Utah Health Plan Quality of Care Report 2019 – Medicaid & CHIP

This report displays results showing the quality of care members received under each Medicaid & CHIP health plan (i.e., managed care or accountable care organization) as measured using HEDIS technical specifications during calendar year 2018. All results were calculated by each individual health plan and validated by an accredited third-party auditor prior to submitting results to the Office of Health Care Statistics at the Utah Department of Health.

Results are reported for the following health plans:

  • Medicaid
    • Health Choice Utah
    • Healthy U
    • Molina
    • SelectHealth Community Care
  • CHIP
    • Molina
    • SelectHealth

Results are sorted highest to lowest for each quality measure with national averages presented along with plan results. For some measures, rates are not reported for the following reasons determined during the third-party audit:

  • No Benefit. The organization did not offer the health benefit required by the measure (e.g., mental health, chemical dependency).
  • Small Denominator. The organization followed the specifications, but the denominator was too small (<30) to report a valid rate.
  • Not Reported. The organization chose not to report the measure.

Quality Measures

Maternity Care

Newborn and Infant Care

Pediatric Care

Adult Care


Maternity Care

Prenatal and Postpartum Care – Postpartum Care

The percentage of deliveries that had a postpartum visit on or between 21 and 56 days after delivery.

Health Plan Rate
SelectHealth Community Care (Medicaid) 76%
Health Choice Utah (Medicaid) 66%
National Average 64%
Healthy U (Medicaid) 55%
Molina (Medicaid) 53%
Molina (CHIP) Small Denominator
SelectHealth (CHIP) Not Reported

For more information, please visit the National Committee for Quality Assurance (NCQA) website for Prenatal and Postpartum Care.

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Prenatal and Postpartum Care – Timeliness of Prenatal Care

The percentage of deliveries that received a prenatal care visit as a member of the organization in the first trimester, on the enrollment start date or within 42 days of enrollment in the organization.

Health Plan Rate
SelectHealth Community Care (Medicaid) 91%
National Average 82%
Healthy U (Medicaid) 74%
Health Choice Utah (Medicaid) 69%
Molina (Medicaid) 62%
Molina (CHIP) Small Denominator
SelectHealth (CHIP) Not Reported

For more information, please visit the National Committee for Quality Assurance (NCQA) website for Prenatal and Postpartum Care.

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Newborn and Infant Care

Childhood Immunization Status – Combo 3

The percentage of children 2 years of age who had a four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); three haemophilus influenza type B (HiB); three hepatitis B (HepB); one chicken pox (VZV); and four pneumococcal conjugate (PCV) by their second birthday.

Health Plan Rate
Healthy U (Medicaid) 79%
Molina (CHIP) 79%
SelectHealth (CHIP) 78%
SelectHealth Community Care (Medicaid) 76%
Health Choice Utah (Medicaid) 72%
Molina (Medicaid) 71%
National Average 68%

For more information, please visit the National Committee for Quality Assurance (NCQA) website for Childhood Immunization Status.

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Well-Child Visits in the first 15 Months of Life – 6 or more visits

Assesses children who turned 15 months old during the measurement year and had 6 well-child visits with a primary care physician during their first 15 months of life.

Health Plan Rate
SelectHealth (CHIP) 74%
Molina (CHIP) 73%
SelectHealth Community Care (Medicaid) 63%
National Average 63%
Molina (Medicaid) 61%
Healthy U (Medicaid) 60%
Health Choice Utah (Medicaid) 59%

For more information, please visit the National Committee for Quality Assurance (NCQA) website for Child and Adolescent Well-Care Visits.

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Pediatric Care

Appropriate Treatment for Children With Upper Respiratory Infection

Assesses children 3 months–18 years of age who were given a diagnosis of upper respiratory infection (URI) and were not dispensed an antibiotic prescription. A higher rate indicates appropriate treatment of children with URI (i.e., the proportion for whom antibiotics were not prescribed).

Health Plan Rate
SelectHealth Community Care (Medicaid) 95%
Healthy U (Medicaid) 95%
Molina (CHIP) 95%
Molina (Medicaid) 94%
Health Choice Utah (Medicaid) 94%
SelectHealth (CHIP) 94%
National Average 90%

For more information, please visit the National Committee for Quality Assurance (NCQA) website for Appropriate Treatment for Children With Upper Respiratory Infection.

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Children and Adolescents Access To PCP – 12-24 Months

Assess children and young adults 12-24 months of age who had a visit with a primary care practitioner (PCP).

Health Plan Rate
Molina (CHIP) 99%
SelectHealth (CHIP) 99%
SelectHealth Community Care (Medicaid) 97%
Molina (Medicaid) 97%
Healthy U (Medicaid) 96%
National Average 95%
Health Choice Utah (Medicaid) 94%

For more information, please visit the National Committee for Quality Assurance (NCQA) website for Children and Adolescents’ Access to Primary Care Practitioners.

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Immunizations for Adolescents – Combination 2

Assesses adolescents 13 years of age who had one dose of meningococcal vaccine, one Tdap vaccine and the complete human papillomavirus vaccine series by their 13th birthday.

Health Plan Rate
Healthy U (Medicaid) 44%
Molina (CHIP) 37%
SelectHealth (CHIP) 37%
National Average 35%
SelectHealth Community Care (Medicaid) 31%
Health Choice Utah (Medicaid) 31%
Molina (Medicaid) 28%

For more information, please visit the National Committee for Quality Assurance (NCQA) website for Immunizations for Adolescents.

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Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents – BMI percentile – Total

Assesses children and adolescents 3-17 years of age who had an outpatient visit with a primary care practitioner or OB/GYN during the measurement year and had evidence of Body mass index (BMI) percentile documentation.

Health Plan Rate
SelectHealth Community Care (Medicaid) 91%
SelectHealth (CHIP) 89%
Healthy U (Medicaid) 84%
National Average 74%
Molina (CHIP) 64%
Molina (Medicaid) 63%
Health Choice Utah (Medicaid) 57%

For more information, please visit the National Committee for Quality Assurance (NCQA) website for Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents.

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Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life

Assesses children 3-6 years of age who received one or more well-child visits with a primary care practitioner during the measurement year.

Health Plan Rate
National Average 72%
SelectHealth (CHIP) 70%
Molina (CHIP) 69%
SelectHealth Community Care (Medicaid) 64%
Healthy U (Medicaid) 64%
Molina (Medicaid) 59%
Health Choice Utah (Medicaid) 58%

For more information, please visit the National Committee for Quality Assurance (NCQA) website for Child and Adolescent Well-Care Visits.

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Adult Care

Adult Access to Preventive and Ambulatory Health Services – Total

The percentage of members 20 years and older who had an ambulatory or preventive care visit during the measurement year.

Healthcare Plan Value
SelectHealth Community Care (Medicaid) 88%
Healthy U (Medicaid) 85%
Health Choice Utah (Medicaid) 83%
Molina (Medicaid) 83%
National Average 80%
Molina (CHIP) Not Reported
SelectHealth (CHIP) Not Reported

For more information, please visit the National Committee for Quality Assurance (NCQA) website for Adults’ Access to Preventive and Ambulatory Health Services.

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Antidepressant Medication Management – Effective Acute Phase Treatment

Assesses adults 18 years of age and older with a diagnosis of major depression who were newly treated with antidepressant medication and remained on an antidepressant medication for at least 84 days (12 weeks).

Health Plan Rate
SelectHealth Community Care (Medicaid) 54%
National Average 53%
Healthy U (Medicaid) 47%
Health Choice Utah (Medicaid) Small Denominator
Molina (CHIP) Small Denominator
Molina (Medicaid) Small Denominator
SelectHealth (CHIP) Not Reported

For more information, please visit the National Committee for Quality Assurance (NCQA) website for Antidepressant Medication Management.

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Antidepressant Medication Management – Effective Continuation Phase Treatment

Assesses adults 18 years of age and older with a diagnosis of major depression who were newly treated with antidepressant medication and remained on an antidepressant medication for at least 84 days (12 weeks).

Health Plan Rate
SelectHealth Community Care (Medicaid) 34%
National Average 38%
Healthy U (Medicaid) 33%
Health Choice Utah (Medicaid) Small Denominator
Molina (CHIP) Small Denominator
Molina (Medicaid) Small Denominator
SelectHealth (CHIP) Not Reported

For more information, please visit the National Committee for Quality Assurance (NCQA) website for Antidepressant Medication Management.

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Breast Cancer Screening

Assesses women 50–74 years of age who had at least one mammogram to screen for breast cancer in the past two years.

Health Plan Rate
National Average 58%
Healthy U (Medicaid) 48%
SelectHealth Community Care (Medicaid) 47%
Molina (Medicaid) 40%
Health Choice Utah (Medicaid) 29%
Molina (CHIP) Not Reported
SelectHealth (CHIP) Small Denominator

For more information, please visit the National Committee for Quality Assurance (NCQA) website for Breast Cancer Screening.

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Cervical Cancer Screening

Assesses women 21–64 years of age who were screened for cervical cancer using either of the following criteria:

  • Women age 21–64 who had cervical cytology performed every 3 years.
  • Women age 30–64 who had cervical cytology/human papillomavirus (HPV) co-testing performed every 5 years.
Health Plan Rate
National Average 59%
SelectHealth Community Care (Medicaid) 57%
Healthy U (Medicaid) 57%
Molina (Medicaid) 53%
Health Choice Utah (Medicaid) 44%
Molina (CHIP) Not Reported
SelectHealth (CHIP) Not Reported

For more information, please visit the National Committee for Quality Assurance (NCQA) website for Cervical Cancer Screening.

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Comprehensive Diabetes Care – HbA1c Testing

Assesses adults 18–75 years of age with diabetes (type 1 and type 2) who had Hemoglobin A1c (HbA1c) testing.

Health Plan Rate
SelectHealth Community Care (Medicaid) 89%
Healthy U (Medicaid) 89%
National Average 88%
Molina (Medicaid) 87%
Health Choice Utah (Medicaid) 82%
Molina (CHIP) Not Reported
SelectHealth (CHIP) Not Reported

For more information, please visit the National Committee for Quality Assurance (NCQA) website for Comprehensive Diabetes Care.

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Comprehensive Diabetes Care – Eye Exams

Assesses adults 18–75 years of age with diabetes (type 1 and type 2) who had an eye exam (retinal) performed.

Health Plan Rate
SelectHealth Community Care (Medicaid) 66%
National Average 57%
Healthy U (Medicaid) 56%
Molina (Medicaid) 52%
Health Choice Utah (Medicaid) 49%
Molina (CHIP) Not Reported
SelectHealth (CHIP) Not Reported

For more information, please visit the National Committee for Quality Assurance (NCQA) website for Comprehensive Diabetes Care.

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Controlling High Blood Pressure

Assesses adults 18–85 years of age with a diagnosis of hypertension and whose blood pressure was adequately controlled based on the following criteria:

  • Adults 18-59 years of age whose blood pressure was <140/90 mm Hg.
  • Adults 60-85 years of age, with a diagnosis of diabetes, whose blood pressure was <140/90 mm Hg.
  • Adults 60-85 years of age, without a diagnosis of diabetes, whose blood pressure was <150/90 mm Hg.
Health Plan Rate
Healthy U (Medicaid) 76%
SelectHealth Community Care (Medicaid) 73%
Health Choice Utah (Medicaid) 61%
National Average 59%
Molina (Medicaid) 55%
Molina (CHIP) Not Reported
SelectHealth (CHIP) Not Reported

For more information, please visit the National Committee for Quality Assurance (NCQA) website for Controlling High Blood Pressure.

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Follow-Up After Hospitalization For Mental Illness – 7 days – Total

Assesses adults and children 6 years of age and older who were hospitalized for treatment of selected mental illness or intentional self-harm and had an outpatient visit, an intensive outpatient encounter or a partial hospitalization with a mental health practitioner. The measure identifies the percentage of members who received follow-up within 7 days of discharge.

Healthcare Plan Value
National Average 36%
SelectHealth (CHIP) 32%
Health Choice Utah (Medicaid) No Benefit
Healthy U (Medicaid) No Benefit
Molina (CHIP) Small Denominator
Molina (Medicaid) Small Denominator
SelectHealth Community Care (Medicaid) No Benefit

For more information, please visit the National Committee for Quality Assurance (NCQA) website for Follow-Up After Hospitalization for Mental Illness.

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Follow-Up After Hospitalization For Mental Illness – 30 days – Total

Assesses adults and children 6 years of age and older who were hospitalized for treatment of selected mental illness or intentional self-harm and had an outpatient visit, an intensive outpatient encounter or a partial hospitalization with a mental health practitioner. The measure identifies the percentage of members who received follow-up within 30 days of discharge.

Healthcare Plan Value
SelectHealth (CHIP) 61%
National Average 57%
Health Choice Utah (Medicaid) No Benefit
Healthy U (Medicaid) No Benefit
Molina (CHIP) Small Denominator
Molina (Medicaid) Small Denominator
SelectHealth Community Care (Medicaid) No Benefit

For more information, please visit the National Committee for Quality Assurance (NCQA) website for Follow-Up After Hospitalization for Mental Illness.

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Initiation and Engagement of Alcohol and Other Drug Dependence Treatment – Initiation of AOD – Total

Assesses adults and adolescents 13 years of age and older with a new episode of alcohol or other drug (AOD) dependence who initiated treatment through an inpatient AOD admission, outpatient visit, intensive outpatient encounter or partial hospitalization, telehealth or medication-assisted treatment (MAT) within 14 days of diagnosis.

Healthcare Plan Value
National Average 43%
Health Choice Utah (Medicaid) No Benefit
Healthy U (Medicaid) No Benefit
Molina (CHIP) Not Reported
Molina (Medicaid) Not Reported
SelectHealth Community Care (Medicaid) No Benefit
SelectHealth (CHIP) Small Denominator

For more information, please visit the National Committee for Quality Assurance (NCQA) website for Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment.

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Initiation and Engagement of Alcohol and Other Drug Dependence Treatment – Engagement of AOD – Total

Assesses adults and adolescents 13 years of age and older with a new episode of alcohol or other drug (AOD) dependence who initiated treatment and had two or more additional AOD services or MAT within 34 days of the initiation visit.

Healthcare Plan Value
National Average 14%
Health Choice Utah (Medicaid) No Benefit
Healthy U (Medicaid) No Benefit
Molina (CHIP) Not Reported
Molina (Medicaid) Not Reported
SelectHealth (CHIP) Small Denominator
SelectHealth Community Care (Medicaid) No Benefit

For more information, please visit the National Committee for Quality Assurance (NCQA) website for Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment.

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Use of Imaging Studies for Low Back Pain

Assesses adults 18–50 with a primary diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI or CT scan) within 28 days of the diagnosis (a higher score indicates better performance).

Health Plan Rate
Health Choice Utah (Medicaid) 80%
SelectHealth Community Care (Medicaid) 74%
Healthy U (Medicaid) 72%
National Average 72%
Molina (Medicaid) 67%
Molina (CHIP) Not Reported
SelectHealth (CHIP) Small Denominator

For more information, please visit the National Committee for Quality Assurance (NCQA) website for Use of Imaging Studies for Low Back Pain.

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