 0.10 0.12 N/A N/A
Medical Cost Ratio 0.82 0.85 N/A N/A
Number of Enrollees 869,626 189,570 N/A N/A
Number of Physicians 45,799 144,761 N/A N/A
Premium Per Member Per Month $585 $582 N/A N/A
Profit/Loss Ratio 0.09 0.04 N/A N/A
Administrative Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Administrative Ratio 2020 0.12 0.13 N/A N/A
2019 0.10 0.12 N/A N/A
2018 0.11 0.14 86.19 92.68
2017 0.10 0.12 86.39 93.13
Medical Cost Ratio 2020 0.81 0.81 N/A N/A
2019 0.81 0.84 N/A N/A
2018 0.83 0.83 92.60 95.85
2017 0.82 0.83 93.13 96.59
Number of Enrollees 2020 758,061 157,206 N/A N/A
2019 649,455 136,748 N/A N/A
2018 532,548 129,656 92 96
2017 669,975 133,992 92 97
Number of Physicians 2020 40,310 118,547 N/A N/A
2019 33,561 105,314 N/A N/A
2018 29,248 86,806 87 95
2017 28,352 81,926 87 95
Premium Per Member Per Month 2020 $579 $529 N/A N/A
2019 $590 $511 N/A N/A
2018 $532 $517 N/A N/A
2017 $435 $370 N/A N/A
Profit/Loss Ratio 2020 0.07 0.06 N/A N/A
2019 0.10 0.04 N/A N/A
2018 0.06 0.04 N/A N/A
2017 0.08 0.05 N/A N/A
Info
Financial Data 2021 Plan State Avg Nat Avg 90th Pctl.
Income $488,291,833 $84,171,275 N/A N/A
Net Worth $1,302,629,884 $444,659,972 N/A N/A
Premiums Earned $5,861,278,122 $1,315,605,350 N/A N/A
Financial Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Income 2020 $333,253,034 $108,797,768 N/A N/A
2019 $395,505,743 $81,234,487 N/A N/A
2018 $146,778,850 $44,046,244 N/A N/A
2017 $183,916,865 $34,422,501 N/A N/A
Net Worth 2020 $888,682,148 $381,868,187 N/A N/A
2019 $904,301,049 $340,553,480 N/A N/A
2018 $566,871,633 $279,558,644 N/A N/A
2017 $595,066,070 $263,890,874 N/A N/A
Premiums Earned 2020 $5,028,447,884 $1,079,933,473 N/A N/A
2019 $4,536,680,481 $936,529,722 N/A N/A
2018 $3,496,135,978 $815,577,345 N/A N/A
2017 $3,474,182,105 $645,600,589 N/A N/A
Info
Years in Business 2021 Plan State Avg Nat Avg 90th Pctl.
Years in Business 35 39 N/A N/A
Years in Business Year Plan State Avg. Natl. Avg. 90th Pctl.
Years in Business 2020 34 38 N/A N/A
2019 33 37 N/A N/A
2018 32 36 N/A N/A
2017 31 35 N/A N/A
Member Satisfaction
Info
Member Satisfaction 2021 Plan State Avg Nat Avg 90th Pctl.
Getting Care Quickly N/A 83.79% 83.12% 89.04%
Getting Needed Care N/A 85.63% 84.05% 89.10%
How Well Doctors Communicate 92.83% 94.61% 95.28% 97.41%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 56.25% 66.71% 67.27% 78.31%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 84.47% 83.98% 84.85% 88.79%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 76.80% 78.88% 77.89% 84.07%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 81.62% 83.94% 85.47% 90.41%
Member Satisfaction Year Plan State Avg. Natl. Avg. 90th Pctl.
Getting Care Quickly 2020 N/A 85.38% 86.32% 91.51%
2019 82.88% 87.14% 86.32% 90.57%
2018 81.17% 85.27% 85.23% 89.89%
2017 87.93% 87.22% 85.34% 89.83%
Getting Needed Care 2020 90.08% 87.88% 88.01% 92.51%
2019 87.17% 87.88% 87.38% 91.22%
2018 84.10% 85.53% 86.33% 90.45%
2017 85.45% 87.44% 86.71% 90.37%
How Well Doctors Communicate 2020 95.90% 95.93% 95.93% 97.98%
2019 94.71% 94.99% 95.85% 97.38%
2018 93.24% 94.70% 95.31% 97.22%
2017 94.15% 94.74% 95.10% 96.91%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 2020 62.30% 65.21% 69.04% 80.59%
2019 70.69% 69.24% 67.91% 78.57%
2018 62.89% 64.78% 64.53% 76.79%
2017 53.18% 61.26% 62.44% 75.00%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 2020 81.90% 86.67% 87.14% 91.18%
2019 86.92% 88.18% 86.27% 90.20%
2018 83.33% 84.82% 84.41% 88.57%
2017 80.45% 83.86% 84.62% 88.77%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 2020 77.03% 79.32% 80.71% 87.04%
2019 80.00% 79.81% 80.27% 86.36%
2018 76.33% 76.02% 78.17% 83.95%
2017 72.92% 76.98% 77.27% 82.99%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 2020 82.80% 85.69% 86.56% 91.30%
2019 85.91% 87.91% 87.34% 90.94%
2018 83.33% 84.08% 85.14% 89.78%
2017 85.57% 83.95% 84.60% 89.86%
Overuse/Appropriateness
Info
Antipsychotics 2021 Plan State Avg Nat Avg 90th Pctl.
Metabolic Monitoring for Children and Adolescents on Antipsychotics - Ages 1-17 30.30% 45.59% 35.85% 48.30%
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 73.08% 60.14% 63.65% 75.31%
Antipsychotics Year Plan State Avg. Natl. Avg. 90th Pctl.
Metabolic Monitoring for Children and Adolescents on Antipsychotics - Ages 1-17 2020 24.77% 38.77% 31.82% 42.98%
2019 25.12% 42.62% 37.50% 49.28%
2018 24.44% 44.74% 36.17% 47.41%
2017 22.40% 50.55% 36.07% 48.57%
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 2020 76.39% 60.42% 62.97% 76.39%
2019 63.16% 63.47% 61.05% 78.36%
2018 54.39% 57.96% 56.00% 70.54%
2017 56.10% 58.14% 54.52% 68.67%
Info
Cervical Cancer Screening in Adolescent Females 2021 Plan State Avg Nat Avg 90th Pctl.
Non-Recommended Cervical Cancer Screening in Adolescent Females 0.29% 0.37% 0.59% 0.10%
Cervical Cancer Screening in Adolescent Females Year Plan State Avg. Natl. Avg. 90th Pctl.
Non-Recommended Cervical Cancer Screening in Adolescent Females 2020 0.42% 0.46% 0.67% 0.19%
2019 0.55% 0.58% 0.85% 0.24%
2018 0.75% 0.71% 1.05% 0.33%
2017 1.03% 0.94% 1.47% 0.50%
Info
Lower Back Pain 2021 Plan State Avg Nat Avg 90th Pctl.
Use of Imaging for Low Back Pain 72.14% 75.38% 77.23% 84.21%
Lower Back Pain Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Imaging for Low Back Pain 2020 72.45% 77.22% 78.53% 85.60%
2019 68.85% 77.01% 76.69% 83.47%
2018 68.07% 74.77% 75.11% 82.95%
2017 66.25% 73.85% 75.16% 82.29%
Info
Respiratory 2021 Plan State Avg Nat Avg 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 95.16% 95.68% 94.48% 98.12%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 39.51% 44.79% 46.61% 61.68%
Respiratory Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 2020 91.66% 93.12% 91.57% 95.67%
2019 90.27% 91.87% 90.76% 95.51%
2018 91.08% 92.50% 91.22% 95.48%
2017 88.31% 90.92% 89.19% 94.59%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 2020 38.13% 41.88% 43.24% 59.45%
2019 35.48% 38.42% 39.91% 54.09%
2018 27.96% 33.60% 33.16% 48.28%
2017 21.79% 30.67% 30.99% 49.52%
Info
Use of Opiods 2021 Plan State Avg Nat Avg 90th Pctl.
Use of Opioids at High Dosage 5.20% 6.26% 5.24% 1.88%
Use of Opioids From Multiple Providers - Multiple Pharmacies 1.56% 1.32% 1.59% 0.33%
Use of Opioids From Multiple Providers - Multiple Prescribers 13.74% 16.64% 13.69% 8.71%
Use of Opioids From Multiple Providers - Multiple Prescribers and Multiple Pharmacies 0.85% 0.70% 0.77% 0.00%
Use of Opiods Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Opioids at High Dosage 2020 5.81% 6.49% 5.76% 1.88%
2019 6.03% 6.96% 6.08% 1.88%
2018 5.37% 5.32% 4.54% 1.87%
2017 N/A N/A N/A N/A
Use of Opioids From Multiple Providers - Multiple Pharmacies 2020 3.10% 2.27% 1.67% 0.62%
2019 4.62% 3.75% 2.79% 0.69%
2018 5.16% 5.21% 3.80% 1.40%
2017 N/A N/A N/A N/A
Use of Opioids From Multiple Providers - Multiple Prescribers 2020 14.44% 16.62% 13.32% 8.20%
2019 14.66% 17.64% 14.51% 9.79%
2018 15.44% 18.32% 15.02% 9.64%
2017 N/A N/A N/A N/A
Use of Opioids From Multiple Providers - Multiple Prescribers and Multiple Pharmacies 2020 1.15% 1.22% 0.76% 0.08%
2019 1.87% 1.70% 1.24% 0.00%
2018 2.50% 2.68% 1.76% 0.47%
2017 N/A N/A N/A N/A
Risk Adjusted Utilization
Info
Acute Hospital Utilization Rate 2021 Plan State Avg Nat Avg 90th Pctl.
Acute Hospital Utilization - Medicine 20.92% 23.22% 0.78% 0.58%
Acute Hospital Utilization - Surgery 14.49% 11.64% N/A N/A
Acute Hospital Utilization - Total Acute 35.41% 34.86% 1.02% 0.79%
Acute Hospital Utilization Rate Year Plan State Avg. Natl. Avg. 90th Pctl.
Acute Hospital Utilization - Medicine 2020 18.91% 21.48% 0.72% 0.53%
2019 21.04% 26.50% 0.89% 0.68%
2018 N/A N/A N/A N/A
2017 N/A N/A N/A N/A
Acute Hospital Utilization - Surgery 2020 14.39% 11.94% N/A N/A
2019 17.62% 15.92% N/A N/A
2018 N/A N/A N/A N/A
2017 N/A N/A N/A N/A
Acute Hospital Utilization - Total Acute 2020 33.30% 33.42% 0.97% 0.78%
2019 38.66% 42.42% 1.09% 0.92%
2018 N/A N/A N/A N/A
2017 N/A N/A N/A N/A
Info
Emergency Department Utilization 2021 Plan State Avg Nat Avg 90th Pctl.
Emergency Department Utilization 154.54% 138.89% 0.90% 0.72%
Emergency Department Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Emergency Department Utilization 2020 140.68% 124.84% N/A N/A
2019 196.64% 187.39% 1.04% 0.82%
2018 N/A N/A N/A N/A
2017 N/A N/A N/A N/A
Info
Plan All-Cause Readmissions 2021 Plan State Avg Nat Avg 90th Pctl.
Plan All-Cause Readmissions Ages 18-64 (Total) 5.03% 4.93% 0.60% 0.48%
Plan All-Cause Readmissions Ages 18-44 5.29% 4.20% N/A N/A
Plan All-Cause Readmissions Ages 45-54 4.34% 4.67% N/A N/A
Plan All-Cause Readmissions Ages 55-64 5.28% 5.63% N/A N/A
Plan All-Cause Readmissions Year Plan State Avg. Natl. Avg. 90th Pctl.
Plan All-Cause Readmissions Ages 18-64 (Total) 2020 4.72% 4.88% 0.58% 0.47%
2019 5.52% 4.32% 0.51% 0.37%
2018 11.80% 11.17% N/A N/A
2017 11.76% 12.19% N/A N/A
Plan All-Cause Readmissions Ages 18-44 2020 4.91% 4.26% N/A N/A
2019 5.75% 4.54% N/A N/A
2018 12.39% 11.41% N/A N/A
2017 13.29% 12.99% N/A N/A
Plan All-Cause Readmissions Ages 45-54 2020 4.48% 4.46% N/A N/A
2019 5.45% 4.35% N/A N/A
2018 12.07% 10.56% N/A N/A
2017 11.05% 11.71% N/A N/A
Plan All-Cause Readmissions Ages 55-64 2020 4.74% 5.69% N/A N/A
2019 5.41% 4.26% N/A N/A
2018 11.18% 11.21% N/A N/A
2017 11.03% 11.93% N/A N/A
Utilization
Info
Antibiotic Utilization 2021 Plan State Avg Nat Avg 90th Pctl.
Average number of antibiotic prescriptions per member per year - Total 0.63 0.55 0.57 0.73
Average number of antibiotic prescriptions per member per year - Ages 0-9 0.54 0.39 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 0.39 0.31 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 0.61 0.52 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 0.64 0.57 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 0.74 0.67 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 0.84 0.75 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 1.01 0.82 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 0.59 1.42 N/A N/A
Days suppplied per antibiotic prescription - Total 10.430 10.197 10.210 11.220
Days suppplied per antibiotic prescription - Ages 0-9 10.330 10.540 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 14.330 14.793 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 9.840 9.754 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 9.870 9.787 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 10.610 10.114 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 10.680 10.241 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 9.520 8.940 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 5.880 11.142 N/A N/A
Prescriptions of concern - Total 0.240 0.209 0.230 0.340
Prescriptions of concern - Ages 0-9 0.22 0.14 N/A N/A
Prescriptions of concern - Ages 10-17 0.13 0.10 N/A N/A
Prescriptions of concern - Ages 18-34 0.22 0.18 N/A N/A
Prescriptions of concern - Ages 35-49 0.26 0.22 N/A N/A
Prescriptions of concern - Ages 50-64 0.30 0.28 N/A N/A
Prescriptions of concern - Ages 65-74 0.32 0.29 N/A N/A
Prescriptions of concern - Ages 75-85 0.35 0.27 N/A N/A
Prescriptions of concern - Ages 85 plus 0.37 0.32 N/A N/A
Antibiotic Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Average number of antibiotic prescriptions per member per year - Total 2020 0.63 0.57 0.57 0.71
2019 0.84 0.75 0.74 0.90
2018 0.81 0.74 0.71 0.88
2017 0.89 0.77 0.76 0.90
Average number of antibiotic prescriptions per member per year - Ages 0-9 2020 0.49 0.41 N/A N/A
2019 1.06 0.85 N/A N/A
2018 0.98 0.81 N/A N/A
2017 1.11 0.87 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 2020 0.40 0.33 N/A N/A
2019 0.61 0.52 N/A N/A
2018 0.60 0.52 N/A N/A
2017 0.70 0.57 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 2020 0.60 0.53 N/A N/A
2019 0.74 0.66 N/A N/A
2018 0.72 0.65 N/A N/A
2017 0.78 0.67 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 2020 0.65 0.59 N/A N/A
2019 0.82 0.74 N/A N/A
2018 0.80 0.73 N/A N/A
2017 0.88 0.75 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 2020 0.75 0.70 N/A N/A
2019 0.93 0.85 N/A N/A
2018 0.91 0.84 N/A N/A
2017 0.99 0.88 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 2020 0.88 0.77 N/A N/A
2019 1.04 0.95 N/A N/A
2018 1.06 0.97 N/A N/A
2017 1.18 1.00 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 2020 0.84 0.80 N/A N/A
2019 1.06 1.15 N/A N/A
2018 0.95 1.21 N/A N/A
2017 1.34 1.12 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 2020 1.81 1.56 N/A N/A
2019 1.28 0.95 N/A N/A
2018 1.80 1.32 N/A N/A
2017 1.49 1.12 N/A N/A
Days suppplied per antibiotic prescription - Total 2020 10.520 10.133 10.310 11.480
2019 9.950 9.888 9.890 10.660
2018 10.080 9.950 9.910 10.890
2017 10.050 10.024 9.880 10.830
Days suppplied per antibiotic prescription - Ages 0-9 2020 10.560 10.550 N/A N/A
2019 9.930 10.025 N/A N/A
2018 9.880 9.979 N/A N/A
2017 9.850 10.050 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 2020 14.290 14.369 N/A N/A
2019 12.160 12.591 N/A N/A
2018 12.530 12.948 N/A N/A
2017 12.320 12.689 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 2020 9.800 9.729 N/A N/A
2019 9.500 9.695 N/A N/A
2018 9.650 9.731 N/A N/A
2017 9.750 9.836 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 2020 10.070 9.703 N/A N/A
2019 9.720 9.488 N/A N/A
2018 9.750 9.568 N/A N/A
2017 9.730 9.591 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 2020 10.630 10.027 N/A N/A
2019 9.990 9.756 N/A N/A
2018 10.130 9.769 N/A N/A
2017 10.000 9.856 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 2020 11.110 9.997 N/A N/A
2019 9.880 9.766 N/A N/A
2018 10.650 9.830 N/A N/A
2017 10.490 9.850 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 2020 9.290 10.119 N/A N/A
2019 9.390 9.645 N/A N/A
2018 10.040 9.428 N/A N/A
2017 10.340 10.604 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 2020 5.940 10.606 N/A N/A
2019 5.320 9.997 N/A N/A
2018 8.410 9.026 N/A N/A
2017 9.000 9.873 N/A N/A
Prescriptions of concern - Total 2020 0.250 0.227 0.240 0.320
2019 0.380 0.339 0.330 0.430
2018 0.360 0.338 0.330 0.430
2017 0.410 0.354 0.360 0.450
Prescriptions of concern - Ages 0-9 2020 0.20 0.15 N/A N/A
2019 0.47 0.34 N/A N/A
2018 0.42 0.32 N/A N/A
2017 0.48 0.35 N/A N/A
Prescriptions of concern - Ages 10-17 2020 0.13 0.11 N/A N/A
2019 0.24 0.20 N/A N/A
2018 0.23 0.20 N/A N/A
2017 0.27 0.22 N/A N/A
Prescriptions of concern - Ages 18-34 2020 0.22 0.20 N/A N/A
2019 0.31 0.28 N/A N/A
2018 0.30 0.28 N/A N/A
2017 0.34 0.28 N/A N/A
Prescriptions of concern - Ages 35-49 2020 0.27 0.25 N/A N/A
2019 0.38 0.35 N/A N/A
2018 0.38 0.35 N/A N/A
2017 0.43 0.37 N/A N/A
Prescriptions of concern - Ages 50-64 2020 0.31 0.31 N/A N/A
2019 0.44 0.41 N/A N/A
2018 0.44 0.42 N/A N/A
2017 0.49 0.44 N/A N/A
Prescriptions of concern - Ages 65-74 2020 0.35 0.33 N/A N/A
2019 0.46 0.44 N/A N/A
2018 0.48 0.48 N/A N/A
2017 0.55 0.50 N/A N/A
Prescriptions of concern - Ages 75-85 2020 0.35 0.34 N/A N/A
2019 0.44 0.51 N/A N/A
2018 0.46 0.62 N/A N/A
2017 0.65 0.54 N/A N/A
Prescriptions of concern - Ages 85 plus 2020 0.87 0.41 N/A N/A
2019 0.36 0.36 N/A N/A
2018 0.87 0.45 N/A N/A
2017 0.88 0.48 N/A N/A
Info
Mental Health Utilization 2021 Plan State Avg Nat Avg 90th Pctl.
Mental Health Utilization - Any Service - Total 10.46% 9.40% 9.48% 13.63%
Mental Health Utilization - Any Service - Ages 0-12 7.20% 6.00% N/A N/A
Mental Health Utilization - Any Service - Ages 13-17 18.83% 16.24% N/A N/A
Mental Health Utilization - Any Service - Ages 18-64 10.54% 9.76% N/A N/A
Mental Health Utilization - Any Service - Ages 65 plus 3.16% 3.11% N/A N/A
Mental Health Utilization - ED - Total 0.01% 0.05% 0.07% 0.17%
Mental Health Utilization - ED - Ages 0-12 0.02% 0.02% N/A N/A
Mental Health Utilization - ED - Ages 13-17 0.09% 0.21% N/A N/A
Mental Health Utilization - ED - Ages 18-64 0.01% 0.04% N/A N/A
Mental Health Utilization - ED - Ages 65 plus 0.00% 0.01% N/A N/A
Mental Health Utilization - Inpatient - Total 0.26% 0.24% 0.25% 0.33%
Mental Health Utilization - Inpatient - Ages 0-12 0.11% 0.08% N/A N/A
Mental Health Utilization - Inpatient - Ages 13-17 1.05% 0.88% N/A N/A
Mental Health Utilization - Inpatient - Ages 18-64 0.23% 0.22% N/A N/A
Mental Health Utilization - Inpatient - Ages 65 plus 0.09% 0.08% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Total 0.09% 0.08% 0.16% 0.31%
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 0-12 0.02% 0.03% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 13-17 0.46% 0.40% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 18-64 0.07% 0.07% 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 6.08% 4.73% 5.70% 8.26%
Mental Health Utilization - Outpatient - Ages 0-12 5.18% 3.72% N/A N/A
Mental Health Utilization - Outpatient - Ages 13-17 12.99% 9.85% N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 5.79% 4.63% N/A N/A
Mental Health Utilization - Outpatient - Ages 65 plus 1.96% 1.73% N/A N/A
Mental Health Utilization - Telehealth - Total 6.89% 6.68% 6.01% 9.77%
Mental Health Utilization - Telehealth - Ages 0-12 3.84% 3.74% N/A N/A
Mental Health Utilization - Telehealth - Ages 13-17 11.29% 10.92% N/A N/A
Mental Health Utilization - Telehealth - Ages 18-64 7.20% 7.11% N/A N/A
Mental Health Utilization - Telehealth - Ages 65 plus 1.79% 1.96% N/A N/A
Mental Health Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Mental Health Utilization - Any Service - Total 2020 10.41% 9.13% 9.07% 12.95%
2019 10.43% 8.33% 8.86% 12.67%
2018 9.10% 7.63% 7.98% 11.76%
2017 N/A N/A N/A N/A
Mental Health Utilization - Any Service - Ages 0-12 2020 7.47% 6.25% N/A N/A
2019 8.66% 6.35% N/A N/A
2018 7.60% 6.12% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Any Service - Ages 13-17 2020 17.93% 15.31% N/A N/A
2019 18.49% 15.01% N/A N/A
2018 16.52% 13.96% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Any Service - Ages 18-64 2020 10.49% 9.40% N/A N/A
2019 10.24% 8.45% N/A N/A
2018 8.89% 7.62% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Any Service - Ages 65 plus 2020 3.26% 3.53% N/A N/A
2019 3.66% 3.17% N/A N/A
2018 3.47% 3.20% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - ED - Total 2020 0.00% 0.03% 0.06% 0.15%
2019 0.01% 0.04% 0.08% 0.17%
2018 0.01% 0.09% 0.10% 0.22%
2017 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 0-12 2020 0.00% 0.01% N/A N/A
2019 0.01% 0.02% N/A N/A
2018 0.01% 0.05% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 13-17 2020 0.00% 0.10% N/A N/A
2019 0.04% 0.17% N/A N/A
2018 0.03% 0.28% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 18-64 2020 0.01% 0.03% N/A N/A
2019 0.01% 0.03% N/A N/A
2018 0.01% 0.08% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 65 plus 2020 0.00% 0.01% N/A N/A
2019 0.02% 0.07% N/A N/A
2018 0.02% 0.02% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Total 2020 0.23% 0.22% 0.24% 0.31%
2019 0.27% 0.25% 0.27% 0.34%
2018 0.24% 0.27% 0.27% 0.34%
2017 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 0-12 2020 0.07% 0.07% N/A N/A
2019 0.11% 0.12% N/A N/A
2018 0.07% 0.12% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 13-17 2020 0.96% 0.79% N/A N/A
2019 0.90% 0.85% N/A N/A
2018 0.74% 0.95% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 18-64 2020 0.20% 0.20% N/A N/A
2019 0.26% 0.24% N/A N/A
2018 0.23% 0.26% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 65 plus 2020 0.02% 0.06% N/A N/A
2019 0.13% 0.11% N/A N/A
2018 0.06% 0.06% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Total 2020 0.08% 0.07% 0.15% 0.30%
2019 0.10% 0.11% 0.20% 0.40%
2018 0.10% 0.12% 0.19% 0.38%
2017 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 0-12 2020 0.03% 0.05% N/A N/A
2019 0.07% 0.10% N/A N/A
2018 0.07% 0.15% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 13-17 2020 0.32% 0.26% N/A N/A
2019 0.32% 0.35% N/A N/A
2018 0.43% 0.49% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 18-64 2020 0.06% 0.06% N/A N/A
2019 0.09% 0.09% N/A N/A
2018 0.08% 0.09% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 65 plus 2020 0.04% 0.01% N/A N/A
2019 0.08% 0.02% N/A N/A
2018 0.02% 0.02% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Total 2020 7.98% 7.22% 6.95% 9.99%
2019 10.36% 8.24% 8.73% 12.61%
2018 9.03% 7.53% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Ages 0-12 2020 6.22% 5.23% N/A N/A
2019 8.63% 6.32% N/A N/A
2018 7.56% 6.10% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Ages 13-17 2020 14.94% 12.84% N/A N/A
2019 18.38% 14.86% N/A N/A
2018 16.37% 13.80% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 2020 7.86% 7.35% N/A N/A
2019 10.17% 8.36% N/A N/A
2018 8.82% 7.51% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Ages 65 plus 2020 2.49% 2.62% N/A N/A
2019 3.64% 3.07% N/A N/A
2018 3.43% 3.16% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Total 2020 6.00% 4.92% 5.19% 8.37%
2019 0.10% 0.11% 0.11% 0.22%
2018 0.04% 0.10% 0.05% 0.11%
2017 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Ages 0-12 2020 3.52% 3.07% N/A N/A
2019 0.03% 0.04% N/A N/A
2018 0.03% 0.03% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Ages 13-17 2020 9.97% 8.30% N/A N/A
2019 0.11% 0.15% N/A N/A
2018 0.07% 0.19% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Ages 18-64 2020 6.22% 5.11% N/A N/A
2019 0.12% 0.12% N/A N/A
2018 0.04% 0.11% N/A N/A
2017 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Ages 65 plus 2020 1.72% 1.80% N/A N/A
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
2021 data updated on: 07/05/2023