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PIEDMONT COMMUNITY HEALTHCARE HMO, INC.

Company Information

  • Company Providing Plan:Piedmont Community Health Group
  • Address:2316 ATHERHOLT ROAD
    LYNCHBURG VA 24501
  • Telephone :434-947-4463
  • Website:WWW.PCHP.NET
2021
Number of Enrollees: 5,614
PMPM: $617
Number of Physicians: 1,268
NCQA Accreditation:

*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

Amherst, Appomattox, Augusta, Bedford, Campbell, Nelson, Pittsylvania, Prince Edward

Cities

Danville, Lynchburg, Staunton, Waynesboro

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

Administrative Data

2021 2020 2019 2018 2017
Number of Enrollees 5,614 6,891 7,670 19,917 NA
PMPM $617 $607 $716 $706 NA
Medical Cost Ratio 83% 79% 75% 84% NA
Administrative Ratio 13% NA 15% 16% NA
Profit/Loss Ratio 6% 6% 9% 1% NA
Number of Physicians 1,268 1,038 1,665 1,732 NA

*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 $41,017,881 $54,000,144 $69,474,600 $176,161,864 NA
Income $1,926,605 $2,462,258 $4,723,624 $2,339,879 NA
Net Worth $14,582,268 $12,738,249 $25,310,008 $14,556,508 NA

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

Performance

  • Per NCQA, Piedmont Community Healthcare HMO, Inc. is newly accredited for commercial and has a ‚standards only‚ accreditation which means they are not required to and did not submit any HEDIS or CAHPS data for HEDIS measurement year 2018
Access/Availability of Care
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Adult Access To Preventive/Ambulatory Health Services 2021 Plan State Avg Nat Avg 90th Pctl.
Adult Access To Preventive/Ambulatory Health Services Year Plan State Avg. Natl. Avg. 90th Pctl.
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Alcohol and Other Drug Dependence Treatment 2021 Plan State Avg Nat Avg 90th Pctl.
Alcohol and Other Drug Dependence Treatment Year Plan State Avg. Natl. Avg. 90th Pctl.
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Prenatal and Postpartum Care 2021 Plan State Avg Nat Avg 90th Pctl.
Prenatal and Postpartum Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Behavioral Health
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Adherence to Antipsychotic Medications for Individuals with Schizophrenia 2021 Plan State Avg Nat Avg 90th Pctl.
Adherence to Antipsychotic Medications for Individuals with Schizophrenia Year Plan State Avg. Natl. Avg. 90th Pctl.
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Antidepressant Medication Management 2021 Plan State Avg Nat Avg 90th Pctl.
Antidepressant Medication Management Year Plan State Avg. Natl. Avg. 90th Pctl.
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Attention-Deficit/Hyperactivity Disorder (ADHD) Medication 2021 Plan State Avg Nat Avg 90th Pctl.
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication Year Plan State Avg. Natl. Avg. 90th Pctl.
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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.
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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.
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Follow-up After Hospitalization For Mental Illness 2021 Plan State Avg Nat Avg 90th Pctl.
Follow-up After Hospitalization For Mental Illness Year Plan State Avg. Natl. Avg. 90th Pctl.
Effectiveness of Care
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Asthma Medication Ratio 2021 Plan State Avg Nat Avg 90th Pctl.
Asthma Medication Ratio Year Plan State Avg. Natl. Avg. 90th Pctl.
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Cardiovascular Disease Management 2021 Plan State Avg Nat Avg 90th Pctl.
Cardiovascular Disease Management Year Plan State Avg. Natl. Avg. 90th Pctl.
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Cervical Cancer Screening 2021 Plan State Avg Nat Avg 90th Pctl.
Cervical Cancer Screening Year Plan State Avg. Natl. Avg. 90th Pctl.
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Common Childhood Illnesses 2021 Plan State Avg Nat Avg 90th Pctl.
Common Childhood Illnesses Year Plan State Avg. Natl. Avg. 90th Pctl.
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Diabetes Care and Management 2021 Plan State Avg Nat Avg 90th Pctl.
Diabetes Care and Management Year Plan State Avg. Natl. Avg. 90th Pctl.
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Immunizations 2021 Plan State Avg Nat Avg 90th Pctl.
Immunizations Year Plan State Avg. Natl. Avg. 90th Pctl.
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Pharmacotherapy of COPD Exacerbation 2021 Plan State Avg Nat Avg 90th Pctl.
Pharmacotherapy of COPD Exacerbation Year Plan State Avg. Natl. Avg. 90th Pctl.
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Preventive Care 2021 Plan State Avg Nat Avg 90th Pctl.
Preventive Care Year Plan State Avg. Natl. Avg. 90th Pctl.
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Spirometry Testing 2021 Plan State Avg Nat Avg 90th Pctl.
Spirometry Testing Year Plan State Avg. Natl. Avg. 90th Pctl.
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Statin Therapy 2021 Plan State Avg Nat Avg 90th Pctl.
Statin Therapy Year Plan State Avg. Natl. Avg. 90th Pctl.
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Weight Assessment and Counseling 2021 Plan State Avg Nat Avg 90th Pctl.
Weight Assessment and Counseling Year Plan State Avg. Natl. Avg. 90th Pctl.
Health Plan Stability/Descriptive
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Administrative Data 2021 Plan State Avg Nat Avg 90th Pctl.
Administrative Ratio 0.13 0.12 N/A N/A
Medical Cost Ratio 0.83 0.85 N/A N/A
Number of Enrollees 5,614 189,570 N/A N/A
Number of Physicians 1,268 144,761 N/A N/A
Premium Per Member Per Month $617 $582 N/A N/A
Profit/Loss Ratio 0.06 0.04 N/A N/A
Administrative Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Administrative Ratio 2020 N/A 0.13 N/A N/A
2019 0.15 0.12 N/A N/A
2018 0.16 0.14 86.19 92.68
2017 N/A 0.12 86.39 93.13
Medical Cost Ratio 2020 0.79 0.81 N/A N/A
2019 0.75 0.84 N/A N/A
2018 0.84 0.83 92.60 95.85
2017 N/A 0.83 93.13 96.59
Number of Enrollees 2020 6,891 157,206 N/A N/A
2019 7,670 136,748 N/A N/A
2018 19,917 129,656 92 96
2017 N/A 133,992 92 97
Number of Physicians 2020 1,038 118,547 N/A N/A
2019 1,665 105,314 N/A N/A
2018 1,732 86,806 87 95
2017 N/A 81,926 87 95
Premium Per Member Per Month 2020 $607 $529 N/A N/A
2019 $716 $511 N/A N/A
2018 $706 $517 N/A N/A
2017 N/A $370 N/A N/A
Profit/Loss Ratio 2020 0.06 0.06 N/A N/A
2019 0.09 0.04 N/A N/A
2018 0.01 0.04 N/A N/A
2017 N/A 0.05 N/A N/A
Info
Financial Data 2021 Plan State Avg Nat Avg 90th Pctl.
Income $1,926,605 $84,171,275 N/A N/A
Net Worth $14,582,268 $444,659,972 N/A N/A
Premiums Earned $41,017,881 $1,315,605,350 N/A N/A
Financial Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Income 2020 $2,462,258 $108,797,768 N/A N/A
2019 $4,723,624 $81,234,487 N/A N/A
2018 $2,339,879 $44,046,244 N/A N/A
2017 N/A $34,422,501 N/A N/A
Net Worth 2020 $12,738,249 $381,868,187 N/A N/A
2019 $25,310,008 $340,553,480 N/A N/A
2018 $14,556,508 $279,558,644 N/A N/A
2017 N/A $263,890,874 N/A N/A
Premiums Earned 2020 $54,000,144 $1,079,933,473 N/A N/A
2019 $69,474,600 $936,529,722 N/A N/A
2018 $176,161,864 $815,577,345 N/A N/A
2017 N/A $645,600,589 N/A N/A
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Years in Business 2021 Plan State Avg Nat Avg 90th Pctl.
Years in Business Year Plan State Avg. Natl. Avg. 90th Pctl.
Member Satisfaction
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Member Satisfaction 2021 Plan State Avg Nat Avg 90th Pctl.
Member Satisfaction Year Plan State Avg. Natl. Avg. 90th Pctl.
Overuse/Appropriateness
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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.
Lower Back Pain Year Plan State Avg. Natl. Avg. 90th Pctl.
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Respiratory 2021 Plan State Avg Nat Avg 90th Pctl.
Respiratory Year Plan State Avg. Natl. Avg. 90th Pctl.
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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