Health Insurance in Virginia

HMO Profile

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Optimum Choice, Inc.

Company Information

  • Company Providing Plan:United Health Group
  • Address:9800 Health Care Lane, MN017-E900
    Minnetonka, MN 55343
  • Telephone :240-632-8109
  • Website:www.mamsi.com
2020
Number of Enrollees: *11,467
PMPM: *$446
Number of Physicians: *82,581
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

Accomack, Albemarle, Alleghany, Amelia, Appomattox, Arlington, Augusta, Bath, Bedford, Bland, Botetourt, Buchanan, Buckingham, Campbell, Caroline, Carroll, Charles City, Charlotte, Chesterfield, Clarke, Craig, Culpeper, Cumberland, Dickenson, Dinwiddie, Fairfax, Fauquier, Floyd, Fluvanna, Franklin, Frederick, Giles, Gloucester, Goochland, Grayson, Greene, Greensville, Halifax, Hanover, Henrico, Highland, Isle of Wight, James City, King and Queen, King George, King William, Lee, Loudoun, Louisa, Lunenburg, Madison, Mathews, Mecklenburg, Middlesex, Montgomery, Nelson, New Kent, Northampton, Northumberland, Nottoway, Orange, Page, Patrick, Pittsylvania, Powhatan, Prince Edward, Prince George, Prince William, Pulaski, Rappahannock, Richmond, Roanoke, Rockingham, Russell, Scott, Smyth, Southampton, Spotsylvania, Stafford, Surry, Sussex, Tazewell, Washington, Westmoreland, Wise, Wythe, York

Cities

Alexandria, Bristol, Charlottesville, Chesapeake, Clifton Forge, Colonial Heights, Covington, Danville, Emporia, Fairfax, Falls Church, Franklin, Fredericksburg, Galax, Hampton, Harrisonburg, Hopewell, Manassas, Manassas Park, Newport News, Norfolk, Norton, Petersburg, Poquoson, Portsmouth, Radford, Richmond, Roanoke, Salem, Staunton, Suffolk, Virginia Beach, Waynesboro, Williamsburg, Winchester

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

Administrative Data

2020 2019 2018 2017 2016
*Number of Enrollees 11,467 15,951 19,012 15,028 10,191
PMPM $446 $379 $369 $361 $364
*Medical Cost Ratio 77% 80% 73% 78% 69%
*Administrative Ratio 20% 17% 18% 15% 18%
*Profit/Loss Ratio 4% 4% 10% 7% 14%
*Number of Physicians 82,581 68,683 67,323 63,577 48,611

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

Financial Data

2020 2019 2018 2017 2016
Premiums Earned $73,339,294 $79,820,333 $78,432,406 $52,057,443 $38,883,614
*Income $7,796,081 $8,064,099 $21,053,057 $10,844,824 $15,432,754
*Net Worth $38,833,267 $41,479,893 $33,897,415 $22,379,138 $19,902,986

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

Performance

Access/Availability of Care
Info
Adult Access To Preventive/Ambulatory Health Services 2020 Plan State Avg Nat Avg 90th Pctl.
Adult Access (Age 20-44) To Preventive/Ambulatory Health Services 92.19% 93.90% 92.88% 95.71%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 94.02% 96.11% 95.86% 97.54%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 94.81% 96.79% 96.95% 98.30%
Adult Access To Preventive/Ambulatory Health Services Year Plan State Avg. Natl. Avg. 90th Pctl.
Adult Access (Age 20-44) To Preventive/Ambulatory Health Services 2019 91.19% 92.78% 92.66% 95.76%
2018 91.07% 92.43% 92.33% 95.45%
2017 91.81% 92.73% 92.45% 95.43%
2016 92.06% 92.81% 92.73% 95.55%
Adult Access (Age 45-64) To Preventive/Ambulatory Health Services 2019 93.68% 95.78% 95.87% 97.69%
2018 93.72% 95.50% 95.64% 97.49%
2017 93.84% 95.57% 95.61% 97.46%
2016 94.46% 95.78% 95.78% 97.61%
Adult Access (Age 65 and Older) To Preventive/Ambulatory Health Services 2019 95.88% 97.13% 97.14% 98.42%
2018 95.84% 97.15% 97.17% 98.45%
2017 97.22% 97.82% 97.07% 98.47%
2016 96.97% 97.30% 97.19% 98.61%
Info
Alcohol and Other Drug Dependence Treatment 2020 Plan State Avg Nat Avg 90th Pctl.
Initiation of Alcohol and Other Drug Dependence Treatment - Total 37.53% 40.49% 36.39% 45.24%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 22.22% 35.48% 44.95% 59.06%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 37.82% 40.55% 36.18% 45.12%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 13.20% 15.16% 12.46% 17.48%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 11.11% 14.80% 17.76% 27.27%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 13.24% 15.15% 12.33% 17.48%
Alcohol and Other Drug Dependence Treatment Year Plan State Avg. Natl. Avg. 90th Pctl.
Initiation of Alcohol and Other Drug Dependence Treatment - Total 2019 34.44% 39.13% 35.63% 41.36%
2018 34.67% 37.53% 35.68% 42.36%
2017 29.74% 36.14% 36.11% 42.01%
2016 32.75% 35.69% 32.93% 40.24%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2019 16.67% 36.19% 42.41% 54.29%
2018 41.67% 49.35% 40.21% 51.02%
2017 50.00% 40.06% 39.91% 52.54%
2016 37.50% 40.15% 40.47% 51.96%
Initiation of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2019 34.80% 39.20% 35.47% 40.96%
2018 34.53% 37.34% 35.51% 42.35%
2017 29.20% 36.00% 35.97% 41.96%
2016 32.65% 35.55% 32.64% 40.33%
Engagement of Alcohol and Other Drug Dependence Treatment - Total 2019 11.98% 13.47% 12.31% 16.44%
2018 12.40% 14.69% 12.58% 17.04%
2017 9.48% 13.36% 12.65% 17.26%
2016 11.84% 12.51% 11.46% 16.72%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 13-17 2019 0.00% 10.34% 16.48% 27.14%
2018 16.67% 18.18% 16.91% 25.00%
2017 0.00% 14.40% 14.95% 23.85%
2016 12.50% 11.28% 15.68% 23.73%
Engagement of Alcohol and Other Drug Dependence Treatment - Ages 18 plus 2019 12.22% 13.52% 12.20% 16.41%
2018 12.31% 14.58% 12.47% 16.97%
2017 9.73% 13.40% 12.55% 17.38%
2016 11.83% 12.57% 11.32% 16.09%
Info
Prenatal and Postpartum Care 2020 Plan State Avg Nat Avg 90th Pctl.
Postpartum Care 48.99% 74.05% 78.11% 92.47%
Timeliness of Prenatal Care 55.96% 79.76% 81.82% 93.92%
Prenatal and Postpartum Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Postpartum Care 2019 72.68% 78.66% 80.52% 91.97%
2018 72.68% 75.10% 75.89% 88.80%
2017 67.88% 73.45% 75.05% 88.13%
2016 66.92% 74.50% 73.95% 88.85%
Timeliness of Prenatal Care 2019 86.07% 86.76% 85.57% 95.33%
2018 86.07% 88.15% 84.75% 94.17%
2017 84.18% 86.37% 84.34% 94.89%
2016 88.81% 86.71% 85.57% 96.28%
Behavioral Health
Info
Adherence to Antipsychotic Medications for Individuals with Schizophrenia 2020 Plan State Avg Nat Avg 90th Pctl.
Adherence to Antipsychotic Medications for Individuals With Schizophrenia 58.33% 70.63% 69.41% 79.41%
Adherence to Antipsychotic Medications for Individuals with Schizophrenia Year Plan State Avg. Natl. Avg. 90th Pctl.
Adherence to Antipsychotic Medications for Individuals With Schizophrenia 2019 N/A N/A N/A N/A
2018 N/A N/A N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Info
Antidepressant Medication Management 2020 Plan State Avg Nat Avg 90th Pctl.
Antidepressant Medication Management - Effective Acute Phase Treatment 71.05% 77.14% 73.70% 81.07%
Antidepressant Medication Management - Effective Continuation Phase Treatment 55.43% 59.69% 57.32% 64.22%
Antidepressant Medication Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Antidepressant Medication Management - Effective Acute Phase Treatment 2019 71.26% 73.53% 71.19% 78.79%
2018 71.45% 71.96% 68.64% 77.59%
2017 68.66% 71.12% 67.11% 75.76%
2016 70.65% 70.29% 66.56% 74.77%
Antidepressant Medication Management - Effective Continuation Phase Treatment 2019 53.96% 55.44% 54.90% 62.18%
2018 54.08% 54.22% 53.01% 60.39%
2017 52.63% 54.87% 51.53% 60.24%
2016 54.55% 53.51% 50.69% 58.60%
Info
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication 2020 Plan State Avg Nat Avg 90th Pctl.
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Initiation 45.88% 45.87% 41.24% 50.34%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 40.00% 56.56% 48.67% 59.32%
Attention-Deficit/Hyperactivity Disorder (ADHD) Medication Year Plan State Avg. Natl. Avg. 90th Pctl.
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Initiation 2019 38.75% 42.67% 40.66% 51.30%
2018 42.86% 42.91% 39.85% 50.42%
2017 52.94% 41.27% 41.13% 50.83%
2016 43.10% 41.91% 38.93% 48.61%
Follow-up care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) Medication-Continuation 2019 46.15% 50.69% 47.95% 58.82%
2018 47.06% 40.32% 48.73% 60.57%
2017 54.55% 55.09% 47.07% 58.44%
2016 50.00% 46.92% 45.82% 56.86%
Info
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence 2020 Plan State Avg Nat Avg 90th Pctl.
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence within 7 days after hospital discharge 17.24% 14.52% 13.45% 21.43%
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence within 30 days after hospital discharge 17.24% 19.84% 18.03% 26.07%
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence Year Plan State Avg. Natl. Avg. 90th Pctl.
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence within 7 days after hospital discharge 2019 4.65% 8.56% 11.48% 18.26%
2018 10.13% 9.96% 10.81% 17.07%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence within 30 days after hospital discharge 2019 8.14% 14.74% 15.35% 24.56%
2018 11.39% 13.52% 14.98% 23.11%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Info
Follow-Up After Emergency Department Visit for Mental Illness 2020 Plan State Avg Nat Avg 90th Pctl.
Follow-Up After Emergency Department Visit for Mental Illness within 7 days after hospital discharge 35.85% 48.22% 47.90% 68.29%
Follow-Up After Emergency Department Visit for Mental Illness within 30 days after hospital discharge 45.28% 59.38% 62.36% 78.77%
Follow-Up After Emergency Department Visit for Mental Illness Year Plan State Avg. Natl. Avg. 90th Pctl.
Follow-Up After Emergency Department Visit for Mental Illness within 7 days after hospital discharge 2019 36.05% 45.64% 48.70% 70.67%
2018 28.57% 38.46% 46.62% 66.57%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Follow-Up After Emergency Department Visit for Mental Illness within 30 days after hospital discharge 2019 52.33% 60.35% 62.59% 77.75%
2018 43.96% 53.38% 60.75% 77.57%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Info
Follow-up After Hospitalization For Mental Illness 2020 Plan State Avg Nat Avg 90th Pctl.
Follow-up After Hospitalization For Mental Illness within 7 days after hospital discharge 41.43% 49.46% 49.62% 63.68%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 65.71% 72.67% 70.00% 79.46%
Follow-up After Hospitalization For Mental Illness Year Plan State Avg. Natl. Avg. 90th Pctl.
Follow-up After Hospitalization For Mental Illness within 7 days after hospital discharge 2019 44.76% 49.77% 45.66% 58.20%
2018 42.61% 48.09% 44.98% 60.38%
2017 48.94% 52.18% 46.63% 62.81%
2016 50.65% 52.99% 52.06% 67.31%
Follow-up After Hospitalization For Mental Illness within 30 days after hospital discharge 2019 65.71% 72.38% 67.81% 80.65%
2018 66.96% 69.84% 66.68% 80.29%
2017 67.02% 69.80% 68.66% 82.58%
2016 74.03% 73.85% 71.36% 84.17%
Effectiveness of Care
Info
Asthma Medication Ratio 2020 Plan State Avg Nat Avg 90th Pctl.
Asthma Medication Ratio - Ages 5-11 94.44% 93.70% 89.98% 95.00%
Asthma Medication Ratio - Ages 12-18 80.95% 84.76% 81.90% 89.30%
Asthma Medication Ratio - Ages 19-50 67.18% 78.90% 75.62% 84.47%
Asthma Medication Ratio - Ages 51-64 82.11% 85.69% 82.47% 89.38%
Asthma Medication Ratio - Total 76.11% 83.04% 79.76% 85.85%
Asthma Medication Ratio Year Plan State Avg. Natl. Avg. 90th Pctl.
Asthma Medication Ratio - Ages 5-11 2019 93.10% 86.54% 85.94% 93.20%
2018 75.00% 85.26% 87.15% 93.97%
2017 85.19% 86.06% 86.90% 93.55%
2016 100.00% 91.67% 86.40% 93.97%
Asthma Medication Ratio - Ages 12-18 2019 96.67% 84.88% 77.43% 86.25%
2018 84.62% 84.71% 78.77% 84.72%
2017 81.48% 84.80% 76.69% 85.94%
2016 78.26% 81.12% 78.30% 86.34%
Asthma Medication Ratio - Ages 19-50 2019 72.22% 80.50% 74.07% 81.27%
2018 78.05% 82.69% 75.11% 82.84%
2017 71.43% 78.94% 74.23% 81.70%
2016 65.91% 75.24% 73.51% 81.08%
Asthma Medication Ratio - Ages 51-64 2019 86.49% 86.85% 81.27% 88.51%
2018 82.80% 86.11% 82.81% 89.49%
2017 85.88% 89.17% 82.83% 89.28%
2016 81.63% 83.27% 81.70% 88.64%
Asthma Medication Ratio - Total 2019 81.53% 83.92% 78.10% 84.69%
2018 80.08% 84.32% 79.34% 85.18%
2017 79.10% 84.01% 79.04% 85.85%
2016 76.34% 80.60% 78.29% 85.46%
Info
Cardiovascular Disease Management 2020 Plan State Avg Nat Avg 90th Pctl.
Controlling High Blood Pressure 5.38% 43.15% 53.49% 69.10%
Persistence of Beta-Blockers 80.00% 87.06% 87.38% 94.19%
Cardiovascular Disease Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Controlling High Blood Pressure 2019 56.69% 60.96% 61.02% 74.21%
2018 56.69% 60.55% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Persistence of Beta-Blockers 2019 94.29% 88.62% 85.16% 92.47%
2018 74.07% 83.54% 82.37% 89.29%
2017 78.57% 85.80% 85.18% 93.41%
2016 89.29% 90.70% 83.61% 90.83%
Info
Cervical Cancer Screening 2020 Plan State Avg Nat Avg 90th Pctl.
Cervical Cancer Screening 67.44% 75.44% 75.50% 81.71%
Cervical Cancer Screening Year Plan State Avg. Natl. Avg. 90th Pctl.
Cervical Cancer Screening 2019 74.85% 78.50% 77.40% 83.91%
2018 74.85% 77.90% 76.08% 83.21%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Info
Common Childhood Illnesses 2020 Plan State Avg Nat Avg 90th Pctl.
Appropriate Testing for Children With Pharyngitis 90.06% 90.05% 84.77% 92.62%
Common Childhood Illnesses Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Testing for Children With Pharyngitis 2019 89.99% 90.44% 86.62% 93.98%
2018 93.95% 92.74% 87.97% 94.94%
2017 88.77% 92.30% 87.45% 94.64%
2016 89.60% 90.38% 84.50% 93.75%
Info
Diabetes Care and Management 2020 Plan State Avg Nat Avg 90th Pctl.
Comprehensive Diabetes Care-Blood Pressure Control (<140/90 mm Hg) 4.67% 44.59% 55.85% 73.48%
Comprehensive Diabetes Care-HbA1c control (<8.0%) 47.46% 55.20% 55.37% 65.50%
Comprehensive Diabetes Care-Rate of Eye Exams 36.66% 53.44% 50.27% 64.23%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 44.24% 36.05% 34.87% 23.45%
Comprehensive Diabetes Care-Testing for HbA1c 84.30% 86.71% 87.74% 91.73%
Diabetes Care and Management Year Plan State Avg. Natl. Avg. 90th Pctl.
Comprehensive Diabetes Care-Blood Pressure Control (<140/90 mm Hg) 2019 59.37% 62.53% 63.23% 77.86%
2018 59.37% 63.70% 62.59% 77.37%
2017 59.85% 63.40% 60.82% 76.41%
2016 55.09% 60.88% 61.06% 78.35%
Comprehensive Diabetes Care-HbA1c control (<8.0%) 2019 58.39% 63.81% 58.07% 66.33%
2018 58.39% 62.46% 57.79% 66.33%
2017 58.39% 62.51% 57.48% 67.15%
2016 51.39% 58.36% 56.62% 66.39%
Comprehensive Diabetes Care-Rate of Eye Exams 2019 41.61% 58.32% 55.45% 69.32%
2018 41.61% 56.58% 54.40% 69.68%
2017 44.89% 56.95% 54.06% 70.69%
2016 44.44% 58.46% 52.96% 72.04%
Comprehensive Diabetes Care-Rate of Poor HbA1c control 2019 30.66% 26.09% 30.80% 20.82%
2018 30.66% 27.18% 30.85% 20.62%
2017 29.38% 27.63% 31.91% 21.41%
2016 37.04% 30.47% 32.15% 20.98%
Comprehensive Diabetes Care-Testing for HbA1c 2019 91.73% 92.45% 91.60% 94.71%
2018 91.73% 92.11% 91.29% 94.71%
2017 91.79% 91.52% 90.96% 94.18%
2016 90.05% 90.38% 90.32% 94.83%
Info
Immunizations 2020 Plan State Avg Nat Avg 90th Pctl.
Childhood Immunization for Multiple Diseases Including Chicken Pox 58.14% 76.23% 77.26% 88.52%
Childhood Immunization for Multiple Diseases Including Pneumovax 56.81% 74.94% 75.84% 87.36%
Flu Vaccinations for Adults Ages 18-64 53.64% 57.13% 57.41% 67.88%
Immunizations for Adolescents - Combination 2 24.79% 61.54% N/A N/A
Immunizations for Adolescents - HPV 28.45% 35.09% 31.84% 39.17%
Immunizations for Adolescents - Meningococcal 76.06% 37.80% 33.38% 42.34%
Immunizations for Adolescents - Tdap 89.01% 80.71% 85.83% 93.12%
Immunizations Year Plan State Avg. Natl. Avg. 90th Pctl.
Childhood Immunization for Multiple Diseases Including Chicken Pox 2019 81.92% 82.73% 80.16% 89.29%
2018 79.39% 80.96% 79.32% 88.06%
2017 79.57% 73.55% 79.44% 89.14%
2016 84.42% 75.86% 78.93% 89.03%
Childhood Immunization for Multiple Diseases Including Pneumovax 2019 80.76% 81.30% 78.32% 87.99%
2018 77.36% 79.46% 77.50% 86.62%
2017 76.09% 80.09% 77.67% 87.61%
2016 83.42% 82.08% 77.04% 87.50%
Flu Vaccinations for Adults Ages 18-64 2019 48.50% 59.38% 55.06% 65.24%
2018 50.81% 53.06% 51.93% 61.07%
2017 49.64% 55.21% 49.33% 59.27%
2016 N/A N/A N/A N/A
Immunizations for Adolescents - Combination 2 2019 25.25% 55.69% N/A N/A
2018 79.90% 55.16% N/A N/A
2017 79.26% 47.24% N/A N/A
2016 81.34% N/A N/A N/A
Immunizations for Adolescents - HPV 2019 27.72% 33.16% 29.59% 40.63%
2018 22.42% 79.55% 82.25% 91.52%
2017 21.74% 80.48% 80.23% 89.54%
2016 81.34% 77.95% 77.63% 88.81%
Immunizations for Adolescents - Meningococcal 2019 80.45% 35.43% 31.21% 42.46%
2018 80.67% 32.22% 28.05% 37.23%
2017 82.27% 28.29% 23.98% 32.36%
2016 86.19% 77.95% 77.63% 88.81%
Immunizations for Adolescents - Tdap 2019 92.08% 81.83% 85.01% 92.59%
2018 89.95% 80.66% 83.69% 92.94%
2017 88.63% 82.05% 81.75% 90.27%
2016 87.31% 79.65% 79.20% 90.02%
Info
Pharmacotherapy of COPD Exacerbation 2020 Plan State Avg Nat Avg 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 85.37% 86.03% 81.34% 88.51%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 75.61% 75.06% 74.31% 85.07%
Pharmacotherapy of COPD Exacerbation Year Plan State Avg. Natl. Avg. 90th Pctl.
Pharmacotherapy of COPD Exacerbation - Bronchodilator 2019 82.69% 83.91% 80.32% 88.97%
2018 79.66% 85.49% 78.92% 87.88%
2017 68.75% 80.88% 79.87% 87.50%
2016 85.00% 84.12% 76.30% 85.98%
Pharmacotherapy of COPD Exacerbation - Corticosteroid 2019 80.77% 81.14% 76.90% 87.69%
2018 69.49% 76.41% 74.76% 83.55%
2017 75.00% 78.84% 76.26% 84.38%
2016 80.00% 79.54% 70.70% 81.82%
Info
Preventive Care 2020 Plan State Avg Nat Avg 90th Pctl.
Breast Cancer Screening 64.42% 72.56% 72.44% 79.39%
Chlamydia Screening in Women-all Age groups 43.95% 49.80% 48.49% 63.85%
Colorectal Cancer Screening 41.48% 60.99% 63.64% 74.42%
Preventive Care Year Plan State Avg. Natl. Avg. 90th Pctl.
Breast Cancer Screening 2019 65.31% 72.92% 74.81% 81.58%
2018 65.44% 72.13% 73.73% 81.17%
2017 65.97% 71.85% 72.81% 80.91%
2016 63.90% 71.80% 72.90% 80.63%
Chlamydia Screening in Women-all Age groups 2019 48.49% 54.77% 51.86% 67.02%
2018 47.96% 52.91% 51.41% 67.76%
2017 44.76% 51.46% 50.16% 66.08%
2016 45.50% 49.79% 48.98% 63.50%
Colorectal Cancer Screening 2019 53.04% 68.10% 66.15% 77.91%
2018 48.91% 64.94% 64.37% 76.52%
2017 57.18% 65.16% 62.43% 74.72%
2016 53.24% 64.67% 61.71% 74.09%
Info
Spirometry Testing 2020 Plan State Avg Nat Avg 90th Pctl.
Use of Spirometry Testing in the Assessment and diagnosis of COPD 23.96% 37.53% 37.16% 43.86%
Spirometry Testing Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Spirometry Testing in the Assessment and diagnosis of COPD 2019 42.53% 39.81% 42.11% 52.78%
2018 42.65% 44.14% 41.48% 50.95%
2017 38.10% 43.12% 41.90% 50.52%
2016 44.29% 42.48% 42.55% 51.02%
Info
Statin Therapy 2020 Plan State Avg Nat Avg 90th Pctl.
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 21-75 years (Male) 84.17% 85.75% 84.86% 89.67%
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 40–75 years (Female) 78.16% 77.46% 75.69% 81.94%
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - Total 82.66% 83.41% 82.46% 87.85%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 21-75 years (Male) 75.69% 81.24% 81.04% 86.60%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 40–75 years (Female) 76.47% 78.29% 77.58% 86.55%
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - Total 75.87% 80.47% 80.55% 86.26%
Statin Therapy for Patients with Diabetes - Received Therapy 62.87% 66.42% 65.49% 71.27%
Statin Therapy for Patients with Diabetes - Statin Adherence 80% 66.27% 73.48% 74.69% 82.04%
Statin Therapy Year Plan State Avg. Natl. Avg. 90th Pctl.
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 21-75 years (Male) 2019 81.65% 85.53% 84.83% 90.71%
2018 80.09% 84.45% 83.64% 89.14%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - 40–75 years (Female) 2019 72.60% 75.96% 74.89% 81.82%
2018 75.47% 76.45% 73.26% 81.82%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Received Therapy - Total 2019 79.71% 82.97% 82.41% 88.24%
2018 79.18% 82.21% 81.23% 87.21%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 21-75 years (Male) 2019 73.39% 78.19% 78.73% 85.40%
2018 69.36% 75.19% 77.14% 82.88%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - 40–75 years (Female) 2019 64.15% 75.98% 73.50% 82.09%
2018 70.00% 72.78% 72.12% 81.10%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Statin Therapy for Patients with Cardiovascular Disease - Statin Adherence 80% - Total 2019 71.59% 77.63% 77.38% 84.14%
2018 69.48% 74.49% 75.95% 82.83%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Statin Therapy for Patients with Diabetes - Received Therapy 2019 61.71% 65.53% 64.43% 70.97%
2018 60.06% 63.94% 62.57% 70.05%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Statin Therapy for Patients with Diabetes - Statin Adherence 80% 2019 67.90% 71.84% 71.74% 79.50%
2018 62.72% 68.88% 69.52% 78.00%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Info
Weight Assessment and Counseling 2020 Plan State Avg Nat Avg 90th Pctl.
Children/Adolescents BMI Assessment - Total 27.91% 61.27% 70.64% 88.81%
Children/Adolescents BMI Assessment - Ages 3-11 28.89% 64.54% 72.11% 88.89%
Children/Adolescents BMI Assessment - Ages 12-17 26.58% 57.19% 68.80% 87.79%
Counseling for Nutrition for Children/Adolescents - Total 16.30% 56.08% 65.06% 82.43%
Counseling for Nutrition for Children/Adolescents - Ages 3-11 18.10% 59.21% 67.32% 84.32%
Counseling for Nutrition for Children/Adolescents - Ages 12-17 13.87% 52.10% 62.24% 79.49%
Counseling for Physical Activity for Children/Adolescents - Total 11.30% 52.21% 60.81% 80.29%
Counseling for Physical Activity for Children/Adolescents - Ages 3-11 11.69% 52.27% 60.31% 81.14%
Counseling for Physical Activity for Children/Adolescents - Ages 12-17 10.77% 51.96% 61.40% 79.85%
Weight Assessment and Counseling Year Plan State Avg. Natl. Avg. 90th Pctl.
Children/Adolescents BMI Assessment - Total 2019 72.41% 74.97% 74.90% 90.00%
2018 72.41% 73.74% 72.87% 90.00%
2017 64.96% 70.41% 70.59% 88.08%
2016 60.65% 69.07% 65.62% 88.08%
Children/Adolescents BMI Assessment - Ages 3-11 2019 74.89% 78.68% 76.00% 90.91%
2018 74.89% 76.94% 74.00% 90.91%
2017 64.73% 71.37% 71.84% 88.89%
2016 64.34% 70.86% 67.11% 88.19%
Children/Adolescents BMI Assessment - Ages 12-17 2019 68.90% 70.46% 73.46% 89.29%
2018 68.90% 69.73% 71.39% 88.97%
2017 65.29% 68.96% 68.94% 87.82%
2016 55.17% 66.72% 64.28% 87.29%
Counseling for Nutrition for Children/Adolescents - Total 2019 67.34% 72.58% 68.74% 85.24%
2018 67.34% 71.79% 67.72% 85.06%
2017 64.23% 69.47% 65.50% 83.21%
2016 59.72% 66.76% 61.76% 83.68%
Counseling for Nutrition for Children/Adolescents - Ages 3-11 2019 71.86% 77.02% 71.33% 86.49%
2018 71.86% 75.91% 69.85% 86.21%
2017 64.73% 71.63% 68.20% 84.82%
2016 63.95% 69.25% 64.59% 85.48%
Counseling for Nutrition for Children/Adolescents - Ages 12-17 2019 60.98% 66.89% 65.44% 84.29%
2018 60.98% 66.37% 64.92% 84.29%
2017 63.53% 66.54% 61.92% 80.26%
2016 53.45% 63.42% 58.79% 81.87%
Counseling for Physical Activity for Children/Adolescents - Total 2019 62.28% 66.86% 64.24% 82.78%
2018 62.28% 66.42% 63.08% 81.32%
2017 60.10% 64.30% 59.96% 77.32%
2016 55.09% 60.41% 55.96% 79.44%
Counseling for Physical Activity for Children/Adolescents - Ages 3-11 2019 62.77% 66.12% 63.39% 82.53%
2018 62.77% 65.48% 61.70% 80.92%
2017 56.43% 62.31% 58.84% 75.00%
2016 54.65% 58.91% 54.72% 76.52%
Counseling for Physical Activity for Children/Adolescents - Ages 12-17 2019 61.59% 67.67% 65.38% 84.68%
2018 61.59% 67.51% 64.79% 84.03%
2017 65.29% 66.86% 61.40% 79.89%
2016 55.75% 62.44% 58.47% 83.05%
Health Plan Stability/Descriptive
Info
Administrative Data 2020 Plan State Avg Nat Avg 90th Pctl.
Administrative Ratio 0.20 0.13 N/A N/A
Medical Cost Ratio 0.77 0.81 N/A N/A
Number of Enrollees 11,467 170,871 N/A N/A
Number of Physicians 82,581 133,088 N/A N/A
Premium Per Member Per Month $446 $522 N/A N/A
Profit/Loss Ratio 0.04 0.06 N/A N/A
Administrative Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Administrative Ratio 2019 0.17 0.12 N/A N/A
2018 0.18 0.14 86.19 92.68
2017 0.15 0.12 86.39 93.13
2016 0.18 0.15 N/A N/A
Medical Cost Ratio 2019 0.80 0.84 N/A N/A
2018 0.73 0.83 92.60 95.85
2017 0.78 0.83 93.13 96.59
2016 0.69 0.83 N/A N/A
Number of Enrollees 2019 15,951 136,748 N/A N/A
2018 19,012 129,656 92 96
2017 15,028 133,992 92 97
2016 10,191 136,796 N/A N/A
Number of Physicians 2019 68,683 105,314 N/A N/A
2018 67,323 86,806 87 95
2017 63,577 81,926 87 95
2016 48,611 73,426 N/A N/A
Premium Per Member Per Month 2019 $379 $511 N/A N/A
2018 $369 $517 N/A N/A
2017 $361 $370 N/A N/A
2016 $364 $370 N/A N/A
Profit/Loss Ratio 2019 0.04 0.04 N/A N/A
2018 0.10 0.04 N/A N/A
2017 0.07 0.05 N/A N/A
2016 0.14 0.03 N/A N/A
Info
Financial Data 2020 Plan State Avg Nat Avg 90th Pctl.
Income $7,796,081 $117,272,490 N/A N/A
Net Worth $38,833,267 $414,233,312 N/A N/A
Premiums Earned $73,339,294 $1,173,200,139 N/A N/A
Financial Data Year Plan State Avg. Natl. Avg. 90th Pctl.
Income 2019 $8,064,099 $81,234,487 N/A N/A
2018 $21,053,057 $44,046,244 N/A N/A
2017 $10,844,824 $34,422,501 N/A N/A
2016 $15,432,754 $38,212,136 N/A N/A
Net Worth 2019 $41,479,893 $340,553,480 N/A N/A
2018 $33,897,415 $279,558,644 N/A N/A
2017 $22,379,138 $263,890,874 N/A N/A
2016 $19,902,986 $267,217,323 N/A N/A
Premiums Earned 2019 $79,820,333 $936,529,722 N/A N/A
2018 $78,432,406 $815,577,345 N/A N/A
2017 $52,057,443 $645,600,589 N/A N/A
2016 $38,883,614 $644,862,921 N/A N/A
Info
Years in Business 2020 Plan State Avg Nat Avg 90th Pctl.
Years in Business 32 38 N/A N/A
Years in Business Year Plan State Avg. Natl. Avg. 90th Pctl.
Years in Business 2019 31 37 N/A N/A
2018 30 36 N/A N/A
2017 29 35 N/A N/A
2016 28 34 N/A N/A
Member Satisfaction
Info
Member Satisfaction 2020 Plan State Avg Nat Avg 90th Pctl.
Getting Care Quickly N/A 85.38% 86.32% 91.51%
Getting Needed Care 86.48% 87.88% 88.01% 92.51%
How Well Doctors Communicate 94.57% 95.93% 95.93% 97.98%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 51.81% 65.21% 69.04% 80.59%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) N/A 86.67% 87.14% 91.18%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 72.80% 79.32% 80.71% 87.04%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 84.52% 85.69% 86.56% 91.30%
Member Satisfaction Year Plan State Avg. Natl. Avg. 90th Pctl.
Getting Care Quickly 2019 86.53% 87.14% 86.32% 90.57%
2018 84.01% 85.27% 85.23% 89.89%
2017 N/A 87.22% 85.34% 89.83%
2016 N/A 85.81% 85.14% 90.00%
Getting Needed Care 2019 84.46% 87.88% 87.38% 91.22%
2018 83.11% 85.53% 86.33% 90.45%
2017 83.54% 87.44% 86.71% 90.37%
2016 80.44% 86.38% 87.25% 91.54%
How Well Doctors Communicate 2019 95.23% 94.99% 95.85% 97.38%
2018 95.38% 94.70% 95.31% 97.22%
2017 90.64% 94.74% 95.10% 96.91%
2016 95.99% 95.22% 95.39% 97.21%
Members highly rating their HMO (8 to 10 on a 0-10 scale) 2019 55.62% 69.24% 67.91% 78.57%
2018 50.78% 64.78% 64.53% 76.79%
2017 48.68% 61.26% 62.44% 75.00%
2016 51.55% 62.47% 62.27% 74.92%
Members highly rating their most often seen specialist (8 to 10 on a 0-10 scale) 2019 88.07% 88.18% 86.27% 90.20%
2018 83.33% 84.82% 84.41% 88.57%
2017 82.35% 83.86% 84.62% 88.77%
2016 80.43% 83.44% 84.72% 88.74%
Members highly rating their overall health care (8 to 10 on a 0-10 scale) 2019 71.15% 79.81% 80.27% 86.36%
2018 71.17% 76.02% 78.17% 83.95%
2017 68.18% 76.98% 77.27% 82.99%
2016 78.36% 77.49% 77.19% 83.29%
Members highly rating their personal doctor (8 to 10 on a 0-10 scale) 2019 88.27% 87.91% 87.34% 90.94%
2018 83.33% 84.08% 85.14% 89.78%
2017 79.43% 83.95% 84.60% 89.86%
2016 83.33% 84.65% 84.57% 88.37%
Overuse/Appropriateness
Info
Antipsychotics 2020 Plan State Avg Nat Avg 90th Pctl.
Metabolic Monitoring for Children and Adolescents on Antipsychotics - Ages 1-17 37.84% 38.77% 31.82% 42.98%
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 47.06% 60.42% 62.97% 76.39%
Antipsychotics Year Plan State Avg. Natl. Avg. 90th Pctl.
Metabolic Monitoring for Children and Adolescents on Antipsychotics - Ages 1-17 2019 45.45% 42.62% 37.50% 49.28%
2018 53.85% 44.74% 36.17% 47.41%
2017 33.33% 50.55% 36.07% 48.57%
2016 52.17% 34.87% 35.80% 45.93%
Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics - Ages 1-17 2019 40.00% 63.47% 61.05% 78.36%
2018 52.63% 57.96% 56.00% 70.54%
2017 31.58% 58.14% 54.52% 68.67%
2016 50.00% 61.93% 58.30% 75.00%
Info
Cervical Cancer Screening in Adolescent Females 2020 Plan State Avg Nat Avg 90th Pctl.
Non-Recommended Cervical Cancer Screening in Adolescent Females 0.42% 0.46% 0.67% 0.19%
Cervical Cancer Screening in Adolescent Females Year Plan State Avg. Natl. Avg. 90th Pctl.
Non-Recommended Cervical Cancer Screening in Adolescent Females 2019 0.93% 0.58% 0.85% 0.24%
2018 1.15% 0.71% 1.05% 0.33%
2017 0.94% 0.94% 1.47% 0.50%
2016 2.04% 1.60% 1.84% 0.62%
Info
Lower Back Pain 2020 Plan State Avg Nat Avg 90th Pctl.
Use of Imaging for Low Back Pain 81.96% 77.22% 78.53% 85.60%
Lower Back Pain Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Imaging for Low Back Pain 2019 79.91% 77.01% 76.69% 83.47%
2018 78.19% 74.77% 75.11% 82.95%
2017 79.56% 73.85% 75.16% 82.29%
2016 78.73% 73.58% 72.67% 80.11%
Info
Respiratory 2020 Plan State Avg Nat Avg 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 93.58% 93.12% 91.57% 95.67%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 37.95% 41.88% 43.24% 59.45%
Respiratory Year Plan State Avg. Natl. Avg. 90th Pctl.
Appropriate Treatment for Children With Upper Respiratory Infection 2019 91.73% 91.87% 90.76% 95.51%
2018 92.66% 92.50% 91.22% 95.48%
2017 90.00% 90.92% 89.19% 94.59%
2016 88.30% 88.81% 88.51% 94.80%
Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 2019 36.92% 38.42% 39.91% 54.09%
2018 30.76% 33.60% 33.16% 48.28%
2017 29.56% 30.67% 30.99% 49.52%
2016 25.43% 27.03% 28.19% 41.72%
Info
Use of Opioids 2020 Plan State Avg Nat Avg 90th Pctl.
Use of Opioids at High Dosage 5.61% 6.49% 5.76% 1.88%
Use of Opioids From Multiple Providers - Multiple Prescribers 16.87% 2.32% 1.67% 0.62%
Use of Opioids Year Plan State Avg. Natl. Avg. 90th Pctl.
Use of Opioids at High Dosage 2019 6.38% 6.96% 6.08% 1.88%
2018 3.89% 5.32% 4.54% 1.87%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Use of Opioids From Multiple Providers - Multiple Prescribers 2019 19.16% 3.71% 2.79% 0.69%
2018 18.07% 5.11% 3.80% 1.40%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Risk Adjusted Utilization
Info
Acute Hospital Utilization Rate 2020 Plan State Avg Nat Avg 90th Pctl.
Acute Hospital Utilization - Medicine 22.38% 21.48% 0.72% 0.53%
Acute Hospital Utilization - Surgery 10.29% 11.94% N/A N/A
Acute Hospital Utilization - Total Acute 32.67% 33.42% 0.97% 0.78%
Acute Hospital Utilization Rate Year Plan State Avg. Natl. Avg. 90th Pctl.
Acute Hospital Utilization - Medicine 2019 23.93% 26.50% 0.89% 0.68%
2018 N/A N/A N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Acute Hospital Utilization - Surgery 2019 12.57% 15.92% N/A N/A
2018 N/A N/A N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Acute Hospital Utilization - Total Acute 2019 36.51% 42.42% 1.09% 0.92%
2018 N/A N/A N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Info
Emergency Department Utilization 2020 Plan State Avg Nat Avg 90th Pctl.
Emergency Department Utilization 123 125 N/A N/A
Emergency Department Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Emergency Department Utilization 2019 179 187 1 1
2018 N/A N/A N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Info
Plan All-Cause Readmissions 2020 Plan State Avg Nat Avg 90th Pctl.
Plan All-Cause Readmissions Ages 18-64 (Total) 4.41% 4.88% 0.58% 0.47%
Plan All-Cause Readmissions Ages 18-44 3.94% 4.26% N/A N/A
Plan All-Cause Readmissions Ages 45-54 4.26% 4.46% N/A N/A
Plan All-Cause Readmissions Ages 55-64 4.86% 5.69% N/A N/A
Plan All-Cause Readmissions Year Plan State Avg. Natl. Avg. 90th Pctl.
Plan All-Cause Readmissions Ages 18-64 (Total) 2019 3.81% 4.32% 0.51% 0.37%
2018 8.74% 11.17% N/A N/A
2017 11.59% 12.19% N/A N/A
2016 0.11% 0.12% N/A N/A
Plan All-Cause Readmissions Ages 18-44 2019 3.26% 4.54% N/A N/A
2018 8.18% 11.41% N/A N/A
2017 13.09% 12.99% N/A N/A
2016 0.11% 0.12% N/A N/A
Plan All-Cause Readmissions Ages 45-54 2019 3.73% 4.35% N/A N/A
2018 8.20% 10.56% N/A N/A
2017 10.06% 11.71% N/A N/A
2016 0.11% 0.12% N/A N/A
Plan All-Cause Readmissions Ages 55-64 2019 4.31% 4.26% N/A N/A
2018 9.47% 11.21% N/A N/A
2017 11.55% 11.93% N/A N/A
2016 0.11% 0.11% N/A N/A
Utilization
Info
Antibiotic Utilization 2020 Plan State Avg Nat Avg 90th Pctl.
Average number of antibiotic prescriptions per member per year - Total 0.54 0.57 0.57 0.71
Average number of antibiotic prescriptions per member per year - Ages 0-9 0.43 0.41 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 0.33 0.33 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 0.49 0.53 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 0.55 0.59 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 0.67 0.70 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 0.73 0.77 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 0.91 0.80 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 0.31 1.56 N/A N/A
Days suppplied per antibiotic prescription - Total 9.570 10.133 10.310 11.480
Days suppplied per antibiotic prescription - Ages 0-9 10.750 10.550 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 12.750 14.369 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 9.320 9.729 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 9.080 9.703 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 9.490 10.027 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 9.410 9.997 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 8.780 10.119 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 10.000 10.606 N/A N/A
Prescriptions of concern - Total 0.230 0.227 0.240 0.320
Prescriptions of concern - Ages 0-9 0.16 0.15 N/A N/A
Prescriptions of concern - Ages 10-17 0.11 0.11 N/A N/A
Prescriptions of concern - Ages 18-34 0.19 0.20 N/A N/A
Prescriptions of concern - Ages 35-49 0.25 0.25 N/A N/A
Prescriptions of concern - Ages 50-64 0.31 0.31 N/A N/A
Prescriptions of concern - Ages 65-74 0.36 0.33 N/A N/A
Prescriptions of concern - Ages 75-85 0.44 0.34 N/A N/A
Prescriptions of concern - Ages 85 plus 0.00 0.41 N/A N/A
Antibiotic Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Average number of antibiotic prescriptions per member per year - Total 2019 0.71 0.75 0.74 0.90
2018 0.71 0.74 0.71 0.88
2017 0.71 0.77 0.76 0.90
2016 0.70 0.79 0.76 0.90
Average number of antibiotic prescriptions per member per year - Ages 0-9 2019 0.86 0.85 N/A N/A
2018 0.83 0.81 N/A N/A
2017 0.88 0.87 N/A N/A
2016 0.90 0.97 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 10-17 2019 0.52 0.52 N/A N/A
2018 0.55 0.52 N/A N/A
2017 0.58 0.57 N/A N/A
2016 0.53 0.60 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 18-34 2019 0.62 0.66 N/A N/A
2018 0.62 0.65 N/A N/A
2017 0.61 0.67 N/A N/A
2016 0.60 0.69 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 35-49 2019 0.69 0.74 N/A N/A
2018 0.69 0.73 N/A N/A
2017 0.67 0.75 N/A N/A
2016 0.67 0.77 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 50-64 2019 0.80 0.85 N/A N/A
2018 0.81 0.84 N/A N/A
2017 0.81 0.88 N/A N/A
2016 0.80 0.87 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 65-74 2019 0.94 0.95 N/A N/A
2018 0.92 0.97 N/A N/A
2017 0.90 1.00 N/A N/A
2016 0.92 0.99 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 75-85 2019 1.10 1.15 N/A N/A
2018 1.21 1.21 N/A N/A
2017 1.05 1.12 N/A N/A
2016 1.15 1.23 N/A N/A
Average number of antibiotic prescriptions per member per year - Ages 85 plus 2019 0.00 0.95 N/A N/A
2018 0.69 1.32 N/A N/A
2017 0.53 1.12 N/A N/A
2016 0.14 0.73 N/A N/A
Days suppplied per antibiotic prescription - Total 2019 9.360 9.888 9.890 10.660
2018 9.550 9.950 9.910 10.890
2017 9.680 10.024 9.880 10.830
2016 9.730 10.090 9.880 10.830
Days suppplied per antibiotic prescription - Ages 0-9 2019 10.170 10.025 N/A N/A
2018 10.030 9.979 N/A N/A
2017 10.140 10.050 N/A N/A
2016 10.410 10.041 N/A N/A
Days suppplied per antibiotic prescription - Ages 10-17 2019 11.580 12.591 N/A N/A
2018 12.490 12.948 N/A N/A
2017 12.090 12.689 N/A N/A
2016 11.590 12.799 N/A N/A
Days suppplied per antibiotic prescription - Ages 18-34 2019 8.980 9.695 N/A N/A
2018 9.300 9.731 N/A N/A
2017 9.490 9.836 N/A N/A
2016 9.480 10.074 N/A N/A
Days suppplied per antibiotic prescription - Ages 35-49 2019 9.180 9.488 N/A N/A
2018 9.140 9.568 N/A N/A
2017 9.170 9.591 N/A N/A
2016 9.410 9.620 N/A N/A
Days suppplied per antibiotic prescription - Ages 50-64 2019 9.120 9.756 N/A N/A
2018 9.380 9.769 N/A N/A
2017 9.540 9.856 N/A N/A
2016 9.500 9.816 N/A N/A
Days suppplied per antibiotic prescription - Ages 65-74 2019 9.210 9.766 N/A N/A
2018 8.980 9.830 N/A N/A
2017 9.590 9.850 N/A N/A
2016 9.700 9.929 N/A N/A
Days suppplied per antibiotic prescription - Ages 75-85 2019 8.610 9.645 N/A N/A
2018 7.440 9.428 N/A N/A
2017 11.830 10.604 N/A N/A
2016 12.120 10.594 N/A N/A
Days suppplied per antibiotic prescription - Ages 85 plus 2019 N/A 9.997 N/A N/A
2018 7.000 9.026 N/A N/A
2017 7.000 9.873 N/A N/A
2016 10.000 9.431 N/A N/A
Prescriptions of concern - Total 2019 0.330 0.339 0.330 0.430
2018 0.340 0.338 0.330 0.430
2017 0.330 0.354 0.360 0.450
2016 0.350 0.383 0.360 0.450
Prescriptions of concern - Ages 0-9 2019 0.34 0.34 N/A N/A
2018 0.33 0.32 N/A N/A
2017 0.36 0.35 N/A N/A
2016 0.39 0.43 N/A N/A
Prescriptions of concern - Ages 10-17 2019 0.22 0.20 N/A N/A
2018 0.22 0.20 N/A N/A
2017 0.23 0.22 N/A N/A
2016 0.24 0.24 N/A N/A
Prescriptions of concern - Ages 18-34 2019 0.27 0.28 N/A N/A
2018 0.28 0.28 N/A N/A
2017 0.27 0.28 N/A N/A
2016 0.28 0.31 N/A N/A
Prescriptions of concern - Ages 35-49 2019 0.33 0.35 N/A N/A
2018 0.34 0.35 N/A N/A
2017 0.34 0.37 N/A N/A
2016 0.36 0.40 N/A N/A
Prescriptions of concern - Ages 50-64 2019 0.40 0.41 N/A N/A
2018 0.42 0.42 N/A N/A
2017 0.42 0.44 N/A N/A
2016 0.44 0.46 N/A N/A
Prescriptions of concern - Ages 65-74 2019 0.46 0.44 N/A N/A
2018 0.49 0.48 N/A N/A
2017 0.47 0.50 N/A N/A
2016 0.45 0.51 N/A N/A
Prescriptions of concern - Ages 75-85 2019 0.65 0.51 N/A N/A
2018 0.76 0.62 N/A N/A
2017 0.70 0.54 N/A N/A
2016 0.65 0.65 N/A N/A
Prescriptions of concern - Ages 85 plus 2019 0.00 0.36 N/A N/A
2018 0.00 0.45 N/A N/A
2017 0.27 0.48 N/A N/A
2016 0.00 0.34 N/A N/A
Info
Mental Health Utilization 2020 Plan State Avg Nat Avg 90th Pctl.
Mental Health Utilization - Any Service - Total 6.50% 9.13% 9.07% 12.95%
Mental Health Utilization - Any Service - Ages 0-12 4.54% 6.25% N/A N/A
Mental Health Utilization - Any Service - Ages 13-17 11.68% 15.31% N/A N/A
Mental Health Utilization - Any Service - Ages 18-64 6.58% 9.40% N/A N/A
Mental Health Utilization - Any Service - Ages 65 plus 2.25% 3.53% N/A N/A
Mental Health Utilization - ED - Total 0.03% 0.03% 0.06% 0.15%
Mental Health Utilization - ED - Ages 0-12 0.00% 0.01% N/A N/A
Mental Health Utilization - ED - Ages 13-17 0.21% 0.10% N/A N/A
Mental Health Utilization - ED - Ages 18-64 0.03% 0.03% N/A N/A
Mental Health Utilization - ED - Ages 65 plus 0.00% 0.01% N/A N/A
Mental Health Utilization - Inpatient - Total 0.17% 0.22% 0.24% 0.31%
Mental Health Utilization - Inpatient - Ages 0-12 0.04% 0.07% N/A N/A
Mental Health Utilization - Inpatient - Ages 13-17 0.67% 0.79% N/A N/A
Mental Health Utilization - Inpatient - Ages 18-64 0.16% 0.20% N/A N/A
Mental Health Utilization - Inpatient - Ages 65 plus 0.08% 0.06% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Total 0.06% 0.07% 0.15% 0.30%
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 0-12 0.07% 0.05% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 13-17 0.29% 0.26% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 18-64 0.04% 0.06% N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 65 plus 0.00% 0.01% N/A N/A
Mental Health Utilization - Outpatient - Total 5.06% 7.22% 6.95% 9.99%
Mental Health Utilization - Outpatient - Ages 0-12 3.98% 5.23% N/A N/A
Mental Health Utilization - Outpatient - Ages 13-17 9.68% 12.84% N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 5.04% 7.35% N/A N/A
Mental Health Utilization - Outpatient - Ages 65 plus 1.42% 2.62% N/A N/A
Mental Health Utilization - Telehealth - Total 3.22% 4.92% 5.19% 8.37%
Mental Health Utilization - Telehealth - Ages 0-12 1.76% 3.07% N/A N/A
Mental Health Utilization - Telehealth - Ages 13-17 6.07% 8.30% N/A N/A
Mental Health Utilization - Telehealth - Ages 18-64 3.30% 5.11% N/A N/A
Mental Health Utilization - Telehealth - Ages 65 plus 1.42% 1.80% N/A N/A
Mental Health Utilization Year Plan State Avg. Natl. Avg. 90th Pctl.
Mental Health Utilization - Any Service - Total 2019 6.44% 8.33% 8.86% 12.67%
2018 5.76% 7.63% 7.98% 11.76%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Any Service - Ages 0-12 2019 4.79% 6.35% N/A N/A
2018 4.81% 6.12% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Any Service - Ages 13-17 2019 13.16% 15.01% N/A N/A
2018 12.51% 13.96% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Any Service - Ages 18-64 2019 6.36% 8.45% N/A N/A
2018 5.55% 7.62% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Any Service - Ages 65 plus 2019 1.98% 3.17% N/A N/A
2018 2.02% 3.20% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - ED - Total 2019 0.04% 0.04% 0.08% 0.17%
2018 0.08% 0.09% 0.10% 0.22%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 0-12 2019 0.05% 0.02% N/A N/A
2018 0.07% 0.05% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 13-17 2019 0.28% 0.17% N/A N/A
2018 0.44% 0.28% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 18-64 2019 0.02% 0.03% N/A N/A
2018 0.06% 0.08% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - ED - Ages 65 plus 2019 0.00% 0.07% N/A N/A
2018 0.00% 0.02% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Total 2019 0.23% 0.25% 0.27% 0.34%
2018 0.24% 0.27% 0.27% 0.34%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 0-12 2019 0.11% 0.12% N/A N/A
2018 0.07% 0.12% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 13-17 2019 0.78% 0.85% N/A N/A
2018 1.11% 0.95% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 18-64 2019 0.21% 0.24% N/A N/A
2018 0.22% 0.26% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Inpatient - Ages 65 plus 2019 0.34% 0.11% N/A N/A
2018 0.00% 0.06% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Total 2019 0.11% 0.11% 0.20% 0.40%
2018 0.14% 0.12% 0.19% 0.38%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 0-12 2019 0.22% 0.10% N/A N/A
2018 0.22% 0.15% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 13-17 2019 0.50% 0.35% N/A N/A
2018 0.80% 0.49% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 18-64 2019 0.08% 0.09% N/A N/A
2018 0.09% 0.09% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Intensive Outpatient or Partial Hospitalization - Ages 65 plus 2019 0.00% 0.02% N/A N/A
2018 0.00% 0.02% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Total 2019 6.32% 8.24% 8.73% 12.61%
2018 5.65% 7.53% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Ages 0-12 2019 4.75% 6.32% N/A N/A
2018 4.79% 6.10% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Ages 13-17 2019 12.84% 14.86% N/A N/A
2018 12.24% 13.80% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Ages 18-64 2019 6.26% 8.36% N/A N/A
2018 5.45% 7.51% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Outpatient - Ages 65 plus 2019 1.89% 3.07% N/A N/A
2018 2.02% 3.16% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Total 2019 0.09% 0.11% 0.11% 0.22%
2018 0.06% 0.10% 0.05% 0.11%
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Ages 0-12 2019 0.03% 0.04% N/A N/A
2018 0.03% 0.03% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Ages 13-17 2019 0.00% 0.15% N/A N/A
2018 0.20% 0.19% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Ages 18-64 2019 0.10% 0.12% N/A N/A
2018 0.05% 0.11% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
Mental Health Utilization - Telehealth - Ages 65 plus 2019 0.00% 0.02% N/A N/A
2018 0.00% 0.02% N/A N/A
2017 N/A N/A N/A N/A
2016 N/A N/A N/A N/A
2020 data updated on: 02/08/2022