Utah Health Plan Quality of Care Report 2020

This report displays results showing the quality of care members received under each Medicaid and CHIP health plan (i.e., managed care or accountable care organization) and commercial health plan reporting to the Office of Health Care Statistics as measured using HEDIS technical specifications during calendar year 2019. The previous year’s results are also listed. Each year is reported separately. 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.

The report is separated into two components:

  1. Medicaid and CHIP
  2. Commercial

Results are sorted highest to lowest for each quality measure for the most recent reported year 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.
  • Not Required. The organization was not required to report the measure.

Medicaid and CHIP

Results are reported for the following health plans:

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

For information and results about commercial plans, please see the section covering commercial plans.

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 2018 2019
SelectHealth Community Care (Medicaid) 76% 80%
Healthy U (Medicaid) 55% 77%
National Average (Medicaid) 64% 75%
Molina (Medicaid) 53% 75%
HealthChoice Utah (Medicaid) 66% 66%
SelectHealth (CHIP) Not Reported Not Required
Molina (CHIP) Small Denominator Small Denominator

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 2018 2019
SelectHealth Community Care (Medicaid) 91% 96%
Molina (Medicaid) 62% 91%
National Average (Medicaid) 82% 87%
Healthy U (Medicaid) 74% 85%
HealthChoice Utah (Medicaid) 69% 69%
SelectHealth (CHIP) Not Reported Not Required
Molina (CHIP) Small Denominator Small Denominator

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 2018 2019
Molina (CHIP) 79% 85%
SelectHealth (CHIP) 78% 81%
HealthChoice Utah (Medicaid) 72% 78%
Healthy U (Medicaid) 79% 75%
SelectHealth Community Care (Medicaid) 76% 73%
Molina (Medicaid) 71% 72%
National Average (Medicaid) 68% 70%

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 2018 2019
Molina (CHIP) 73% 80%
SelectHealth (CHIP) 74% 79%
Molina (Medicaid) 61% 69%
National Average (Medicaid) 63% 66%
SelectHealth Community Care (Medicaid) 63% 65%
HealthChoice Utah (Medicaid) 59% 59%
Healthy U (Medicaid) 60% 57%

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–17 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 2018 2019
SelectHealth Community Care (Medicaid) 95% 95%
Healthy U (Medicaid) 95% 94%
Molina (Medicaid) 94% 93%
HealthChoice Utah (Medicaid) 94% 93%
SelectHealth (CHIP) 94% 93%
Molina (CHIP) 95% 92%
National Average (Medicaid) 90% 91%

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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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 2018 2019
SelectHealth (CHIP) 37% 43%
Molina (CHIP) 37% 40%
Healthy U (Medicaid) 44% 40%
National Average (Medicaid) 35% 38%
SelectHealth Community Care (Medicaid) 31% 37%
HealthChoice Utah (Medicaid) 31% 31%
Molina (Medicaid) 28% 27%

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 2018 2019
SelectHealth (CHIP) 89% 93%
SelectHealth Community Care (Medicaid) 91% 90%
Healthy U (Medicaid) 84% 85%
Molina (CHIP) 64% 82%
Molina (Medicaid) 63% 79%
National Average (Medicaid) 74% 77%
HealthChoice Utah (Medicaid) 57% 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 2018 2019
National Average (Medicaid) 72% 74%
SelectHealth (CHIP) 70% 71%
Molina (CHIP) 69% 70%
Healthy U (Medicaid) 64% 68%
SelectHealth Community Care (Medicaid) 64% 67%
Molina (Medicaid) 59% 66%
HealthChoice Utah (Medicaid) 58% 60%

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.

Health Plan 2018 2019
SelectHealth Community Care (Medicaid) 88% 88%
Healthy U (Medicaid) 85% 86%
HealthChoice Utah (Medicaid) 83% 84%
Molina (Medicaid) 83% 83%
National Average (Medicaid) 80% 80%
SelectHealth (CHIP) Not Reported Not Reported
Molina (CHIP) Not Reported 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 2018 2019
National Average (Medicaid) 53% 55%
SelectHealth Community Care (Medicaid) 54% 51%
Healthy U (Medicaid) 47% 51%
Molina (CHIP) Small Denominator Small Denominator
Molina (Medicaid) Small Denominator Small Denominator
HealthChoice Utah (Medicaid) Small Denominator Small Denominator
SelectHealth (CHIP) Not Reported Not Required

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 2018 2019
National Average (Medicaid) 58% 58%
SelectHealth Community Care (Medicaid) 47% 50%
Healthy U (Medicaid) 48% 49%
Molina (Medicaid) 40% 40%
HealthChoice Utah (Medicaid) 29% 35%
SelectHealth (CHIP) Small Denominator Not Reported
Molina (CHIP) Not Reported 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 2018 2019
National Average (Medicaid) 59% 60%
SelectHealth Community Care (Medicaid) 57% 58%
Molina (Medicaid) 53% 55%
Healthy U (Medicaid) 57% 48%
HealthChoice Utah (Medicaid) 44% 44%
SelectHealth (CHIP) Not Reported Not Required
Molina (CHIP) Not Reported 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 2018 2019
SelectHealth Community Care (Medicaid) 89% 92%
Healthy U (Medicaid) 89% 89%
National Average (Medicaid) 88% 88%
Molina (Medicaid) 87% 88%
HealthChoice Utah (Medicaid) 82% 88%
SelectHealth (CHIP) Not Reported Not Required
Molina (CHIP) Not Reported 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 2018 2019
SelectHealth Community Care (Medicaid) 66% 65%
Healthy U (Medicaid) 56% 59%
National Average (Medicaid) 57% 57%
HealthChoice Utah (Medicaid) 49% 57%
Molina (Medicaid) 52% 52%
SelectHealth (CHIP) Not Reported Not Required
Molina (CHIP) Not Reported 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 2018 2019
Healthy U (Medicaid) 76% 81%
SelectHealth Community Care (Medicaid) 73% 76%
National Average (Medicaid) 59% 61%
Molina (Medicaid) 55% 61%
HealthChoice Utah (Medicaid) 61% 61%
SelectHealth (CHIP) Not Reported Not Required
Molina (CHIP) Not Reported Not Reported

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

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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 2018 2019
HealthChoice Utah (Medicaid) 61% 78%
SelectHealth Community Care (Medicaid) 73% 75%
National Average (Medicaid) 59% 75%
Molina (Medicaid) 55% 73%
Healthy U (Medicaid) 76% 72%
SelectHealth (CHIP) Not Reported Small Denominator
Molina (CHIP) Not Reported Not Reported

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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Commercial

Results are reported for the following health plans:

  • Aetna Health
  • Aetna Life
  • Cigna
  • Humana
  • Regence BCBS
  • SelectHealth
  • United

For information and results about Medicaid and CHIP plans, please see the section covering Medicaid and CHIP plans.

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 2018 2019
SelectHealth 89% 93%
United 79% 79%
Cigna 47% 79%
National Average 73% 77%
Regence BCBS 73% 73%
Aetna Health 70% 70%
Aetna Life 48% 56%
Humana Small Denominator Small Denominator

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 2018 2019
SelectHealth 95% 98%
United 81% 81%
National Average 82% 81%
Aetna Health 77% 77%
Cigna 24% 72%
Regence BCBS 69% 69%
Aetna Life Not Reported 27%
Humana Small Denominator Small Denominator

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 2018 2019
SelectHealth 84% 86%
Regence BCBS 80% 82%
United 76% 81%
National Average 74% 80%
Aetna Health 60% 74%
Cigna 21% 60%
Aetna Life Not Reported Not Reported
Humana Small Denominator Small Denominator

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 2018 2019
SelectHealth 81% 83%
National Average 80% 81%
Cigna 76% 75%
Aetna Life 73% 75%
United 61% 74%
Regence BCBS 77% 73%
Aetna Health 73% 69%
Humana Small Denominator Small Denominator

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–17 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 2018 2019
United 93% 93%
SelectHealth 93% 92%
Regence BCBS 91% 91%
Cigna 93% 91%
Aetna Life 94% 91%
Aetna Health 93% 90%
National Average 90% 90%
Humana Small Denominator Small Denominator

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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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 2018 2019
SelectHealth 28% 32%
National Average 25% 28%
Aetna Health 19% 25%
Regence BCBS 24% 24%
United 18% 20%
Humana 18% 18%
Cigna 14% 18%
Aetna Life 16% 15%

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 2018 2019
SelectHealth 89% 89%
Aetna Health 72% 72%
National Average 66% 68%
Aetna Life 67% 67%
Cigna 5% 66%
United 64% 64%
Regence BCBS 62% 62%
Humana 57% 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 2019
National Average 77% 78%
SelectHealth 71% 73%
Cigna 65% 70%
United 65% 69%
Aetna Life 65% 68%
Humana 56% 64%
Regence BCBS 68% 63%
Aetna Health 64% 63%

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 2018 2019
SelectHealth 94% 95%
Aetna Health 95% 95%
United 94% 94%
Regence BCBS 94% 94%
National Average 94% 94%
Aetna Life 94% 94%
Cigna 94% 93%
Humana 92% 91%

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 2018 2019
Regence BCBS 72% 74%
National Average 69% 71%
Cigna 65% 71%
Aetna Life 70% 70%
SelectHealth 67% 68%
Aetna Health 64% 65%
United 62% 63%
Humana Small Denominator Small Denominator

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 2018 2019
National Average 72% 73%
SelectHealth 70% 72%
Humana 75% 69%
Regence BCBS 66% 67%
United 64% 64%
Cigna 64% 63%
Aetna Life 61% 62%
Aetna Health 61% 59%

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 2018 2019
National Average 74% 75%
United 73% 73%
Cigna 62% 73%
Regence BCBS 70% 70%
Humana 69% 69%
SelectHealth 70% 68%
Aetna Health 65% 65%
Aetna Life 64% 64%

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 2018 2019
SelectHealth 94% 93%
Humana 92% 92%
Cigna 90% 92%
United 91% 91%
Regence BCBS 91% 91%
National Average 91% 91%
Aetna Health 87% 87%
Aetna Life 86% 86%

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 2018 2019
SelectHealth 67% 62%
Aetna Health 61% 61%
Regence BCBS 59% 59%
National Average 53% 53%
Aetna Life 49% 49%
United 46% 46%
Cigna 35% 39%
Humana 36% 36%

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 2018 2019
Humana 76% 76%
SelectHealth 68% 72%
United 60% 62%
Regence BCBS 62% 62%
Aetna Health 60% 60%
National Average 55% 56%
Cigna 5% 56%
Aetna Life 8% 12%

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

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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 2018 2019
United 82% 82%
Cigna 80% 81%
Aetna Life 80% 81%
Aetna Health 75% 81%
National Average 76% 77%
Regence BCBS 76% 76%
SelectHealth 76% 75%
Humana Small Denominator 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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