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Optima Health Plan


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General Information
    Company Providing Plan : Sentara Health Care
    Address : 4417 Corporation Lane
    City : Virginia Beach, VA 23462
    Telephone : (757) 252-8011
    Website : www.sentara.com
     

    2008

    Number of Enrollees : 267,154
    PMPM : $284
    Number of Physicians : 9,209
    NCQA Accreditation : Excellent


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

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


Administrative Information
2008 2007 2006 2005 2004
Number of Enrollees :
267,154
246,393
244,010
243,142
221,777
PMPM :
$284
$275
$262
$249
$239
Medical Cost Ratio :
87%
84%
83%
82%
82%
Administrative Ratio :
9%
8%
8%
7%
8%
Profit/Loss Ratio :
5%
9%
10%
12%
10%
Number of Physicians :
9,209
7,558
7,052
6,695
5,933


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



Financial Information
2008 2007 2006 2005 2004
Premiums Earned :
$867,217,639
$792,927,068
$782,762,776
$695,908,425
$586,620,238
Income :
$43,379,586
$74,495,618
$79,793,271
$82,335,126
$60,026,604
Net Worth :
$153,377,953
$188,092,906
$182,891,905
$161,435,679
$139,452,928


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



Performance


Select a measurement name to display more information.

Click on the measurement name to get more information about an individual measure.

Access/Availability of Care - Click for Single Year

Adult Access To Preventive/Ambulatory Health Services Measurement Year Plan
 State
Avg.		 Natl.
Avg.		 90th Pctl.
Adult Access (Age 20-44) To Preventive/Ambulatory Health Services
2008 93.50% 93.66% 92.48% 95.85%
2007 92.95% 93.57% 92.33% 95.38%
2006 93.23% 93.45% 93.09% 95.90%
2005 93.32% 92.85% 92.73% 95.50%
2004 93.77% 92.79% 92.69% 95.50%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services
2008 95.90% 95.54% 94.79% 96.70%
2007 95.42% 95.46% 94.57% 96.68%
2006 95.59% 95.37% 95.08% 96.92%
2005 95.66% 94.99% 94.76% 96.82%
2004 95.84% 94.76% 94.64% 96.73%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services
2008 97.71% 96.99% 96.18% 98.87%
2007 98.12% 97.02% 95.77% 98.31%
2006 97.86% 96.53% 96.64% 98.60%
2005 98.07% 96.32% 96.40% 98.38%
2004 98.31% 96.24% 96.20% 98.38%

 Access/Availability of Care - Click for Single Year

Child Access to Primary Care Practitioners Measurement Year Plan
 State
Avg.		 Natl.
Avg.		 90th Pctl.
12-24 month old Child Access to Primary Care Practitioners
2008 97.34% 97.39% 95.41% 99.13%
2007 97.26% 97.16% 95.61% 98.93%
2006 97.77% 97.59% 97.04% 99.07%
2005 97.80% 97.72% 96.98% 99.07%
2004 97.92% 97.59% 96.75% 99.13%
25 month to 6 year old Child Access to Primary Care Practitioners
2008 91.41% 91.46% 86.98% 93.13%
2007 91.44% 91.35% 88.17% 94.42%
2006 91.10% 91.22% 89.33% 94.97%
2005 90.96% 91.15% 89.33% 94.67%
2004 90.23% 89.99% 88.08% 94.08%
7-11 year old Child Access to Primary Care Practitioners
2008 91.58% 92.13% 87.20% 93.17%
2007 90.29% 91.23% 88.43% 95.36%
2006 90.59% 91.29% 89.19% 95.72%
2005 88.76% 89.92% 88.60% 95.26%
2004 90.12% 90.00% 88.54% 94.95%
12-19 year old Child Access to Primary Care Practitioners
2008 86.29% 87.92% 85.14% 91.73%
2007 85.71% 87.57% 85.50% 93.14%
2006 85.31% 87.28% 86.64% 93.71%
2005 84.05% 85.84% 86.10% 92.62%
2004 84.89% 86.18% 85.52% 92.82%

 Access/Availability of Care - Click for Single Year

Prenatal and Postpartum Care Measurement Year Plan
 State
Avg.		 Natl.
Avg.		 90th Pctl.
Postpartum Care
2008 85.35% 84.03% 81.18% 91.48%
2007 85.02% 82.10% 69.00% 89.04%
2006 81.34% 79.87% 79.87% 89.08%
2005 84.99% 83.27% 81.46% 89.04%
2004 82.35% 83.02% 80.65% 88.32%
Timeliness of Prenatal Care
2008 92.36% 93.97% 90.04% 96.84%
2007 91.90% 93.02% 77.45% 97.44%
2006 94.12% 92.61% 90.56% 97.53%
2005 93.31% 94.11% 91.84% 97.11%
2004 94.93% 93.67% 90.82% 96.88%

 Effectiveness of Care - Click for Single Year

Asthma Medication Management Measurement Year Plan
 State
Avg.		 Natl.
Avg.		 90th Pctl.
Use of Appropriate Medications for children 5-9 years old with Asthma
2008 97.31% 96.98% 96.46% 99.32%
2007 95.77% 97.39% 97.11% 100.00%
2006 92.96% 95.97% 96.41% 98.80%
2005 96.30% 95.86% 95.65% 98.91%
2004 71.79% 76.17% 75.89% 83.72%
Use of Appropriate Medications for children 10-17 years old with Asthma
2008 93.80% 93.69% 93.16% 97.14%
2007 93.94% 94.87% 94.31% 97.44%
2006 92.91% 92.79% 92.88% 96.57%
2005 92.25% 93.64% 91.69% 96.35%
2004 69.37% 70.02% 69.54% 77.51%
Use of Appropriate Medications for adults 18-56 years old with Asthma
2008 91.91% 92.25% 90.66% 94.51%
2007 90.23% 92.36% 91.18% 94.38%
2006 86.73% 91.45% 90.31% 94.29%
2005 85.61% 92.56% 88.50% 93.33%
2004 72.35% 75.43% 73.36% 80.21%
Use of Appropriate Medications for people with Asthma
2008 93.01% 93.22% 91.94% 95.36%
2007 91.59% 93.57% 92.52% 95.29%
2006 88.88% 92.40% 91.64% 94.84%
2005 88.43% 93.26% 89.87% 94.06%
2004 71.70% 74.38% 72.85% 79.23%

 Effectiveness of Care - Click for Single Year

Attention-Deficit/Hyperactivity Disorder (ADHD) Medication Measurement Year Plan
 State
Avg.		 Natl.
Avg.		 90th Pctl.
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Initiation
2008 34.22% 36.52% 33.90% 42.42%
2007 34.65% 34.43% 32.96% 43.27%
2006 33.74% 33.84% 32.99% 41.96%
2005 33.95% 33.89% N/A N/A
2004   N/A   N/A N/A N/A
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation
2008 39.75% 47.08% 40.16% 52.38%
2007 39.51% 43.08% 36.94% 49.56%
2006 46.08% 42.89% 32.99% 41.96%
2005   N/A   N/A N/A N/A
2004   N/A   N/A N/A N/A

 Effectiveness of Care - Click for Single Year

Avoiding Antibiotics Measurement Year Plan
 State
Avg.		 Natl.
Avg.		 90th Pctl.
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis
2008 19.54% 20.21% 28.33% 43.98%
2007 20.83% 25.27% 27.04% 36.51%
2006 25.47% 26.12% 28.69% 38.79%
2005 34.30% 29.54% N/A N/A
2004   N/A   N/A N/A N/A

 Effectiveness of Care - Click for Single Year

Cardiovascular Disease Management Measurement Year Plan
 State
Avg.		 Natl.
Avg.		 90th Pctl.
Cholesterol Management After Acute Cardiovascular Events-Rate of LDL-C Screening
2008 87.10% 87.60% 88.95% 94.02%
2007 85.36% 85.92% 82.69% 91.94%
2006 79.02% 85.77% 87.53% 91.97%
2005 79.63% 80.59% N/A N/A
2004 76.47% 80.21% 81.76% 87.50%
Cholesterol Management After Acute Cardiovascular Events-Rate of affected members with <100 LDL-C Level
2008 60.04% 60.39% 57.98% 70.98%
2007 57.11% 57.58% 47.84% 68.81%
2006 52.55% 56.96% 56.61% 66.18%
2005 45.47% 51.35% N/A N/A
2004 50.17% 53.42% N/A N/A
Controlling High Blood Pressure
2008 62.36% 63.15% 62.20% 71.05%
2007 61.79% 62.28% 62.16% 70.28%
2006 61.79% 58.40% 59.66% 68.13%
2005 72.69% 72.28% 68.82% 76.27%
2004 66.59% 66.26% 66.84% 75.35%

 Effectiveness of Care - Click for Single Year

Common Childhood Illnesses Measurement Year Plan
 State
Avg.		 Natl.
Avg.		 90th Pctl.
Appropriate Testing for Children With Pharyngitis
2008 100.00% 86.61% 73.51% 89.16%
2007 87.79% 82.64% 74.21% 85.96%
2006 85.22% 79.43% 72.70% 85.96%
2005 85.09% 76.56% 69.65% 85.09%
2004 86.17% 79.26% 72.56% 88.41%
Appropriate Treatment for Children With Upper Respiratory Infection
2008 85.90% 84.35% 82.79% 95.92%
2007 86.57% 83.54% 83.29% 92.03%
2006 87.26% 83.23% 82.84% 91.14%
2005 88.64% 88.28% 82.86% 91.22%
2004 89.28% 85.20% 82.73% 90.45%

 Effectiveness of Care - Click for Single Year

Diabetes Care and Management Measurement Year Plan
 State
Avg.		 Natl.
Avg.		 90th Pctl.
Comprehensive Diabetes Care-Rate of LDL-C Screening
2008 81.58% 84.26% 84.73% 91.03%
2007 81.58% 82.23% 79.47% 88.08%
2006 80.56% 82.77% 83.35% 88.00%
2005 89.39% 91.07% 92.27% 95.44%
2004 90.48% 90.73% 91.00% 94.89%
Comprehensive Diabetes Care-Rate of Eye Exams
2008 55.98% 56.13% 56.05% 75.43%
2007 53.96% 55.11% 46.87% 67.69%
2006 49.15% 54.49% 54.65% 71.17%
2005 49.35% 56.48% 54.79% 69.34%
2004 48.27% 53.54% 50.95% 66.18%
Comprehensive Diabetes Care-Rate of Medical Attention for Diabetic Nephropathy
2008 83.94% 83.52% 83.46% 92.46%
2007 83.94% 79.65% N/A N/A
2006 82.69% 79.51% N/A N/A
2005   N/A   N/A N/A N/A
2004   N/A   N/A N/A N/A
Comprehensive Diabetes Care-Rate of Poor HbA1c control
2008 22.80% 26.10% 29.62% 18.15%
2007 27.62% 29.16% 43.38% 19.95%
2006 29.92% 30.55% 29.60% 18.98%
2005 31.82% 28.78% 29.68% 20.44%
2004 28.57% 29.54% 20.92% 30.67%
Comprehensive Diabetes Care-Rate of Those under care with <100 LDL-C Level
2008 46.04% 48.49% 44.73% 56.12%
2007 46.04% 44.48% N/A N/A
2006 48.93% 45.18% N/A N/A
2005 49.13% 47.82% N/A N/A
2004 45.24% 44.33% N/A N/A
Comprehensive Diabetes Care-Testing for HbA1c
2008 88.71% 88.00% 88.98% 93.92%
2007 89.29% 86.43% N/A N/A
2006 86.11% 86.84% N/A N/A
2005 81.39% 85.72% N/A N/A
2004 86.80% 86.15% N/A N/A

 Effectiveness of Care - Click for Single Year

Drug Therapy in Rheumatoid Arthritis Measurement Year Plan
 State
Avg.		 Natl.
Avg.		 90th Pctl.
Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis
2008 89.36% 86.64% 85.62% 94.37%
2007 88.18% 85.63% 82.72% 91.25%
2006 85.99% 84.28% 84.81% 92.18%
2005 86.28% 81.06% N/A N/A
2004   N/A   N/A N/A N/A

 Effectiveness of Care - Click for Single Year

Immunizations Measurement Year Plan
 State
Avg.		 Natl.
Avg.		 90th Pctl.
Childhood Immunization for Multiple diseases including Chicken Pox
2008 83.30% 82.99% 79.05% 89.52%
2007 83.00% 82.50% 66.90% 88.14%
2006 88.64% 80.75% 79.79% 87.65%
2005 88.64% 81.63% 77.71% 86.54%
2004 74.39% 75.76% 72.47% 81.73%
Childhood Immunization for Multiple diseases including pneumovax
2008 80.34% 77.66% 74.17% 87.34%
2007 79.76% 76.69% 62.33% 84.80%
2006 63.08% 65.34% 72.76% 87.83%
2005 63.08% 56.21% N/A N/A
2004   N/A   N/A N/A N/A
Flu Shots for Adults Ages 50-64
2008 51.58% 51.68% 50.10% 59.89%
2007 49.69% 49.15% 48.41% 57.09%
2006 45.10% 47.79% 45.57% 55.18%
2005 35.40% 36.81% 36.28% 46.88%
2004 37.98% 38.59% 38.87% 48.29%

 Effectiveness of Care - Click for Single Year

Mental Health: Care and Follow-up Measurement Year Plan
 State
Avg.		 Natl.
Avg.		 90th Pctl.
Antidepressant Medication Management-Acute Phase Treatment
2008 61.65% 64.67% 64.97% 78.18%
2007 61.23% 63.55% 63.24% 70.00%
2006 58.66% 63.43% 61.09% 69.52%
2005 57.59% 61.44% 61.35% 69.89%
2004 60.25% 63.17% 60.91% 69.31%
Antidepressant Medication Management-Continuation Phase Treatment
2008 41.77% 46.79% 48.21% 62.62%
2007 43.57% 46.66% 46.72% 55.07%
2006 43.79% 47.49% 45.10% 53.02%
2005 43.37% 43.76% 44.99% 53.24%
2004 42.28% 44.97% 44.30% 53.59%
Follow-up After Hospitalization For Mental Illness within 7 days after hospital discharge
2008 77.07% 61.00% 56.11% 76.02%
2007 73.80% 55.56% 49.86% 70.53%
2006 62.34% 57.21% 56.74% 72.50%
2005 50.24% 57.58% 55.80% 70.46%
2004 52.51% 55.48% 55.87% 70.18%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge
2008 88.89% 80.30% 75.42% 86.72%
2007 86.46% 74.62% 69.56% 85.50%
2006 81.17% 76.72% 75.84% 87.61%
2005 77.99% 77.13% 75.89% 86.42%
2004 79.00% 75.39% 75.95% 86.22%

 Effectiveness of Care - Click for Single Year

Persistent Medications Measurement Year Plan
 State
Avg.		 Natl.
Avg.		 90th Pctl.
Annual Monitoring for Patients on Persistent Medications
2008 81.29% 78.19% 78.94% 84.31%
2007 78.40% 78.75% 75.89% 81.71%
2006 76.66% 80.23% 74.26% 81.46%
2005 75.13% 74.26% N/A N/A
2004   N/A   N/A N/A N/A

 Effectiveness of Care - Click for Single Year

Preventive Care Measurement Year Plan
 State
Avg.		 Natl.
Avg.		 90th Pctl.
Breast Cancer Screening
2008 72.83% 69.71% 70.84% 81.54%
2007 69.91% 68.48% 67.32% 76.03%
2006 70.52% 69.14% 68.88% 76.66%
2005 74.54% 72.27% 72.02% 80.10%
2004 75.30% 73.82% 73.41% 81.19%
Cervical Cancer Screening
2008 86.26% 82.39% 79.51% 87.25%
2007 84.58% 82.57% 78.43% 86.00%
2006 79.74% 81.72% 81.03% 87.10%
2005 85.50% 83.64% 81.81% 87.85%
2004 83.69% 83.33% 80.88% 87.24%
Chlamydia Screening in Women-all Age groups
2008 44.27% 43.82% 42.88% 62.04%
2007 38.73% 39.83% 36.40% 48.66%
2006 41.98% 40.31% 37.28% 48.57%
2005 36.97% 38.80% 34.91% 45.50%
2004 35.15% 36.58% 32.19% 43.07%
Colorectal Cancer Screening
2008 72.65% 61.80% 57.70% 70.06%
2007 72.65% 60.00% 51.34% 65.72%
2006 70.47% 57.57% 54.52% 65.10%
2005 68.02% 54.32% 52.30% 63.50%
2004 67.61% 52.42% 49.01% 61.75%

 Effectiveness of Care - Click for Single Year

Spirometry Testing Measurement Year Plan
 State
Avg.		 Natl.
Avg.		 90th Pctl.
Use of Spirometry Testing in the Assessment and diagnosis of COPD
2008 37.89% 36.51% 35.65% 50.00%
2007 41.58% 36.64% 34.85% 44.74%
2006 38.58% 34.42% 36.12% 45.95%
2005 39.73% 32.58% N/A N/A
2004   N/A   N/A N/A N/A

 Effectiveness of Care - Click for Single Year

Use of Imaging for Low Back Pain Measurement Year Plan
 State
Avg.		 Natl.
Avg.		 90th Pctl.
Use of Imaging for Low Back Pain
2008 69.17% 72.02% 72.37% 81.13%
2007 70.84% 72.77% 74.08% 81.58%
2006 74.03% 73.39% 73.87% 81.46%
2005 73.84% 74.17% 75.38% 82.43%
2004 74.47% 74.98% 74.90% 82.10%

 Health Plan Stability/Descriptive - Click for Single Year

Board Certification Rates for Providers Measurement Year Plan
 State
Avg.		 Natl.
Avg.		 90th Pctl.
Board Certification for Geriatricians
2008 90.91% 66.06% 67.64% 100.00%
2007 88.89% 79.66% 67.51% 93.44%
2006 88.89% 74.10% 71.57% 100.00%
2005 83.33% 72.86% 72.60% 97.96%
2004 80.00% 75.33% 74.59% 100.00%
Board Certification for Pediatricians
2008 82.57% 78.99% 81.98% 93.94%
2007 68.97% 81.56% 79.17% 90.78%
2006 69.94% 71.38% 74.11% 91.77%
2005 72.79% 77.91% 76.41% 91.38%
2004 79.25% 78.35% 78.21% 93.19%
Board Certification Rate for Family Medicine Physicians
2008 83.59% 76.06% 77.99% 95.18%
2007 83.04% 81.58% 74.96% 90.72%
2006   N/A   N/A N/A N/A
2005   N/A   N/A N/A N/A
2004   N/A   N/A N/A N/A
Board Certification Rate for Internal Medicine Physicians
2008 83.21% 78.60% 79.71% 92.64%
2007 83.33% 82.67% N/A N/A
2006   N/A   N/A N/A N/A
2005   N/A   N/A N/A N/A
2004   N/A   N/A N/A N/A
Board Certification Rate for OB/GYN Providers
2008 78.64% 74.67% 78.47% 89.61%
2007 83.53% 78.70% 73.60% 88.91%
2006 85.54% 82.67% 80.07% 90.43%
2005 86.58% 81.62% 81.50% 91.03%
2004 85.11% 80.31% 81.19% 89.16%
Board Certification Rate for Other Specialists
2008 84.65% 72.97% 77.02% 93.15%
2007 86.16% 82.00% N/A N/A
2006 84.75% 81.07% N/A N/A
2005 79.53% 80.63% N/A N/A
2004 83.74% 80.70% N/A N/A

 Health Plan Stability/Descriptive - Click for Single Year

Years in Business Measurement Year Plan
 State
Avg.		 Natl.
Avg.		 90th Pctl.
Years in Business
2008 24 25 N/A N/A
2007 23 24 N/A N/A
2006 22 23 N/A N/A
2005 21 22 N/A N/A
2004 20 21 N/A N/A

 Member Satisfaction - Click for Single Year

Member Satisfaction Measurement Year Plan
 State
Avg.		 Natl.
Avg.		 90th Pctl.
Getting Care Quickly
2008 87.52% 86.42% 84.89% 89.76%
2007 87.58% 84.67% 86.33% 90.35%
2006 85.75% 84.38% 86.13% 90.86%
2005 78.76% 76.22% 79.67% 85.71%
2004 78.54% 76.26% 79.37% 85.52%
Getting Needed Care
2008 86.03% 83.93% 84.05% 89.36%
2007 90.73% 82.72% 84.63% 89.16%
2006 90.07% 81.63% 84.15% 89.20%
2005 83.81% 79.21% 80.15% 86.27%
2004 85.25% 78.59% 79.40% 85.49%
How Well Doctors Communicate
2008 92.93% 92.02% 92.52% 95.39%
2007 91.87% 91.90% N/A N/A
2006 94.08% 92.20% N/A N/A
2005 93.22% 91.34% N/A N/A
2004 91.36% 90.54% N/A N/A
Members highly rating their HMO (8 to 10 on a 0-10 scale)
2008 70.51% 63.59% 65.71% 76.23%
2007 67.54% 61.34% 59.84% 71.17%
2006 76.97% 63.64% 63.03% 73.18%
2005 74.22% 65.25% 65.21% 75.31%
2004 70.77% 63.52% 64.10% 73.88%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale)
2008 77.37% 78.89% 80.18% 85.48%
2007 81.89% 78.21% 80.52% 85.35%
2006 86.70% 78.82% 79.90% 84.86%
2005 79.38% 77.44% 78.13% 82.99%
2004 79.31% 77.54% 77.82% 83.00%
Members highly rating their overall health care (8 to 10 on a 0-10 scale)
2008 76.92% 72.48% 74.04% 80.91%
2007 72.90% 70.72% 73.73% 79.37%
2006 77.51% 71.51% 73.61% 80.00%
2005 81.49% 76.16% 78.02% 83.37%
2004 78.19% 73.66% 77.64% 83.43%
Members highly rating their personal doctor or nurse (8 to 10 on a 0-10 scale)
2008 82.27% 80.42% 81.62% 86.36%
2007 82.77% 79.84% 81.41% 86.19%
2006 82.69% 79.86% 81.08% 86.00%
2005 79.46% 76.38% 77.19% 81.37%
2004 73.33% 74.74% 64.10% 73.88%

 Other Data - Click for Single Year

Administrative Data Measurement Year Plan
 State
Avg.		 Natl.
Avg.		 90th Pctl.
Administrative Ratio
2008 8.78% 10.07% N/A N/A
2007 8.48% 10.35% N/A N/A
2006 7.98% 10.17% N/A N/A
2005 7.17% 10.93% N/A N/A
2004 8.11% 11.79% N/A N/A
Medical Cost Ratio
2008 86.70% 90.73% N/A N/A
2007 83.68% 84.06% N/A N/A
2006 83.19% 82.12% N/A N/A
2005 81.92% 83.31% N/A N/A
2004 82.03% 83.68% N/A N/A
Number of Enrollees
2008 267,154 78,725 N/A N/A
2007 246,393 80,979 N/A N/A
2006 244,010 83,170 N/A N/A
2005 243,142 80,931 N/A N/A
2004 221,777 79,289 N/A N/A
Number of Physicians
2008 9,209 19,780 N/A N/A
2007 7,558 17,202 N/A N/A
2006 7,052 16,777 N/A N/A
2005 6,695 20,154 N/A N/A
2004 5,933 18,363 N/A N/A
Premium Per Member Per Month
2008 $284 $287 N/A N/A
2007 $275 $280 N/A N/A
2006 $262 $266 N/A N/A
2005 $249 $249 N/A N/A
2004 $239 $236 N/A N/A
Profit/Loss Ratio
2008 5.16% 0.70% N/A N/A
2007 9.42% 7.09% N/A N/A
2006 10.24% 8.82% N/A N/A
2005 11.82% 6.85% N/A N/A
2004 10.25% 5.85% N/A N/A

 Other Data - Click for Single Year

Financial Data Measurement Year Plan
 State
Avg.		 Natl.
Avg.		 90th Pctl.
Income
2008 $43,379,586 $29,932,407 N/A N/A
2007 $74,495,618 $40,743,178 N/A N/A
2006 $79,793,271 $36,175,834 N/A N/A
2005 $82,335,126 $27,975,662 N/A N/A
2004 $60,026,604 $26,469,104 N/A N/A
Net Worth
2008 $153,377,953 $134,214,291 N/A N/A
2007 $188,092,906 $123,993,953 N/A N/A
2006 $182,891,905 $110,740,773 N/A N/A
2005 $161,435,679 $92,276,648 N/A N/A
2004 $139,452,928 $80,838,330 N/A N/A
Premiums Earned
2008 $867,217,639 $263,333,566 N/A N/A
2007 $792,927,068 $260,335,580 N/A N/A
2006 $782,762,776 $255,951,470 N/A N/A
2005 $695,908,425 $231,851,711 N/A N/A
2004 $586,620,238 $211,152,613 N/A N/A

 Use of Services - Click for Single Year

Child and Adolescent Well Child Visits Measurement Year Plan
 State
Avg.		 Natl.
Avg.		 90th Pctl.
Well Child Visits in the First 15 Months of Life
2008 100.00% 83.58% 72.44% 86.96%
2007 85.02% 81.27% 68.95% 87.10%
2006 78.54% 78.64% 72.93% 88.65%
2005 76.64% 74.55% 71.07% 85.91%
2004 72.28% 72.26% 68.73% 85.72%
Well Child Visits in the 3rd, 4th, 5th and 6th Years
2008 73.57% 71.26% 64.52% 77.78%
2007 73.62% 72.16% 65.03% 82.35%
2006 70.45% 72.18% 66.67% 83.30%
2005 67.41% 70.65% 65.60% 83.21%
2004 66.90% 68.68% 64.37% 82.78%
Adolescent Well-Care Visits
2008 41.81% 44.16% 37.63% 52.80%
2007 40.94% 43.41% 39.02% 58.24%
2006 38.46% 42.58% 40.29% 57.77%
2005 31.81% 37.60% 38.76% 54.99%
2004 31.09% 36.37% 38.23% 55.23%
 Access/Availability of Care (2008)
- Click for Multiple Years


Adult Access To Preventive/Ambulatory Health Services Measurement Plan
 State Avg. Natl. Avg. 90th Pctl.
Adult Access (Age 20-44) To Preventive/Ambulatory Health Services93.50%93.66%92.48%95.85%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services95.90%95.54%94.79%96.70%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services97.71%96.99%96.18%98.87%

Access/Availability of Care (2008)
- Click for Multiple Years


Child Access to Primary Care Practitioners Measurement Plan
 State Avg. Natl. Avg. 90th Pctl.
12-24 month old Child Access to Primary Care Practitioners97.34%97.39%95.41%99.13%
25 month to 6 year old Child Access to Primary Care Practitioners91.41%91.46%86.98%93.13%
7-11 year old Child Access to Primary Care Practitioners91.58%92.13%87.20%93.17%
12-19 year old Child Access to Primary Care Practitioners86.29%87.92%85.14%91.73%

Access/Availability of Care (2008)
- Click for Multiple Years


Prenatal and Postpartum Care Measurement Plan
 State Avg. Natl. Avg. 90th Pctl.
Postpartum Care85.35%84.03%81.18%91.48%
Timeliness of Prenatal Care92.36%93.97%90.04%96.84%

Effectiveness of Care (2008)
- Click for Multiple Years


Asthma Medication Management Measurement Plan
 State Avg. Natl. Avg. 90th Pctl.
Use of Appropriate Medications for children 5-9 years old with Asthma97.31%96.98%96.46%99.32%
Use of Appropriate Medications for children 10-17 years old with Asthma93.80%93.69%93.16%97.14%
Use of Appropriate Medications for adults 18-56 years old with Asthma91.91%92.25%90.66%94.51%
Use of Appropriate Medications for people with Asthma93.01%93.22%91.94%95.36%

Effectiveness of Care (2008)
- Click for Multiple Years


Attention-Deficit/Hyperactivity Disorder (ADHD) Medication Measurement Plan
 State Avg. Natl. Avg. 90th Pctl.
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Initiation34.22%36.52%33.90%42.42%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation39.75%47.08%40.16%52.38%

Effectiveness of Care (2008)
- Click for Multiple Years


Avoiding Antibiotics Measurement Plan
 State Avg. Natl. Avg. 90th Pctl.
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis19.54%20.21%28.33%43.98%

Effectiveness of Care (2008)
- Click for Multiple Years


Cardiovascular Disease Management Measurement Plan
 State Avg. Natl. Avg. 90th Pctl.
Cholesterol Management After Acute Cardiovascular Events-Rate of LDL-C Screening87.10%87.60%88.95%94.02%
Cholesterol Management After Acute Cardiovascular Events-Rate of affected members with <100 LDL-C Level60.04%60.39%57.98%70.98%
Controlling High Blood Pressure62.36%63.15%62.20%71.05%

Effectiveness of Care (2008)
- Click for Multiple Years


Common Childhood Illnesses Measurement Plan
 State Avg. Natl. Avg. 90th Pctl.
Appropriate Testing for Children With Pharyngitis100.00%86.61%73.51%89.16%
Appropriate Treatment for Children With Upper Respiratory Infection85.90%84.35%82.79%95.92%

Effectiveness of Care (2008)
- Click for Multiple Years


Diabetes Care and Management Measurement Plan
 State Avg. Natl. Avg. 90th Pctl.
Comprehensive Diabetes Care-Rate of LDL-C Screening81.58%84.26%84.73%91.03%
Comprehensive Diabetes Care-Rate of Eye Exams55.98%56.13%56.05%75.43%
Comprehensive Diabetes Care-Rate of Medical Attention for Diabetic Nephropathy83.94%83.52%83.46%92.46%
Comprehensive Diabetes Care-Rate of Poor HbA1c control22.80%26.10%29.62%18.15%
Comprehensive Diabetes Care-Rate of Those under care with <100 LDL-C Level46.04%48.49%44.73%56.12%
Comprehensive Diabetes Care-Testing for HbA1c88.71%88.00%88.98%93.92%

Effectiveness of Care (2008)
- Click for Multiple Years


Drug Therapy in Rheumatoid Arthritis Measurement Plan
 State Avg. Natl. Avg. 90th Pctl.
Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis89.36%86.64%85.62%94.37%

Effectiveness of Care (2008)
- Click for Multiple Years


Immunizations Measurement Plan
 State Avg. Natl. Avg. 90th Pctl.
Childhood Immunization for Multiple diseases including Chicken Pox83.30%82.99%79.05%89.52%
Childhood Immunization for Multiple diseases including pneumovax80.34%77.66%74.17%87.34%
Flu Shots for Adults Ages 50-6451.58%51.68%50.10%59.89%

Effectiveness of Care (2008)
- Click for Multiple Years


Mental Health: Care and Follow-up Measurement Plan
 State Avg. Natl. Avg. 90th Pctl.
Antidepressant Medication Management-Acute Phase Treatment61.65%64.67%64.97%78.18%
Antidepressant Medication Management-Continuation Phase Treatment41.77%46.79%48.21%62.62%
Follow-up After Hospitalization For Mental Illness within 7 days after hospital discharge77.07%61.00%56.11%76.02%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge88.89%80.30%75.42%86.72%

Effectiveness of Care (2008)
- Click for Multiple Years


Persistent Medications Measurement Plan
 State Avg. Natl. Avg. 90th Pctl.
Annual Monitoring for Patients on Persistent Medications81.29%78.19%78.94%84.31%

Effectiveness of Care (2008)
- Click for Multiple Years


Preventive Care Measurement Plan
 State Avg. Natl. Avg. 90th Pctl.
Breast Cancer Screening72.83%69.71%70.84%81.54%
Cervical Cancer Screening86.26%82.39%79.51%87.25%
Chlamydia Screening in Women-all Age groups44.27%43.82%42.88%62.04%
Colorectal Cancer Screening72.65%61.80%57.70%70.06%

Effectiveness of Care (2008)
- Click for Multiple Years


Spirometry Testing Measurement Plan
 State Avg. Natl. Avg. 90th Pctl.
Use of Spirometry Testing in the Assessment and diagnosis of COPD37.89%36.51%35.65%50.00%

Effectiveness of Care (2008)
- Click for Multiple Years


Use of Imaging for Low Back Pain Measurement Plan
 State Avg. Natl. Avg. 90th Pctl.
Use of Imaging for Low Back Pain69.17%72.02%72.37%81.13%

Health Plan Stability/Descriptive (2008)
- Click for Multiple Years


Board Certification Rates for Providers Measurement Plan
 State Avg. Natl. Avg. 90th Pctl.
Board Certification for Geriatricians90.91%66.06%67.64%100.00%
Board Certification for Pediatricians82.57%78.99%81.98%93.94%
Board Certification Rate for Family Medicine Physicians83.59%76.06%77.99%95.18%
Board Certification Rate for Internal Medicine Physicians83.21%78.60%79.71%92.64%
Board Certification Rate for OB/GYN Providers78.64%74.67%78.47%89.61%
Board Certification Rate for Other Specialists84.65%72.97%77.02%93.15%

Health Plan Stability/Descriptive (2008)
- Click for Multiple Years


Years in Business Measurement Plan
 State Avg. Natl. Avg. 90th Pctl.
Years in Business 2425N/AN/A

Member Satisfaction (2008)
- Click for Multiple Years


Member Satisfaction Measurement Plan
 State Avg. Natl. Avg. 90th Pctl.
Getting Care Quickly87.52%86.42%84.89%89.76%
Getting Needed Care86.03%83.93%84.05%89.36%
How Well Doctors Communicate92.93%92.02%92.52%95.39%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 70.51%63.59%65.71%76.23%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 77.37%78.89%80.18%85.48%
Members highly rating their overall health care (8 to 10 on a 0-10 scale)76.92%72.48%74.04%80.91%
Members highly rating their personal doctor or nurse (8 to 10 on a 0-10 scale)82.27%80.42%81.62%86.36%

Other Data (2008)
- Click for Multiple Years


Administrative Data Measurement Plan
 State Avg. Natl. Avg. 90th Pctl.
Administrative Ratio8.78%10.07%N/AN/A
Medical Cost Ratio86.70%90.73%N/AN/A
Number of Enrollees267,15478,725N/AN/A
Number of Physicians9,20919,780N/AN/A
Premium Per Member Per Month$284$287N/AN/A
Profit/Loss Ratio5.16%0.70%N/AN/A

Other Data (2008)
- Click for Multiple Years


Financial Data Measurement Plan
 State Avg. Natl. Avg. 90th Pctl.
Income$43,379,586$29,932,407N/AN/A
Net Worth$153,377,953$134,214,291N/AN/A
Premiums Earned$867,217,639$263,333,566N/AN/A

Use of Services (2008)
- Click for Multiple Years


Child and Adolescent Well Child Visits Measurement Plan
 State Avg. Natl. Avg. 90th Pctl.
Well Child Visits in the First 15 Months of Life100.00%83.58%72.44%86.96%
Well Child Visits in the 3rd, 4th, 5th and 6th Years73.57%71.26%64.52%77.78%
Adolescent Well-Care Visits41.81%44.16%37.63%52.80%
* A green value indicates the HMO's rate is better than highlighted value



Coverage Area
Counties : Accomack, Albermarle, Alleghany, Amelia, Amherst, Appomattox, Augusta, Bath, Bedford, Botetourt, Brunswick, Buckingham, Campbell, Caroline, Charles City, Charlotte, Chesterfield, Clarke, Craig, Culpeper, Cumberland, Dinwiddie, Essex, Fauquier, Floyd, Fluvanna, Franklin, Frederick, Giles, Gloucester, Goochland, Greene, Greensville, Halifax, Hanover, Henrico, Henry, Highland, Isle of Wight, James City, King and Queen, King George, King William, Lancaster, Louisa, Loudoun, Lunenburg, Madison, Mathews, Mecklenburg, Middlesex, Montgomery, Nelson, New Kent, Northampton, Northumberland, Nottoway, Orange, Page, Patrick, Pittsylvania, Powhatan, Prince Edward, Prince George, Pulaski, Rappahannock, Richmond, Roanoke, Rockbridge, Rockingham, Shenandoah, Southampton, Spotsylvania, Stafford, Surry, Sussex, Warren, Westmoreland, York
Cities : Bedford, Buena Vista, Charlottesville, Chesapeake, Colonial Heights, Covington, Danville, Emporia, Franklin, Fredericksburg, Hampton, Harrisonburg, Hopewell, Lexington, Lynchburg, Martinsville, Newport News, Norfolk, Petersburg, Poquoson, Portsmouth, Radford, Richmond, Roanoke, Salem, Staunton, Suffolk, Virginia Beach, Waynesboro, Williamsburg, Winchester




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