Health Insurance in Virginia

HMO Profile

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INNOVATION HEALTH PLAN, INC.

Company Information

  • Company Providing Plan:CVS Group
  • Address:151 FARMINGTON AVE, RT21
    HARTFORD CT 06156
  • Telephone :800-843-7421
  • Website:WWW.INNOVATIONHEALTH.COM
2021
Number of Enrollees: 12,800
PMPM: $532
Number of Physicians: 6,924
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

Arlington, Clarke, Fairfax, Fauquier, Frederick, Loudon, Page, Prince William, Shenandoah, Spotsylvania, Stafford, Warren

Cities

Alexandria, Fairfax, Falls Church, Fredericksburg, Manassas, Manassas Park, Winchester

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

Administrative Data

2021 2020 2019 2018 2017
Number of Enrollees 12,800 15,819 14,521 14,892 21,040
PMPM $532 $535 $497 $423 $352
Medical Cost Ratio 83% 85% 85% 79% 82%
Administrative Ratio 12% 13% 13% 16% 17%
Profit/Loss Ratio 5% 2% -1% 5% 1%
Number of Physicians 6,924 27,145 27,160 84,706 79,982

*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 $86,834,256 $105,344,458 $86,019,237 $96,247,408 $104,799,970
Income $3,788,982 $1,517,141 ($1,598,597) $3,296,121 $277,269
Net Worth $33,634,445 $28,920,263 $26,993,776 $26,914,092 $22,523,667

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

Performance

  • Performance Information for Innovation Health Plan, Inc. is available beginning in 2017.
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 N/A 94.34% 93.47% 96.29%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services N/A 96.22% 96.12% 97.63%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services N/A 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 N/A 93.90% 92.88% 95.71%
2019 N/A 92.78% 92.66% 95.76%
2018 90.40% 92.43% 92.33% 95.45%
2017 90.18% 92.73% 92.45% 95.43%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 2020 N/A 96.11% 95.86% 97.54%
2019 N/A 95.78% 95.87% 97.69%
2018 93.57% 95.50% 95.64% 97.49%
2017 92.91% 95.57% 95.61% 97.46%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 2020 N/A 96.79% 96.95% 98.30%
2019 N/A 97.13% 97.14% 98.42%
2018 96.15% 97.15% 97.17% 98.45%
2017 99.54% 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 N/A 38.29% 34.72% 43.21%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 N/A 45.84% 41.60% 52.08%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus N/A 38.22% 34.53% 43.21%
Engagement of Alcohol and Other Drug Dependence Treatment - Total N/A 14.66% 11.91% 15.33%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 N/A 16.85% 15.29% 22.05%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus N/A 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 N/A 40.49% 36.39% 45.24%
2019 N/A 39.13% 35.63% 41.36%
2018 32.84% 37.53% 35.68% 42.36%
2017 28.33% 36.14% 36.11% 42.01%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2020 N/A 35.48% 44.95% 59.06%
2019 N/A 36.19% 42.41% 54.29%
2018 20.00% 49.35% 40.21% 51.02%
2017 44.44% 40.06% 39.91% 52.54%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2020 N/A 40.55% 36.18% 45.12%
2019 N/A 39.20% 35.47% 40.96%
2018 33.33% 37.34% 35.51% 42.35%
2017 27.49% 36.00% 35.97% 41.96%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 2020 N/A 15.16% 12.46% 17.48%
2019 N/A 13.47% 12.31% 16.44%
2018 8.96% 14.69% 12.58% 17.04%
2017 11.11% 13.36% 12.65% 17.26%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2020 N/A 14.80% 17.76% 27.27%
2019 N/A 10.34% 16.48% 27.14%
2018 0.00% 18.18% 16.91% 25.00%
2017 11.11% 14.40% 14.95% 23.85%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2020 N/A 15.15% 12.33% 17.48%
2019 N/A 13.52% 12.20% 16.41%
2018 9.30% 14.58% 12.47% 16.97%
2017 11.11% 13.40% 12.55% 17.38%
Info
Prenatal and Postpartum Care 2021 Plan State Avg Nat Avg 90th Pctl.
Postpartum Care N/A 80.79% 81.70% 93.89%
Timeliness of Prenatal Care N/A 86.12% 83.24% 94.16%
Prenatal and Postpartum Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Postpartum Care 2020 N/A 74.05% 78.11% 92.47%
2019 N/A 78.66% 80.52% 91.97%
2018 66.46% 75.10% 75.89% 88.80%
2017 56.59% 73.45% 75.05% 88.13%
Timeliness of Prenatal Care 2020 N/A 79.76% 81.82% 93.92%
2019 N/A 86.76% 85.57% 95.33%
2018 89.24% 88.15% 84.75% 94.17%
2017 81.01% 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 N/A 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 N/A 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 N/A 79.35% 76.18% 83.11%
Antidepressant Medication Management - Effective Continuation Phase Treatment N/A 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 N/A 77.14% 73.70% 81.07%
2019 N/A 73.53% 71.19% 78.79%
2018 76.40% 71.96% 68.64% 77.59%
2017 78.19% 71.12% 67.11% 75.76%
Antidepressant Medication Management - Effective Continuation Phase Treatment 2020 N/A 59.69% 57.32% 64.22%
2019 N/A 55.44% 54.90% 62.18%
2018 55.28% 54.22% 53.01% 60.39%
2017 62.77% 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 N/A 41.24% 36.60% 48.10%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation N/A 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 N/A 45.87% 41.24% 50.34%
2019 N/A 42.67% 40.66% 51.30%
2018 32.26% 42.91% 39.85% 50.42%
2017 38.24% 41.27% 41.13% 50.83%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 2020 N/A 56.56% 48.67% 59.32%
2019 N/A 50.69% 47.95% 58.82%
2018 25.00% 40.32% 48.73% 60.57%
2017 40.00% 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 Year Plan State Avg. Natl. Avg. 90th Pctl.
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 Year Plan State Avg. Natl. Avg. 90th Pctl.
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 N/A 49.75% 48.70% 63.60%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge N/A 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 N/A 49.46% 49.62% 63.68%
2019 N/A 49.77% 45.66% 58.20%
2018 48.48% 48.09% 44.98% 60.38%
2017 67.65% 52.18% 46.63% 62.81%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 2020 N/A 72.67% 70.00% 79.46%
2019 N/A 72.38% 67.81% 80.65%
2018 75.76% 69.84% 66.68% 80.29%
2017 82.35% 69.80% 68.66% 82.58%
Effectiveness of Care
Info
Asthma Medication Ratio 2021 Plan State Avg Nat Avg 90th Pctl.
Asthma Medication Ratio Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Cardiovascular Disease Management 2021 Plan State Avg Nat Avg 90th Pctl.
Controlling High Blood Pressure N/A 60.64% 59.95% 73.24%
Persistence of Beta-Blockers N/A 88.98% 86.08% 93.62%
Cardiovascular Disease Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Controlling High Blood Pressure 2020 N/A 43.15% 53.49% 69.10%
2019 N/A 60.96% 61.02% 74.21%
2018 58.15% 60.55% N/A N/A
2017 N/A N/A N/A N/A
Persistence of Beta-Blockers 2020 N/A 87.06% 87.38% 94.19%
2019 N/A 88.62% 85.16% 92.47%
2018 87.50% 83.54% 82.37% 89.29%
2017 90.00% 85.80% 85.18% 93.41%
Info
Cervical Cancer Screening 2021 Plan State Avg Nat Avg 90th Pctl.
Cervical Cancer Screening Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Common Childhood Illnesses 2021 Plan State Avg Nat Avg 90th Pctl.
Appropriate Testing for Children With Pharyngitis N/A 82.09% 79.49% 89.15%
Common Childhood Illnesses Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Testing for Children With Pharyngitis 2020 N/A 90.05% 84.77% 92.62%
2019 N/A 90.44% 86.62% 93.98%
2018 93.99% 92.74% 87.97% 94.94%
2017 94.64% 92.30% 87.45% 94.64%
Info
Diabetes Care and Management 2021 Plan State Avg Nat Avg 90th Pctl.
Comprehensive Diabetes Care-Rate of Eye Exams N/A 59.77% 62.09% 75.43%
Comprehensive Diabetes Care-Rate of Poor HbA1c control N/A 61.24% 59.64% 67.11%
Comprehensive Diabetes Care-Testing for HbA1c N/A 57.17% 52.65% 64.30%
Diabetes Care and Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Comprehensive Diabetes Care-Rate of Eye Exams 2020 N/A 44.59% 55.85% 73.48%
2019 N/A 62.53% 63.23% 77.86%
2018 48.91% 63.70% 62.59% 77.37%
2017 48.42% 63.40% 60.82% 76.41%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 2020 N/A 55.20% 55.37% 65.50%
2019 N/A 63.81% 58.07% 66.33%
2018 30.17% 62.46% 57.79% 66.33%
2017 38.69% 62.51% 57.48% 67.15%
Comprehensive Diabetes Care-Testing for HbA1c 2020 N/A 53.44% 50.27% 64.23%
2019 N/A 58.32% 55.45% 69.32%
2018 90.27% 56.58% 54.40% 69.68%
2017 90.27% 56.95% 54.06% 70.69%
Info
Immunizations 2021 Plan State Avg Nat Avg 90th Pctl.
Childhood Immunization for Multiple Diseases (Combo 10) N/A 66.38% 60.60% 73.21%
Childhood Immunization for Multiple Diseases Including Pneumovax N/A 82.74% 78.15% 88.27%
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 N/A 74.94% 75.84% 87.36%
2019 N/A 81.30% 78.32% 87.99%
2018 67.18% 79.46% 77.50% 86.62%
2017 62.84% 80.09% 77.67% 87.61%
Info
Pharmacotherapy of COPD Exacerbation 2021 Plan State Avg Nat Avg 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator N/A 86.14% 81.56% 89.58%
Pharmacotherapy of COPD Exacerbation - Corticosteroid N/A 80.22% 74.79% 84.78%
Pharmacotherapy of COPD Exacerbation Year Plan State Avg. Natl. Avg. 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 2020 N/A 86.03% 81.34% 88.51%
2019 N/A 83.91% 80.32% 88.97%
2018 100.00% 85.49% 78.92% 87.88%
2017 92.86% 80.88% 79.87% 87.50%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 2020 N/A 75.06% 74.31% 85.07%
2019 N/A 81.14% 76.90% 87.69%
2018 80.00% 76.41% 74.76% 83.55%
2017 92.86% 78.84% 76.26% 84.38%
Info
Preventive Care 2021 Plan State Avg Nat Avg 90th Pctl.
Breast Cancer Screening N/A 72.93% 72.44% 79.62%
Chlamydia Screening in Women-all Age groups N/A 51.90% 48.47% 62.71%
Colorectal Cancer Screening N/A 63.99% 64.90% 76.16%
Preventive Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Breast Cancer Screening 2020 N/A 72.56% 72.44% 79.39%
2019 N/A 72.92% 74.81% 81.58%
2018 68.21% 72.13% 73.73% 81.17%
2017 64.69% 71.85% 72.81% 80.91%
Chlamydia Screening in Women-all Age groups 2020 N/A 49.80% 48.49% 63.85%
2019 N/A 54.77% 51.86% 67.02%
2018 45.71% 52.91% 51.41% 67.76%
2017 47.00% 51.46% 50.16% 66.08%
Colorectal Cancer Screening 2020 N/A 60.99% 63.64% 74.42%
2019 N/A 68.10% 66.15% 77.91%
2018 47.69% 64.94% 64.37% 76.52%
2017 46.96% 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 N/A 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 N/A 37.53% 37.16% 43.86%
2019 N/A 39.81% 42.11% 52.78%
2018 46.67% 44.14% 41.48% 50.95%
2017 55.17% 43.12% 41.90% 50.52%
Info
Statin Therapy 2021 Plan State Avg Nat Avg 90th Pctl.
Statin Therapy Year Plan State Avg. Natl. Avg. 90th Pctl.
Info
Weight Assessment and Counseling 2021 Plan State Avg Nat Avg 90th Pctl.
Children/Adolescents BMI Assessment - Total N/A 77.31% 75.21% 89.14%
Children/Adolescents BMI Assessment - Ages 3-11 N/A 78.77% 76.73% 90.56%
Children/Adolescents BMI Assessment - Ages 12-17 N/A 75.37% 73.29% 87.42%
Counseling for Nutrition for Children/Adolescents - Total N/A 74.98% 69.95% 83.70%
Counseling for Nutrition for Children/Adolescents - Ages 3-11 N/A 77.08% 72.50% 86.18%
Counseling for Nutrition for Children/Adolescents - Ages 12-17 N/A 72.13% 66.75% 82.14%
Counseling for Physical Activity for Children/Adolescents - Total N/A 71.34% 66.55% 80.86%
Counseling for Physical Activity for Children/Adolescents - Ages 3-11 N/A 69.93% 66.24% 81.08%
Counseling for Physical Activity for Children/Adolescents - Ages 12-17 N/A 73.30% 66.87% 83.09%
Weight Assessment and Counseling Year Plan State Avg. Natl. Avg. 90th Pctl.
Children/Adolescents BMI Assessment - Total 2020 N/A 61.27% 70.64% 88.81%
2019 N/A 74.97% 74.90% 90.00%
2018 64.96% 73.74% 72.87% 90.00%
2017 61.56% 70.41% 70.59% 88.08%
Children/Adolescents BMI Assessment - Ages 3-11 2020 N/A 64.54% 72.11% 88.89%
2019 N/A 78.68% 76.00% 90.91%
2018 68.67% 76.94% 74.00% 90.91%
2017 63.97% 71.37% 71.84% 88.89%
Children/Adolescents BMI Assessment - Ages 12-17 2020 N/A 57.19% 68.80% 87.79%
2019 N/A 70.46% 73.46% 89.29%
2018 59.26% 69.73% 71.39% 88.97%
2017 57.93% 68.96% 68.94% 87.82%
Counseling for Nutrition for Children/Adolescents - Total 2020 N/A 56.08% 65.06% 82.43%
2019 N/A 72.58% 68.74% 85.24%
2018 66.18% 71.79% 67.72% 85.06%
2017 59.61% 69.47% 65.50% 83.21%
Counseling for Nutrition for Children/Adolescents - Ages 3-11 2020 N/A 59.21% 67.32% 84.32%
2019 N/A 77.02% 71.33% 86.49%
2018 69.48% 75.91% 69.85% 86.21%
2017 63.56% 71.63% 68.20% 84.82%
Counseling for Nutrition for Children/Adolescents - Ages 12-17 2020 N/A 52.10% 62.24% 79.49%
2019 N/A 66.89% 65.44% 84.29%
2018 61.11% 66.37% 64.92% 84.29%
2017 53.66% 66.54% 61.92% 80.26%
Counseling for Physical Activity for Children/Adolescents - Total 2020 N/A 52.21% 60.81% 80.29%
2019 N/A 66.86% 64.24% 82.78%
2018 61.56% 66.42% 63.08% 81.32%
2017 51.58% 64.30% 59.96% 77.32%
Counseling for Physical Activity for Children/Adolescents - Ages 3-11 2020 N/A 52.27% 60.31% 81.14%
2019 N/A 66.12% 63.39% 82.53%
2018 61.04% 65.48% 61.70% 80.92%
2017 48.58% 62.31% 58.84% 75.00%
Counseling for Physical Activity for Children/Adolescents - Ages 12-17 2020 N/A 51.96% 61.40% 79.85%
2019 N/A 67.67% 65.38% 84.68%
2018 62.35% 67.51% 64.79% 84.03%
2017 56.10% 66.86% 61.40% 79.89%
Health Plan Stability/Descriptive
Info
Administrative Data 2021 Plan State Avg Nat Avg 90th Pctl.
Administrative Ratio 0.12 0.12 N/A N/A
Medical Cost Ratio 0.83 0.85 N/A N/A
Number of Enrollees 12,800 189,570 N/A N/A
Number of Physicians 6,924 144,761 N/A N/A
Premium Per Member Per Month $532 $582 N/A N/A
Profit/Loss Ratio 0.05 0.04 N/A N/A
Administrative Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Administrative Ratio 2020 0.13 0.13 N/A N/A
2019 0.13 0.12 N/A N/A
2018 0.16 0.14 86.19 92.68
2017 0.17 0.12 86.39 93.13
Medical Cost Ratio 2020 0.85 0.81 N/A N/A
2019 0.85 0.84 N/A N/A
2018 0.79 0.83 92.60 95.85
2017 0.82 0.83 93.13 96.59
Number of Enrollees 2020 15,819 157,206 N/A N/A
2019 14,521 136,748 N/A N/A
2018 14,892 129,656 92 96
2017 21,040 133,992 92 97
Number of Physicians 2020 27,145 118,547 N/A N/A
2019 27,160 105,314 N/A N/A
2018 84,706 86,806 87 95
2017 79,982 81,926 87 95
Premium Per Member Per Month 2020 $535 $529 N/A N/A
2019 $497 $511 N/A N/A
2018 $423 $517 N/A N/A
2017 $352 $370 N/A N/A
Profit/Loss Ratio 2020 0.02 0.06 N/A N/A
2019 -0.01 0.04 N/A N/A
2018 0.05 0.04 N/A N/A
2017 0.01 0.05 N/A N/A
Info
Financial Data 2021 Plan State Avg Nat Avg 90th Pctl.
Income $3,788,982 $84,171,275 N/A N/A
Net Worth $33,634,445 $444,659,972 N/A N/A
Premiums Earned $86,834,256 $1,315,605,350 N/A N/A
Financial Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Income 2020 $1,517,141 $108,797,768 N/A N/A
2019 $-1,598,597 $81,234,487 N/A N/A
2018 $3,296,121 $44,046,244 N/A N/A
2017 $277,269 $34,422,501 N/A N/A
Net Worth 2020 $28,920,263 $381,868,187 N/A N/A
2019 $26,993,776 $340,553,480 N/A N/A
2018 $26,914,092 $279,558,644 N/A N/A
2017 $22,523,667 $263,890,874 N/A N/A
Premiums Earned 2020 $105,344,458 $1,079,933,473 N/A N/A
2019 $86,019,237 $936,529,722 N/A N/A
2018 $96,247,408 $815,577,345 N/A N/A
2017 $104,799,970 $645,600,589 N/A N/A
Info
Years in Business 2021 Plan State Avg Nat Avg 90th Pctl.
Years in Business N/A 39 N/A N/A
Years in Business Year Plan State Avg. Natl. Avg. 90th Pctl.
Years in Business 2020 N/A 38 N/A N/A
2019 N/A 37 N/A N/A
2018 N/A 36 N/A N/A
2017 N/A 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 N/A 94.61% 95.28% 97.41%
Members highly rating their HMO (8 to 10 on a 0-10 scale) N/A 66.71% 67.27% 78.31%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) N/A 83.98% 84.85% 88.79%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) N/A 78.88% 77.89% 84.07%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) N/A 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 N/A 87.14% 86.32% 90.57%
2018 N/A 85.27% 85.23% 89.89%
2017 N/A 87.22% 85.34% 89.83%
Getting Needed Care 2020 N/A 87.88% 88.01% 92.51%
2019 N/A 87.88% 87.38% 91.22%
2018 N/A 85.53% 86.33% 90.45%
2017 N/A 87.44% 86.71% 90.37%
How Well Doctors Communicate 2020 N/A 95.93% 95.93% 97.98%
2019 N/A 94.99% 95.85% 97.38%
2018 N/A 94.70% 95.31% 97.22%
2017 N/A 94.74% 95.10% 96.91%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 2020 N/A 65.21% 69.04% 80.59%
2019 N/A 69.24% 67.91% 78.57%
2018 55.73% 64.78% 64.53% 76.79%
2017 50.39% 61.26% 62.44% 75.00%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 2020 N/A 86.67% 87.14% 91.18%
2019 N/A 88.18% 86.27% 90.20%
2018 81.93% 84.82% 84.41% 88.57%
2017 77.94% 83.86% 84.62% 88.77%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 2020 N/A 79.32% 80.71% 87.04%
2019 N/A 79.81% 80.27% 86.36%
2018 69.03% 76.02% 78.17% 83.95%
2017 75.00% 76.98% 77.27% 82.99%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 2020 N/A 85.69% 86.56% 91.30%
2019 N/A 87.91% 87.34% 90.94%
2018 80.95% 84.08% 85.14% 89.78%
2017 78.64% 83.95% 84.60% 89.86%
Overuse/Appropriateness
Info
Antipsychotics 2021 Plan State Avg Nat Avg 90th Pctl.
Antipsychotics Year Plan State Avg. Natl. Avg. 90th Pctl.
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Cervical Cancer Screening in Adolescent Females 2021 Plan State Avg Nat Avg 90th Pctl.
Cervical Cancer Screening in Adolescent Females Year Plan State Avg. Natl. Avg. 90th Pctl.
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Lower Back Pain 2021 Plan State Avg Nat Avg 90th Pctl.
Use of Imaging for Low Back Pain N/A 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 N/A 77.22% 78.53% 85.60%
2019 N/A 77.01% 76.69% 83.47%
2018 73.45% 74.77% 75.11% 82.95%
2017 70.73% 73.85% 75.16% 82.29%
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Respiratory 2021 Plan State Avg Nat Avg 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection N/A 95.68% 94.48% 98.12%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis N/A 44.79% 46.61% 61.68%
Respiratory Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 2020 N/A 93.12% 91.57% 95.67%
2019 N/A 91.87% 90.76% 95.51%
2018 93.70% 92.50% 91.22% 95.48%
2017 93.88% 90.92% 89.19% 94.59%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 2020 N/A 41.88% 43.24% 59.45%
2019 N/A 38.42% 39.91% 54.09%
2018 31.44% 33.60% 33.16% 48.28%
2017 24.21% 30.67% 30.99% 49.52%
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Use of Opiods 2021 Plan State Avg Nat Avg 90th Pctl.
Use of Opiods Year Plan State Avg. Natl. Avg. 90th Pctl.
Risk Adjusted Utilization
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Acute Hospital Utilization Rate 2021 Plan State Avg Nat Avg 90th Pctl.
Acute Hospital Utilization Rate Year Plan State Avg. Natl. Avg. 90th Pctl.
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Emergency Department Utilization 2021 Plan State Avg Nat Avg 90th Pctl.
Emergency Department Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
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Plan All-Cause Readmissions 2021 Plan State Avg Nat Avg 90th Pctl.
Plan All-Cause Readmissions Year Plan State Avg. Natl. Avg. 90th Pctl.
Utilization
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Antibiotic Utilization 2021 Plan State Avg Nat Avg 90th Pctl.
Antibiotic Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
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Mental Health Utilization 2021 Plan State Avg Nat Avg 90th Pctl.
Mental Health Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
2021 data updated on: 07/05/2023